Probable factors impacting the real-world treatment outcomes of direct-acting antivirals for hepatitis C treated populations: A themed review

Abstract

The therapeutics landscape of hepatitis C is changing expeditiously because of the inclusion of interferon-free antiviral regimens in the treatment strategies. Now, we have highly effective, safe and well-tolerated drugs to cure most patients while achieving higher sustained virologic response rates (SVRs: HCV RNA is undetectable in the serum after the 12 or more weeks of therapy) and hepatitis C recurrence will largely disappear. Such therapeutic regimens in combination or as co-formulated pills present highly efficient treatment options to overcome the hepatitis C related challenges with wide genotype (GT) coverage, short period of treatment and fewer side effects. Interferon-free direct-acting antivirals (IFN-free DAAs) are the drug of choice to triumph the health care burden of hepatitis C infection all over the world, but some challenges still must be met. The therapy costs, treatment access to low and middle-income countries (LMICs), differential routes of hepatitis C transmission and the emergence of treatment-associated adverse events are posing dilemmas too in the real-world clinical experiences. The availability of pan-genotypic DAAs to treat all HCV genotypes/subtypes infections, difficult-to-cure HCV populations and for previous treatment failure with first or second-generation DAAs have made it possible to treat everyone who needs treatment in this decade. The dosage algorithms of certain DAAs are also being evaluated in clinical trials for their administration in infants, children, women of reproductive age and pregnant females. The proposition of this pragmatic review article overviews the treatment based outcomes of these regimens in current clinical settings and highlights the challenges to overcome while achieving the prime objective of hepatitis C elimination by 2030.