Brian L Pearlman
Atlanta Medical Center, USA
Title: Hepatitis C Therapy: History, Standard Of Care, and Future Directions
Biography
Biography: Brian L Pearlman
Abstract
Chronic hepatitis C infection, which is estimated to infect 170 million persons worldwide, has undergone a rapid evolution in therapy. The goal of treatment is to achieve a sustained virologic response or SVR which has been associated with histologic regression of hepatic fibrosis, improved liver-related mortality and diminished overall mortality. For more than a decade, the standard therapy for genotype 1, the most common worldwide isolate, was peginterferon and ribavirin which achieved at best an SVR rate of 45% but was fraught with a multitude of side effects and usually required 48 weeks of treatment. The past few years has seen the near elimination of interferon and the advent of direct acting antiviral agents including NS3-4A protease inhibitors, NS5a inhibitors and nucleotide and non-nucleotide NS5b polymerase inhibitors, that when used in combination, achieve greater than 90% SVR routinely, even in populations that had been heretofore considered difficult to treat. The duration of treatment ranges from 8 to 24 weeks, and therapy is much easier to tolerate, relative to interferon-containing regimens of the recent past. The major limitation of these contemporary regimens is the cost, although medicoeconomic models have shown them to be cost-effective. Future antiviral regimens for hepatitis C are expected to be active across all genotypes (pangenotypic) and may require as little as six weeks of therapy.
