Revolution in hepatitis C antiviral therapy

Introduction: Management of hepatitis C virus (HCV) is rapidly changing as a result of new direct-acting antivirals (DAA). Sources of data: Several peer-reviewed papers featuring new DAAs are now available. Additionally, as new data are emerging so quickly, we also reviewed recent presentations at international congresses, published in abstract form. Areas of agreement: New DAAs are efficacious and superior to prior treatment regimens, with minimal side effects. Shorter interferon-free regimens will soon be the mainstay of HCV treatment. Areas of controversy: Access to new DAAs is variable across global regions. One approach to treating HCV may be to assess early viral kinetics of treatment to identify who may be cured with standard peg-interferon/ribavirin therapy as opposed to using a DAA in all patients. Growing points: Newer studies with combination of DAAs are being conducted. The ideal interferon-free regimen has yet to be determined. Areas timely for developing research: HCV genotype 3 is the new difficult-to-treat genotype. More efficacious regimens for treating HCV genotype 3 are needed. Subgroups of patients who only require even shorter regimens of 6-8 weeks need to be identified. There is still very little data on interferon-free regimens in patients with decompensated cirrhosis and certain other subgroups.