Modern Treatment of Hepatitis C Infection

Abstract

In 2016, the World Health Organization set „Viral hepatitis elimination by 2030” as a goal, which is predicated upon 2 advances: on the one hand, the efficacy of hepatitis B vaccine and, on the other, the sustained viral response to direct-acting antiviral (DAA) therapy for infection with hepatitis C virus (HCV). Romania also adopted this initiative considering the available results confirming the efficiency of this policy. Viral clearance results in reduced morbidity and mortality by liver injury and also by any associated HCV infection manifestations. In order to fulfill the target stated by the WHO any patient with detectable viremia must be treated. Unlike interferon-based regimes, DAA therapy for HCV infection is applicable to all groups of patients, regardless of the severity of their liver injury. Other advantages are high efficiency levels, proved in clinical trials as well as in the real world, oral administration route, good safety profile, a very good rate of sustained virological response in patients with decompensated cirrhosis and the possibility of prescribing them to children older than 8. Despite the remarkable progress, an ideal antiviral therapy has not yet been discovered. The direct-acting antiviral therapy in use today has 3 targets: NS3/4A, NS5A, NS5B. None of the drugs is designed to be used alone. For convenience, the pharmaceutical industry has developed pills containing combinations of 2 or 3 active drugs, which completely changed the hepatitis C treatment paradigm.