[Chronic hepatitis C : Standard treatment and remaining challenges]

Among patients with chronic hepatitis C, 20-30% develop cirrhosis and its complications within 30 years. The antiviral treatment of hepatitis C has become interferon-free, with resulting improvements in sustained virological response rates, safety and tolerability and a shorter duration of treatment.

The mechanism of action of available drugs and current treatment recommendations.

This review is based on relevant publications retrieved by a selective literature search and particularly on studies and reviews concerning the course and treatment of hepatitis C.

The available drugs for interferon-free antiviral treatment of hepatitis C include inhibitors of the RNA-dependent RNA polymerase, NS3/4A protease, and NS5A protein of the hepatitis C virus (HCV), and ribavirin. Typically, two specific inhibitors are given in combination and the usual duration of treatment is 8-12 weeks. The antiviral drugs differ in their genotypic effectiveness and resistance barriers. The appropriate drug(s) should be chosen in consideration of the patient's hepatic and renal function and potential drug-drug interactions. All approved anti-HCV drugs are safe and well-tolerated and result in sustained virological response rates above 95%.

All patients with hepatitis C, whatever their disease stage, can achieve a sustained eradication of HCV using a combination of drugs with direct antiviral activity. Viral eradication is associated with a better quality of life and with lower morbidity and mortality.