New hepatitis C therapies for special patient populations

ABSTRACT

Introduction: Chronic hepatitis C virus (HCV) infection has become a curable disease. More than 90% sustained virologic response rates have been obtained with 8–24 weeks of treatment with distinct combinations of direct-acting antivirals (DAA) in most registration trials. However, outcomes in real-world patients tend to be lower and treatment of special patient populations is often challenging. Areas covered: We address the treatment of chronic hepatitis C with DAA in major special patient populations, such as HIV-positive persons, transplant recipients, patients with advanced cirrhosis, renal insufficiency, hepatitis B or D coinfection, injection drug users (IDUs) and prior DAA failures. Expert opinion: Drug interactions between DAA and medications given to persons with HIV infection or transplant recipients can result in treatment failure and adverse events. Severe organ dysfunction as in kidney insufficiency or decompensated cirrhosis may lead to DAA overexposure and toxicities. Dysfunctional social circumstances and behavior are associated to poor drug adherence and increased risk for HCV re-infection in active IDUs. Finally, DAA response might be impaired by viral interference in patients with hepatitis B or D coinfection or drug resistance in HCV either at baseline or after prior DAA failures.

KEYWORDS:

• Daclatasvir
• HCV
• hepatitis B
• HIV
• kidney insufficiency
• paritaprevir
• simeprevir
• sofosbuvir
• transplantation

Article highlights.

• The advent of oral drugs that cure hepatitis C is rapidly expanding the number of treated HCV patients, including groups poorly represented in registration trials and for whom there is scarce information.

• Potentially harmful drug interactions between DAA and medications prescribed in HIV patients or transplant recipients should be prevented.

• Severe organ dysfunction as in kidney insufficiency or decompensated cirrhosis may lead to DAA overexposure and toxicities.

• Dysfunctional social circumstances and behavior may lead to poor DAA adherence and increased risk for HCV re-infection in active injection drug users.

• HCV response to DAA may be impaired by viral interference in hepatitis B or D coinfection or by the presence of HCV drug resistance either at baseline or after prior DAA failures.

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Declaration of interests

This work was supported in part by grants from Instituto de Salud Carlos III (ISCIII) (ICI14/00372, AC15/00038 and 00041) and Fundacion Investigacion y Educacion en SIDA (F-IES). 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.