J Korean Med Assoc.  2012 Nov;55(11):1113-1120.

Treatment of chronic hepatitis C

• Jun DW

Abstract

In the past 10 years, the standard treatment for chronic hepatitis C has been pegylated interferon and ribavirin for 24 to 48 weeks, based on genotype. Until now, fixed schedule therapy for chronic hepatitis C infection is the standard treatment in most countries. Response-guided therapy (RGT) is an emerging concept in which treatment decisions are based on how the virus responds to treatment. RGT has not been accepted into practice guidelines in all countries. The RGT approach takes into account both viral and host factors. RGT allows clinicians to provide a shorter duration of treatment, sparing patients of ongoing side effects and medical costs. We review several new treatment guidelines on new direct protease inhibitors. In late 2011, telaprevir and boceprevir were approved for treating chronic hepatitis C. Nowadays, the strategy for hepatitis C genotype 1 has been revolutionized by these two drugs. Other new direct acting antiviral agents have increased the sustained viral response significantly in chronic hepatitis genotype 1 patients in several recent clinical trials. In the future, Hepatitis C treatment will be personalized according to early viral response and baseline viral load. An interferon-free regimen will also be available for chronic hepatitis C.

Keyword

Hepatitis C; Standards; Genotype

MeSH Terms

Antiviral Agents
Appointments and Schedules
Genotype
Hepatitis C
Hepatitis C, Chronic
Hepatitis, Chronic
Humans
Interferons
Oligopeptides
Proline
Protease Inhibitors
Ribavirin
Viral Load
Viruses
Antiviral Agents
Interferons
Oligopeptides
Proline
Protease Inhibitors
Ribavirin

Figure

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  Figure 1 Proposed European Association Study for Liver for response guided therapy in HCV hepatitis. (A) Algorithm of genotype 1 can apply also to genotype 4. (B) Algorithm of genotype 2 and 3 can apply also to genotypes 5 and 6. Risk factor stands for low viral load (400,000-800,000 IU/mL), advanced fibrosis, and insulin resistance. The dotted lines indicate weak evidence. HCV, hepatitis C virus; PegINF, pegylated interferon; RBV, ribavirin.

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  Figure 2 Proposed National Hepatitis C Program Office recommendations for direct acting antiviral agents combined triple treatment algorithm. (A) Telaprevir algorithm for genotype 1 patients. (B) Boceprevir algorithm for genotype 1 patients. HCV, hepatitis C virus; PegINF, pegylated interferon; RBV, ribavirin; TVR, telaprevir; BOC, boceprevir.

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