From the Guidelines
For patients with chronic hepatitis C, the standard treatment is direct-acting antiviral (DAA) therapy, with regimens such as sofosbuvir/velpatasvir (Epclusa) for 12 weeks, glecaprevir/pibrentasvir (Mavyret) for 8-12 weeks, or elbasvir/grazoprevir (Zepatier) for 12 weeks, depending on viral genotype, liver status, and prior treatment history, as recommended by the most recent guidelines 1. The goals of hepatitis C treatment are to eradicate HCV and to prevent complications and mortality from liver cirrhosis and hepatocellular carcinoma, with a short-term goal of achieving an SVR defined as an undetectable serum HCV RNA by a sensitive assay with a lower limit of detection <50 IU/mL at 24 weeks after the end of treatment 2. Some key points to consider in the management of chronic hepatitis C include:
- Anti-HCV antibodies are typically positive in chronic hepatitis C infection, serving as a marker that the patient has been exposed to the hepatitis C virus (HCV) 2.
- The presence of anti-HCV alone does not distinguish between active infection and past, resolved infection, and HCV RNA testing is necessary to confirm chronic hepatitis C 2.
- Recent data indicate that DAA treatment in the early phase of HCV infection is cost-effective and useful to achieve micro-elimination in specific groups of patients, whereas postponing therapy to meet the criteria for chronic infection increases the risk of HCV transmission 1.
- High SVR rates have been reported in patients with recently acquired hepatitis C receiving DAA-based regimens, with the ideal duration of treatment remaining unknown 1. The primary goal of HCV therapy is to cure the infection, i.e. to achieve a sustained virological response (SVR) defined as undetectable HCV RNA 12 weeks or 24 weeks after treatment completion, with an SVR being generally associated with normalization of liver enzymes and improvement or disappearance of liver necroinflammation and fibrosis in patients without cirrhosis 3.
From the Research
Anti-HCV Treatment in Chronic Hepatitis C
- The treatment of chronic hepatitis C has evolved with the introduction of direct-acting antiviral (DAA) therapies, which have significantly improved cure rates 4, 5.
- Sofosbuvir/velpatasvir/voxilaprevir (SOF/VEL/VOX) is a pangenotypic treatment regimen that has been shown to be effective in treating patients with chronic HCV infection, including those with genotype 3 and cirrhosis, as well as those who have failed previous DAA therapy 4, 6.
- The combination of sofosbuvir and velpatasvir has also been found to be effective in treating HCV infection of all genotypes, with reported cure rates ranging from 95% to 100% in various patient populations 5.
Treatment Options for Different Patient Populations
- Patients with decompensated cirrhosis or HIV coinfection have been found to have cure rates of 85-100% and 92-100%, respectively, when treated with sofosbuvir/velpatasvir 5.
- SOF/VEL/VOX has been found to be effective in treating patients with genotype 1-4 HCV infection, with overall sustained virological response (SVR) rates of 90.7% to 100% 6.
- The regimen has also been found to be effective in treating patients who have failed previous DAA therapy, including those with prior NS5A experience 6, 7.
Comparison of Different Treatment Regimens
- SOF/VEL/VOX and glecaprevir/pibrentasvir (G/P) are two pangenotypic regimens that have been approved for the treatment of HCV infection, with distinct indications and safety profiles 7.
- SOF/VEL/VOX is positioned as a salvage regimen for patients previously treated with NS5A inhibitors, while G/P is indicated for patients with any genotype who have advanced kidney disease, including those on dialysis 7.