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Recent advances in the treatment of hepatitis C virus infection for special populations and remaining problems

Goki Suda1, Naoya Sakamoto1

  • 1Department of Gastroenterology and Hepatology, Graduate School of Medicine, Hokkaido University, Sapporo, Japan.

Journal of Gastroenterology and Hepatology
|July 16, 2020
PubMed

Insights

Direct-acting antivirals (DAAs) offer a safer and more effective treatment for Hepatitis C virus (HCV) infection in special populations, including those with HIV/HCV coinfection, post-liver transplant, and on dialysis. Ongoing research addresses challenges like drug resistance and HCC occurrence.

Area of Science:

  • Hepatology and Viral Gastroenterology
  • Infectious Diseases and Public Health
  • Pharmacology and Therapeutics

Background:

  • Hepatitis C virus (HCV) infection is a leading cause of liver cirrhosis, hepatocellular carcinoma (HCC), and liver transplantation (LT).
  • High HCV prevalence exists in hemodialysis patients and those with human immunodeficiency virus (HIV) coinfection.
  • Recurrent HCV infection post-LT and rapid fibrosis in HCV/HIV coinfection necessitate urgent treatment strategies.

Purpose of the Study:

  • To review recent advances in Hepatitis C virus (HCV) treatment for special populations.
  • To evaluate the efficacy and safety of direct-acting antivirals (DAAs) in HIV/HCV coinfection, post-liver transplant, and dialysis patients.
  • To identify and discuss unresolved issues concerning DAA therapy in these groups.

Main Methods:

  • Review of recent clinical trials and studies on direct-acting antiviral (DAA) therapies for Hepatitis C virus (HCV).
  • Analysis of treatment outcomes, safety profiles, and adverse events in special patient populations.
  • Examination of emerging challenges, including resistance-associated variants and HCC occurrence post-DAA therapy.

Main Results:

  • Interferon (IFN)-based therapies demonstrated limited efficacy and significant adverse events in special populations.
  • IFN-free DAA-based therapies show superior safety and therapeutic profiles compared to IFN-based treatments.
  • Recent studies confirm high efficacy and safety of DAAs in HIV/HCV coinfection, post-LT, and dialysis patients, despite initial trial exclusions.

Conclusions:

  • IFN-free DAA therapy represents a significant advancement in managing Hepatitis C virus (HCV) infection across diverse patient groups.
  • Despite high efficacy, challenges such as drug resistance and post-treatment HCC require continued investigation and management strategies.
  • Further research is essential to optimize DAA treatment protocols and address long-term outcomes in special populations.

Keywords:
DAAsHCCHCVHIVhemodialysis

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