Expert Analysis Abstract

Updates in HCV Treatment

Abstract

Chronic hepatitis C virus (HCV) infection continues to be a major public health threat both in the United States and worldwide. HCV infection is the primary cause of liver-related death and the most frequent indication for liver transplantation in the United States. Newer, more effective therapeutic approaches are urgently needed, particularly for patients infected with HCV subtypes that respond poorly to current standard of care therapy and for patients with comorbidities or other poor prognostic indicators. At the 2009 Annual Meeting of the American Association for the Study of Liver Diseases (AASLD) held in Boston, Massachusetts, many investigators reported new data on the use of specifically targeted antiviral agents as well as other novel approaches to the treatment of chronic HCV infection. In this CME-certified Expert Analysis, Michael P. Manns, MD; David R. Nelson, MD; and Tram T. Tran, MD, provide an in-depth review of the most critical new findings presented at the 2009 AASLD meeting on the management of patients with chronic HCV infection. Topics that are addressed include new phase II results on the safety, efficacy, resistance profiles, and optimal dosing strategies of triple-therapy regimens combining protease inhibitors with standard-of-care peginterferon/ribavirin therapy in both treatment-naive and treatment-experienced patients from the SILEN-C1; PROVE 1, 2, and 3; SPRINT-1; Study C208; and NEXT-1 trials. Also discussed are the efficacy of protease inhibitor–based therapy in patients with poor prognostic indicators, the latest findings on genetic predictors of response to standard therapy from the IDEAL trial, the prognostic value of early response to protease inhibitor–based treatment, and the safety and efficacy of interferon-free therapy combining protease and polymerase inhibitors from the INFORM-1 trial.