Management of Hepatitis C Infection with Direct Action Antiviral Drugs (DAA)

Abstract

Several new direct action antiviral drugs (DAA) against the HCV virus (HCV) are approved and marketed. The combination of DAA with pegylated interferon and ribavirin (PR) is only recommended to patients with tolerance to interferon (IFN). IFN-free treatments are now considered elective drugs for patients with chronic HCV. More than 90% of patients infected with HCV genotype 1 or 4 (fewer with other genotypes) show sustained virological response, when treated with sofosbuvir combined with simeprevir, daclatasvir or ledipasvir, or by the combination of paritaprevir with ritonavir, ombitasvir and dasabuvir, with or without ribavirin.The safety and efficacy of DAA therapy in HIV-HCV confection is now comparable with HCV monoinfection. DAA drugs are also efficient in patients with previous interferon/ribavirin, or protease inhibitors, treated patients as well as with hepatic transplanted patients.The goal of this review is to clarify the current stage of DAA drugs already approved and available by January-2016. Another objective is to discuss the main drugs regimen recommended by international medical associations and drugs regulatory agencies, including Brazil's Health Ministry. In this review, the authors make an approach about: adverse effects of DAA; interactions with other drugs, efficacy in patients with compensated cirrhosis or comorbidities, different genotypes or subtypes, as well as the development of resistance associated to viral mutants and their possible clinical importance.simultaneously by the pharmaceutical industry, in impressive numbers, increasingly more effective, with reduced usage time and administered orally, and high tolerability to side effects, as disclosed in the major protocols that served as basis for registration in international drug regulatory agencies. Therefore, several IFN-free drugs combination with different viral targets, including NS3-A4 protease inhibitors, nucleoside/nucleotide analogues and nonnucleoside inhibitors of the RNA-dependent RNA polymerase, and NS5A inhibitors, are under development.The safety and high efficacy of DAA therapy in HIV-HCV coinfection is now comparable with HCV monoinfection, and shows high efficiency in naïve or treatment-experienced patients, compensated cirrhotic patients, and hepatic transplant patients.Awaits to brief new antiviral drugs of direct action, pangenomics, with a good security model and without cross-resistance.

Assessing hepatitis C spontaneous clearance and understanding associated factors—A systematic review and meta‐analysis

“…Alternative explanations for the reduced clearance HCV in PWID might reflect that these patients do clear the virus but are re‐infected due to ongoing injecting before being retested. Re‐infection rates in PWID have been found to vary between 1.8 and 46.8 per 100 person‐years in PWID which may increase the risk of new drug resistance …”

The sofosbuvir plus ribavirin vs sofosbuvir plus daclatasvir in obtaining sustained viral response in chronic Hepatitis C.

“…7 When used in conjunction with ribavirin, all HCV genotypes can be successfully treated with the oral nucleotide analogue inhibitor sofosbuvir. 8 In a research, individuals with HCV genotype 3 achieved persistent viral response at a rate of 80% to 89%, demonstrating the effectiveness of sofosbuvir-based antiviral therapy. 9 Patients who received Sofosbuvir and Daclatasvir for 12 weeks while being therapy naive and https://doi.org/10.29309/TPMJ/2023.30.12.7608 Chronic Hepatitis C 2 free of cirrhosis saw an SVR12 of 90% to 96%, according to David R. Nelson, et al's ALLY-3 phase III trial.…”

تقييم الحالة الغذائية لمرضى الالتهاب الکبدي سي بمستشفى کبد المحلة التعليمي

“…Sovaldi is a noval nucleotide analog inhibitor that blocks a specific protein needed by the HCV to replicate (Gaetano, 2014). Sofosbuvir, the first approved new Interferon-free drugs, are active against all genotypes of HCV (pangenotipic) with a genetic high barrier, low interaction with other drugs, treatment with oral use (one tablet of 400 mg/day) and shorter duration ranging from 12-24 weeks (Focaccia, et al ., 2016).…”