George Wu

By Alyssa M. Austria, Vjera Ninčević and George Y. Wu

Hepatitis C virus was discovered nearly 30 years ago, and for the first two decades, treatment was limited to agents with low response rates and substantial side effects. Since the introduction of direct-acting antivirals, there have been rapid advances made toward even higher sustained virologic responses (SVRs) and fewer side effects. This chapter provides a review of the newer agents for treatment of hepatitis C and highlights special populations, including those coinfected with HIV or hepatitis B, previously treated patients, and post-liver transplant patients.

Part of the book: Update on Hepatitis C

By Shaina M. Lynch and George Y. Wu

Hepatitis C virus (HCV) is a significant medical problem and has become one of the leading causes of chronic liver disease. HCV replicates at a high rate, and due to inherently inaccurate nucleotide incorporation and lack of proofreading and post-replication repair, mutations are inevitable. In the era of direct acting antivirals (DAAs), treatment for HCV has become highly effective, but there are still about 5–10% of treated patients who do not achieve sustained virological response (SVR). There are many factors that affect SVR rates including the absorption and metabolism of DAAs, genetic make-up, the presence or absence of cirrhosis, and severity and resistance of HCV to DAAs. An important factor influencing treatment failure is HCV resistance. The majority of treatment failures while on DAAs are not due to on-treatment failures, but due to relapses. The exact mechanism for mutation-associated relapse is unclear, but possible theories include persistent intrahepatocytic viral replication and/or differences in the levels of host immune response.

Part of the book: Update on Hepatitis C