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Management and Treatment of Hepatitis C: Are There Still Unsolved Problems and Unique Populations?

Virginia Solitano1,2, Maria Corina Plaz Torres2,3, Nicola Pugliese1,2

  • 1Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20082 Milan, Italy.

Viruses
|July 2, 2021
PubMed

Insights

Direct-acting antivirals (DAA) offer effective hepatitis C virus (HCV) treatment. This review examines management for "special populations" with HCV, including those with cirrhosis or kidney disease, to ensure treatment success.

Area of Science:

  • Hepatology
  • Infectious Diseases
  • Pharmacology

Background:

  • Direct-acting antivirals (DAA) have transformed hepatitis C virus (HCV) treatment, aligning with WHO goals for HCV elimination by 2030.
  • Certain patient groups, termed "special populations," present challenges in achieving sustained virological response (SVR) due to comorbidities, drug interactions, or prior treatment failures.
  • The definition and clinical relevance of these "special populations" require clarification years after DAA introduction.

Purpose of the Study:

  • To critically review and analyze current evidence regarding the management and treatment of "unique" or "special" patient populations with HCV.
  • To provide an updated overview of the challenges and unmet needs in treating these specific patient groups.

Main Methods:

  • Literature review focusing on direct-acting antiviral (DAA) therapy in hepatitis C virus (HCV) patients.
  • Emphasis on specific subgroups: decompensated cirrhosis, chronic kidney disease (CKD), coinfections (e.g., HIV, HBV), rare HCV genotypes, and patients with prior treatment failure.
  • Analysis of efficacy, safety, and management strategies for these challenging populations.

Main Results:

  • DAAs demonstrate high efficacy and safety across most patient groups, yet SVR rates can be lower in specific populations.
  • Decompensated cirrhosis, advanced CKD, and certain coinfections necessitate tailored treatment regimens and careful monitoring.
  • Previous DAA treatment failure or rare genotypes may require alternative therapeutic approaches.

Conclusions:

  • The concept of "special populations" in HCV treatment remains relevant, requiring individualized management strategies.
  • Further research is needed to optimize DAA therapy for patients with complex comorbidities and unique virological profiles.
  • Addressing the needs of these difficult-to-treat groups is crucial for achieving global HCV elimination goals.

Keywords:
HIV/HBV coinfectionchronic kidney diseasedecompensated cirrhosisend stage renal diseasehepatitis Crare genotypesspecial populationstreatment failureunique populations

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