Protease inhibitors in hepatitis C: from chronic disease to cure.

The recent publication of two controlled trials on boceprevir and three on telaprevir heralds a new era for hepatitis C therapy 1-6 . Bocreprevir and telaprevir are protease inhibitors which act directly on the hepatitis C virus to inhibit replication and are referred to as direct acting antiviral agents (DAA’s). They are the first 2 such agents to be licensed but it is hoped that many more will soon follow 7 . These are very important studies and represent a major advance in treatment for patients with chronic hepatitis C virus infection. To appreciate their significance it is important to be aware of some of the clinical features of hepatitis C virus infection. Firstly, hepatitis C exposure leads to chronic infection in approximately 70% of patients. Over time (years or decades) this may lead to chronic hepatitis, cirrhosis, liver failure and hepatocellular carcinoma. The speed of progression depends on a number of co-factors. Patients who are male, drink alcohol, are overweight, diabetic or co-infected with HIV have more rapid progression to cirrhosis 8 . In contrast young, non-drinking females progress more slowly 9 .