Hepatitis C: Down but Not Out
Authors: Jay H. Hoofnagle, Averell H. Sherker
Journal: Annals of Internal Medicine (2017)

Editorials2 May 2017Hepatitis C: Down but Not OutJay H. Hoofnagle, MD and Averell H. Sherker, MDJay H. Hoofnagle, MDFrom National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland. and Averell H. Sherker, MDFrom National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M17-0567 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Within the past 4 years, no fewer than 10 potent, orally available antiviral drugs have received U.S. Food and Drug Administration (FDA) approval as therapy for chronic hepatitis C virus (HCV) infection. These small molecules are directed at 1 of 3 HCV targets: NS3/4A protease ("-previrs" [simeprevir, paritaprevir, and grazoprevir]), NS5B RNA polymerase ("-buvirs" [sofosbuvir and dasabuvir]), or NS5A polypeptide ("-asvirs" [daclatasvir, elbasvir, ledipasvir, ombitasvir, and velpatasvir]). Most important, combinations of 2 or 3 of these agents have proven highly effective in inducing a sustained virologic response (SVR), with persistent loss of HCV RNA from serum. Long-term follow-up of patients ...References1. Falade-Nwulia O, Suarez-Cuervo C, Nelson DR, Fried MW, Segal JB, Sulkowski MS. Oral direct-acting agent therapy for hepatitis C virus infection. A systematic review. Ann Intern Med. 2017;166:637-48. doi:10.7326/M16-2575 LinkGoogle Scholar2. Smith BD, Morgan RL, Beckett GA, Falck-Ytter Y, Holtzman D, Teo CG, et al; Centers for Disease Control and Prevention. Recommendations for the identification of chronic hepatitis C virus infection among persons born during 1945–1965. MMWR Recomm Rep. 2012;61:1-32. [PMID: 22895429] MedlineGoogle Scholar3. Sofosbuvir/velpatasvir (Epclusa) for hepatitis C. Med Lett Drugs Ther. 2016;58:107-8. [PMID: 27508349] MedlineGoogle Scholar4. Feld JJ, Jacobson IM, Hézode C, Asselah T, Ruane PJ, Gruener N, et al; ASTRAL-1 Investigators. Sofosbuvir and velpatasvir for HCV genotype 1, 2, 4, 5, and 6 infection. N Engl J Med. 2015;373:2599-607. [PMID: 26571066] doi:10.1056/NEJMoa1512610 CrossrefMedlineGoogle Scholar5. Zeuzem S, Ghalib R, Reddy KR, Pockros PJ, Ben Ari Z, Zhao Y, et al. Grazoprevir–elbasvir combination therapy for treatment-naive cirrhotic and noncirrhotic patients with chronic hepatitis C virus genotype 1, 4, or 6 infection: a randomized trial. Ann Intern Med. 2015;163:1-13. [PMID: 25909356]. doi:10.7326/M15-0785 LinkGoogle Scholar6. Collins JM, Raphael KL, Terry C, Cartwright EJ, Pillai A, Anania FA, et al. Hepatitis B virus reactivation during successful treatment of hepatitis C virus with sofosbuvir and simeprevir. Clin Infect Dis. 2015;61:1304-6. [PMID: 26082511] doi:10.1093/cid/civ474 CrossrefMedlineGoogle Scholar7. Dyson JK, Hutchinson J, Harrison L, Rotimi O, Tiniakos D, Foster GR, et al. Liver toxicity associated with sofosbuvir, an NS5A inhibitor and ribavirin use. J Hepatol. 2016;64:234-8. [PMID: 26325535] doi:10.1016/j.jhep.2015.07.041 CrossrefMedlineGoogle Scholar8. U.S. Food and Drug Administration. FDA Drug Safety Communication: FDA warns about the risk of hepatitis B reactivating in some patients treated with direct-acting antivirals for hepatitis C. Silver Spring, MD: U.S. Food and Drug Administration; 2016. Accessed at www.fda.gov/Drugs/DrugSafety/ucm522932.htm on 3 March 2017. Google Scholar9. Innes H, McDonald S, Hayes P, Dillon JF, Allen S, Goldberg D, et al. Mortality in hepatitis C patients who achieve a sustained viral response compared to the general population. J Hepatol. 2017;66:19-27. [PMID: 27545496] doi:10.1016/j.jhep.2016.08.004 CrossrefMedlineGoogle Scholar10. Nault JC, Colombo M. Hepatocellular carcinoma and direct acting antiviral treatments: controversy after the revolution [Editorial]. J Hepatol. 2016;65:663-5. [PMID: 27417216] doi:10.1016/j.jhep.2016.07.004 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland.Financial Support: The authors are U.S. federal government employees of the National Institutes of Health, and this work was done as part of their official duties.Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M17-0567.Corresponding Author: Jay H. Hoofnagle, MD, Director, Liver Disease Research Branch, Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, Room 6005, 6707 Democracy Boulevard, MSC 5450, Bethesda, MD 20892.Current Author Addresses: Dr. Hoofnagle: Liver Disease Research Branch, Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, Room 6005, 6707 Democracy Boulevard, MSC 5450, Bethesda, MD 20892.Dr. Sherker: Liver Disease Research Branch, Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, Room 6003, 6707 Democracy Boulevard, MSC 5450, Bethesda, MD 20892.This article was published at Annals.org on 21 March 2017. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoOral Direct-Acting Agent Therapy for Hepatitis C Virus Infection Oluwaseun Falade-Nwulia , Catalina Suarez-Cuervo , David R. Nelson , Michael W. Fried , Jodi B. Segal , and Mark S. Sulkowski Metrics Cited byEvaluation of a hepatitis C clinical care coordination programme's effect on treatment initiation and cure: A surveillance-based propensity score matching approachThe oncologic burden of hepatitis C virus infection: A clinical perspective 2 May 2017Volume 166, Issue 9Page: 675-676KeywordsAntiviral therapyCirrhosisFood and Drug AdministrationInfectious diseasesInfectious hepatitisLiver diseasesNutritionRNARenal diseasesSystemic vascular resistance ePublished: 21 March 2017 Issue Published: 2 May 2017 PDF downloadLoading ...