AdvAnces in MAnAgeMent of HepAtitis c

Hepatitis C virus (HCV) a member of the Flaviviridae family, was first identified in 1979, as a blood borne infection which can infect the liver decades before symptoms appear. It is estimated that 3% of the world population are chronically infected with HCV but most of them have no knowledge about the infection and its hepatic consequences.1 HCV infection can cause chronic hepatitis which can result in serious long term consequences including cirrhosis, hepatocellular cancer(HCC), liver failure and need for transplantation. Six HCV genotypes, numbered 1–6, and a large number of subtypes have been described.2 The standard of care (SOC) therapy for patients with chronic hepatitis C virus (HCV) infection has been the use of both peginterferon (PegIFN) alpha 2a or 2b and ribavirin (RBV). In patients with HCV genotypes 1, 4, 5, and 6, these drugs are administered for 48 weeks whereas for HCV genotypes 2 and 3, treatment duration is 24 weeks.3 The goal of treatment for chronic HCV infection is to achieve sustained virologic response (SVR), defined as undetectable HCV RNA levels 6 months after completing treatment. Attaining SVR has been shown to slow disease progression, and to reduce mortality associated with HCV infection. The chance of inducing SVR is 40%-50% in those with genotype 1 and of 80% or more in those with genotypes 2 and 3 infections.4 Since half of patients with genotype 1 do not achieve SVR with SOC therapy, alternative treatments continue to be tested. The two protease inhibitors (PI), telaprevir (TVR) and boceprevir (BOC) are the direct acting antiviral agents (DAA) licensed for use in HCV Geno 1 infection. The role of physician is crucial in identifying population at risk with early diagnosis and guidance for appropriate management.