CommentaryImpact of New Hepatitis C Treatments in Different Regions of the World
Section snippets
Prevalence of HCV and Disease Burden in Different Regions of the World
The World Health Organization (WHO) estimates that >185 million people worldwide or 2.8% of the human population have been infected with HCV; of these 130–170 million are chronically infected and 350,000 deaths occur each year as a result of HCV-related cirrhosis and liver cancer.1 The prevalence of HCV varies from 1.2% to 3.8% in different regions of the world (Figure 1). Although HCV is recognized as the most common cause of hepatocellular carcinoma (HCC) and the most frequent indication for
Standard-of-Care HCV Treatment
Until recently, standard-of-care HCV treatment has utilized a combination of pegylated (PEG)-IFN and ribavirin. SVR rates of 65%–75% can be achieved with a 24-week course of PEG-IFN and ribavirin in patients with HCV genotypes 2 or 3, but SVR rates are lower (∼45%), even with a 48-week course of treatment in those with HCV genotype 1. SVR rates are intermediate in patients with HCV genotypes 4, 5, or 6.
Several host, viral, and disease factors have been found to modulate the response to PEG-IFN
New Era of HCV Treatment
After 2 decades of intense research, we now enter an exciting era when new drugs for HCV are expected to be approved every year in Western countries for the next 4–5 years. The availability of multiple DAAs with distinct viral targets promises highly efficacious, well-tolerated, IFN-free combinations with short treatment duration.
In late 2013, 2 additional DAAs—simeprevir, a protease inhibitor and sofosbuvir, a nucleotide polymerase inhibitor—were approved by the US Food and Drug
Limitations of New HCV Treatment
The availability of IFN-free regimens permits many patients who could not be treated previously because of medical or psychiatric contraindications or an inability to tolerate IFN to receive treatment. Nonetheless, SVR rates remain lower in some patient populations, for example, those with cirrhosis and HCV genotypes 3 and 1a (for some DAAs). More important, many patient groups have been largely neglected because drug development and clinical trials are driven by market needs in developed
Implementation of New HCV Treatments in Different Regions of the World
The rapid pace of HCV drug development has led to the optimistic prediction that eradication of HCV is feasible. This would be the first chronic viral infection that can be eradicated in the absence of a prophylactic vaccine. Although HCV eradication is potentially feasible, that time is not imminent; there remain many barriers that need to be overcome (Table 1). Such barriers include the development of simplified and highly effective drug regimens, improving the rates of detection of
Acknowledgments
The authors thank Drs Wei Zhang and Hui-ying Rao for their assistance with the literature review and construction of Figures 2 and 3.
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Conflicts of interest The authors disclose the following: Lai Wei has served on advisory boards of Gilead and GSK and receives research grants from Bristol-Myers Squibb and Roche. Anna S.F. Lok has served on advisory boards of Gilead and Janssen and receives research grants from AbbVie, Bristol-Myers Squibb, Gilead, Idenix, and Merck.
Funding Lai Wei and Anna S.F. Lok are supported by a grant from the University of Michigan Health System – Peking University Health Sciences Center Joint Institute for Clinical and Translational Research. Lai Wei is also supported by the National Science and Technology Major Project for Infectious Diseases Control during the 12th Five-Year Plan Period (2012ZX10002003), the National Science and Technology Basic Work Program of China (2013FY113900), the National Key Clinical Specialty Construction, and the National Major Scientific and Technologic Special Project for “Significant New Drugs Development” during the 12th Five-Year Plan Period (2012ZX09303019).