Personalized care approaches to hepatitis C therapy: recent advances and future directions

ABSTRACT

Introduction

The introduction of direct-acting antivirals (DAAs) has significantly transformed the therapeutic landscape for chronic C hepatitis virus (HCV) infection. However, there is still room for further improvement in optimizing therapy efficacy and minimizing adverse effects.

Areas covered

This review is devoted to the rationale for adopting a personalized approach to HCV therapy. Specifically, we explore the role of host-related factors, such as sex or the presence of comorbidities. We thoroughly examine the implications of commonly encountered comorbidities, including HIV infection, chronic renal disease, liver cirrhosis, and other chronic viral hepatitis infections. Additionally, we discuss the prevalent drug-to-drug interactions between DAAs and other medications, while providing guidance on their management. Finally, we investigate viral-related issues that can influence treatment outcomes, such as viral genotype, quasi-species, and the presence of resistance-associated mutations.

Expert opinion

Despite pivotal trials demonstrating efficacy rates exceeding 90% for currently available DAA regimens, there are still opportunities to optimize therapy outcomes and tailor treatment to each patient. This can be achieved through a meticulous evaluation of the patient’s specific clinical conditions and comorbidities, a vigilant approach to manage potential drug interactions, and diligent patient follow-up.

KEYWORDS:

• Hepatitis C
• personalized therapy
• direct-acting antivirals
• drug-to-drug interactions
• liver disease
• cirrhosis

Article highlights

• Global Burden of HCV: Chronic HCV infection affects approximately 71 million people worldwide, leading to severe liver diseases, such as cirrhosis and hepatocellular carcinoma.

• Treatment Evolution: The development of direct-acting antivirals (DAAs) has significantly improved cure rates and reduced side effects compared to older therapies. However, challenges remain, including high costs, undiagnosed cases, and drug resistance.

• Personalized Screening: A personalized approach to Hepatitis C (HCV) screening involves tailoring screening strategies based on individual risk factors and social and demographic characteristics.

• Personalized Therapy Approaches: A personalized HCV treatment is based on host factors, viral factors, comorbidities, and on the careful management of drug-to-drug interaction

Declaration of interest

Gentile has acted as a consultant for Merck Sharp & Dohme, Gilead, Abbvie, Pfizer, Angelini, Nordic, Abbott, Glaxo Smith Kline and Sobi; other authors do not have compelling interests.

Reviewer disclosures

Peer reviewers in this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.