Pretransplant and posttransplant treatment of hepatitis C virus infection with protease inhibitors

Purpose of review Considering the impact of recurrent hepatitis C after liver transplantation on patient and graft survival, we examine the current and potential use of protease inhibitors in the prevention and treatment of recurrent hepatitis C. Recent findings In genotype-1-infected patients in the waiting list, triple therapy with boceprevir or telaprevir should be considered in compensated cirrhotics. However, tolerability of therapy is low, and side effects are frequent and potentially life-threatening. In posttransplant hepatitis C, available data suggest that triple therapy substantially increases the virological response. Interactions of protease inhibitors with immunosuppressants are considerable, especially between tacrolimus and telaprevir. Anemia seems to be particularly frequent with triple therapy after liver transplantation. Interferon (IFN)-free regimens seem to achieve a high antiviral effect with an excellent safety profile and will probably replace the current IFN-based treatments in a few years from now. Summary Antiviral therapy with protease inhibitors will substantially increase the number of patients achieving sustained hepatitis C virus eradication, either before or after liver transplantation. However, side effects and drug-drug interactions will possibly hamper their applicability in both settings; thus, a careful selection and management of patients will be crucial. In the near future, combination of direct-acting antivirals will allow shorter, safer, and more effective IFN-free regimens.