Hepatitis C Treatment in the Era of Direct-Acting Antiviral Agents: Challenges in Developing Countries

Hepatitis C virus (HCV) infection is a major cause of chronic hepatitis and cirrhosis worldwide. Interferon-based regimens have been the sole therapies HCV for decades. However, this interferon and ribavirin combination is associated with several serious adverse events, and the sustained virologic response rate was suboptimal. The recent discovery of oral direct-acting antiviral agents (DAAs) heralded a revolution in the treatment of chronic HCV. This breakthrough in HCV therapy resulted in sustained virologic response rates ranging between 90% and 100%, reduction in treatment duration to 12. weeks or less adverse events, better compliance, and better management of all genotypes and special patient populations. DAAs are categorized into four major groups, namely: NS5B nucleotide inhibitors, NS5B nonnucleoside inhibitors, NS5A replication complex inhibitors, and NS3/4A protease inhibitors. Several interferon-free regimens have been approved and adequately assessed and several new regimens with high potencies, less cross-resistance and better safety profile are in the process of approval. Although, the era of HCV eradication and cure has begun, access to such extremely expensive medications remains a serious challenge in developing countries.