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Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 14, 2023; 29(6): 949-966
Published online Feb 14, 2023. doi: 10.3748/wjg.v29.i6.949
Decade of optimizing therapy with direct-acting antiviral drugs and the changing profile of patients with chronic hepatitis C
Michał Brzdęk, Dorota Zarębska-Michaluk, Federica Invernizzi, Marta Cilla, Krystyna Dobrowolska, Robert Flisiak
Michał Brzdęk, Krystyna Dobrowolska, Collegium Medicum, Jan Kochanowski University, Kielce 25-516, Poland
Dorota Zarębska-Michaluk, Department of Infectious Diseases, Jan Kochanowski University, Kielce 25-516, Poland
Federica Invernizzi, Marta Cilla, Center for Liver Disease, Division of Internal Medicine and Hepatology, IRCCS Ospedale San Raffaele, Milan 20-132, Italy
Robert Flisiak, Department of Infectious Diseases and Hepatology, Medical University of Białystok, Białystok 15-540, Poland
Author contributions: Brzdęk M designed the manuscript, carried out the literature review, drafted the manuscript and prepared the tables; Zarębska-Michaluk D designed the manuscript and carried out the literature review; Dobrowolska K approved the final version of the manuscript and prepared the manuscript for submission; Flisiak R designed the manuscript; Zarębska-Michaluk D, Invernizzi F, Cilla M and Flisiak R edited and approved the final version of the manuscript.
Conflict-of-interest statement: The authors declare having no relevant conflicts of interest within the submitted work.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Dorota Zarębska-Michaluk, PhD, Professor, Department of Infectious Diseases, Jan Kochanowski University, Radiowa 7, Kielce 25-516, Poland. dorota1010@tlen.pl
Received: October 12, 2022
Peer-review started: October 12, 2022
First decision: November 15, 2022
Revised: November 22, 2022
Accepted: January 9, 2023
Article in press: January 9, 2023
Published online: February 14, 2023
Abstract

Chronic infection with the hepatitis C virus (HCV) remains a major health problem affecting approximately 58 million people worldwide. In the era of interferon (IFN)-based regimens, patients particularly infected with genotypes 1 and 4 achieved a low response rate. The implementation of direct-acting antivirals changed the landscape of HCV treatment. The increase in effectiveness provided us with the hope of eliminating HCV as a significant public threat by 2030. In the following years, there was an observed improvement in the treatment of HCV with genotype-specific regimens and highly effective pangenotypic options that are the most recent stage of the revolution. The optimization of therapy was accompanied by changes in the patient profile from the beginning of the IFN-free era over time. Patients treated with antiviral therapies were younger in successive periods, less burdened with comorbidities and comedications, more frequently treatment-naïve and had less advanced liver disease. Before the IFN-free era, specific subpopulations such as patients with HCV/HIV coinfection, those with a history of previous treatment, patients with renal impairment or with cirrhosis had lower chances for a virologic response. Currently, these populations should no longer be considered difficult to treat. Despite the high effectiveness of HCV therapy, there is a small percentage of patients with treatment failure. However, they can be effectively retreated with pangenotypic rescue regimens.

Keywords: Hepatitis C virus, Interferon, Direct-acting antiviral, Epidemiology, Chronic hepatitis C

Core Tip: A decade ago direct-acting antiviral drugs were introduced and have greatly improved the effectiveness of treatment for patients with hepatitis C virus infection. The new drugs have increased the chances of eliminating hepatitis C virus infection as a significant public threat. This paper described changes in the therapeutic options administered over the past decade and documented the changing patient profile over the years in the interferon-free era. Special populations of difficult-to-treat patients in the interferon era currently not meeting this definition are highlighted.