Published online Aug 18, 2015. doi: 10.4254/wjh.v7.i17.2100
Peer-review started: April 7, 2015
First decision: May 18, 2015
Revised: June 4, 2015
Accepted: July 18, 2015
Article in press: July 22, 2015
Published online: August 18, 2015
Hepatitis C infection can lead to cirrhosis and hepatocellular carcinoma and it is an important cause of mortality and morbidity. Achieving a sustained virological response has been the major aim for decades. Interferon treatment was the primarily developed therapy against the infection. Addition of the guanosine analog ribavirin to stop viral RNA synthesis increased the response rates as well as the adverse effects of the treatment. The increasing demands for alternative regimens led to the development of direct-acting antivirals (DAAs). The approval of sofosbuvir and simeprevir signaled a new era of antiviral treatment for hepatitis C infection. Although the majority of studies have been performed with DAAs in combination with interferon and resulted in a decrease in treatment duration and increase in response rates, the response rates achieved with interferon-free regimens provided hope for patients ineligible for therapy with interferon. Most DAA studies are in phase II leading to phase III. In the near future more DAAs are expected to be approved. The main disadvantage of the therapy remains the cost of the drugs. Here, we focus on new treatment strategies for hepatitis C infection as well as agents targeting hepatitis C virus replication that are in clinical development.
Core tip: In this review, we focused on different treatment regimens for hepatitis C infection, especially those including the newly developed and approved direct-acting antivirals. The guidelines are constantly changing in light of new studies. The recommendations of the guidelines are reviewed and consider different genotypes of the virus in addition to the results of ongoing studies. Continuing medical need for agents that act on novel hepatitis C virus targets has resulted in new compounds targeting viral proteins, which is also highlighted in the manuscript.