The outlook for precision medicine for the treatment of chronic hepatitis C infection: challenges and opportunities

ABSTRACT

Introduction

This review focuses on the milestones and challenges of precision medicine in the natural history of HCV infection.

Areas covered

The manuscript summarizes the genetic and viral factors identified as predictive of outcome in HCV patients and discusses opportunities for a precision medicine approach to the management of patients with HCV infection. Special emphasis will be placed on the factors associated with response to treatment as well as other factors that can help the clinician in the management of patients after sustained virological response.

Expert opinion

The establishment of DAAs in recent years has led to a paradigmatic change in the natural history of hepatitis C virus infection. However, there are still challenges that precision medicine must solve, especially in the management of patients at high risk of liver complications after sustained virological response.

KEYWORDS:

• HCV
• SNPs
• pegIFN/RBV
• DAA
• SVR
• RAS
• fibrosis
• steatosis
• HCC

Article Highlights

• Precision medicine contributed strongly in the treatment of Hepatitis C virus infection. In the era of IFN-based therapies, viral and genetic factors were identified and associated with response to treatment.

• DAAs have revolutionized the treatment of hepatitis C virus infection in recent years, making HCV treatment failure a rare event but precision medicine must continue to support various clinical and therapeutic situations.

• There are two main situations in which precision medicine continues to have a relevant role in the treatment of HCV: patients who do not reach SVR and resistance mutations

• The patients with advanced fibrosis or cirrhosis continue to be at high risk of complications after reaching SVR. Hence, additional monitoring and treatment may be necessary in these patients. Identified precision factors associated with these clinical situations are covered in this review.

Declaration of interest

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.

Reviewers disclosure

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

Additional information

Funding

This study was supported by the Fundación Progreso y Salud, Consejería de Salud de la Junta de Andalucía (PI0187/2013), the Fundación para la Investigación en Salud (FIS) del Instituto Carlos III (PI15/01017), and the Red de Investigación en SIDA de España ISCIII-RETIC (RD16/0025/0034). ARJ and MF are recipient of postdoctoral perfection grants by the Spanish Ministry of Science, Innovation and Universities of Spain (CP18/00111 and CD18/00091, respectively).