Managing HCV treatment failure and the potential of resistance testing in informing second-line therapy options

ABSTRACT

Introduction: Direct acting antivirals have completely changed the landscape of the treatment of chronic hepatitis C. The management of the few patients who relapse to direct acting antivirals requires a careful analysis of the chances to achieve therapeutic success with a second antiviral course. In this context, the usefulness of viral resistances testing, able to detect resistance-associated substitutions in the viral sequence, is at present a matter of debate.

Areas covered: The role of resistance associated substitutions is examined through the evaluation of the data from clinical trials that have assessed the impact of viral resistances on the treatment outcome. Special attention has been paid on the data from re-treatment studies.

Expert commentary: The treatment failure in chronic hepatitis C is still a possible event. Therefore, additional real-world clinical data on relapse rates and on the relapse management are welcome to definitely address the clinical guidelines. At present, the testing of viral resistances is an exquisite tool for the choice of the re-treatment schedule. In the near future, widespread use of the most recently registered direct acting antivirals with high barrier to resistance will probably weaken the need of resistance testing as a support in clinical decisions.

KEYWORDS:

• Chronic hepatitis C
• viral resistance
• resistance-associated substitutions
• direct acting antivirals
• treatment failure

Declaration of interest

P Andreone has served as speaker, consultant and advisory board member for AbbVie, BMS, Boehringer Ingelheim, Gilead Sciences, Janssen Cilag, MSD, Roche, and has received research funding from Gilead Sciences, MSD, BMS and Roche. R Vukotic has received research grant from Gilead Sciences. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

The manuscript was not funded.