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. 2016 Oct;12(10 Suppl 4):1-11.

The HCV Treatment Revolution Continues: Resistance Considerations, Pangenotypic Efficacy, and Advances in Challenging Populations

Ira M Jacobson  1
Affiliations

The HCV Treatment Revolution Continues: Resistance Considerations, Pangenotypic Efficacy, and Advances in Challenging Populations

Ira M Jacobson. Gastroenterol Hepatol (N Y). 2016 Oct.

Abstract

The US Food and Drug Administration has now approved 10 direct-acting antivirals (DAAs) for the management of hepatitis C virus (HCV). These therapies are combined into 6 regimens that are given for varying durations, with or without ribavirin, depending on the viral genotype, the presence or absence of baseline resistance-associated variants (RAVs), and the patient type. RAVs may be present before exposure to a drug or may become detectable de novo during exposure to a drug. Emerging resistant strains are the most common cause of failure of HCV DAA regimens. Second-generation DAAs provide superior coverage of resistant variants compared with first-generation members of that class. They may also cover a broader range of viral genotypes. Numerous clinical trials have evaluated the safety and efficacy of DAAs in a variety of patient populations, including those with cirrhosis, HIV, and end-stage renal disease. This article evaluates the data from these studies, and discusses recommendations from the American Association for the Study of Liver Diseases (AASLD) and the Infectious Diseases Society of America (IDSA) guidance document.

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Figures

Figure 1.
Figure 1.
“Famous” RAVs in viral hepatitis.
Figure 2.
Figure 2.
SVR12 in HCV/HIV-coinfected patients with genotype 1 infection treated with ledipasvir/sofosbuvir for 12 weeks.
Figure 3.
Figure 3.
On-treatment changes in hemoglobin from baseline in HCV-infected patients with severe renal impairment treated with grazoprevir/elbasvir.
See this image and copyright information in PMC

References

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