The current and future epidemiologic burden of hepatitis C virus (HCV) is increasingly recognized as a major public health issue. Even though the greatest wave of liver disease attributable to HCV could be ahead of us, even now HCV is the most common cause of chronic liver disease, liver transplantation, and hepatic carcinoma in the United States. Because of insufficient identification of at-risk persons based on risk-factor profiles alone, the CDC has recommended that clinicians screen all persons born from 1945-1965 for HCV.
Supporting such initiatives is the recent evolution of treatment regimens characterized by higher success rates, greater efficacy in resistant subgroups, better tolerability, and more consistent across-genotype applicability than prior regimens.
Genotype 1 among HCV patients has been noted to be relatively refractory to older treatment regimens. Recently, a highly effective regimen combining ledipasvir (LED) and sofosbuvir (SOF) for 12 weeks demonstrated cure (i.e., sustained viral response, defined as absence of detectable HCV for at least 6 months post-treatment) in more than 95% of this highly resistant group.
To evaluate the potential efficacy of an even shorter course, Kowdley compared LED + SOF (8 weeks) vs LED + SOF (12 weeks) vs LED + SOF + ribavirin (12 weeks). They determined that not only was the LED + SOF 8-week course non-inferior to 12 weeks of the same, but that ribavirin imparted no meaningful additional efficacy and was associated with more adverse effects. Patients with HCV can look forward to a variety of highly effective, well tolerated, short-course treatments.
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