Discussion on critical points for a tailored therapy to cure hepatitis C virus infection

• Main Authors: Nadia Marascio, Angela Quirino, Giorgio Settimo Barreca, Luisa Galati, Chiara Costa, Vincenzo Pisani, Maria Mazzitelli, Giovanni Matera, Maria Carla Liberto, Alfredo Focà, Carlo Torti
• Format: Article
• Language: English
• Published: Korean Association for the Study of the Liver 2019-03-01
• Series: Clinical and Molecular Hepatology
• Subjects: Direct-acting antivirals; Resistance-associated substitutions; Genetic variation; Deep sequencing
• Online Access: http://e-cmh.org/upload/pdf/cmh-2018-0061.pdf

Hepatitis C virus (HCV) infects around 71 million people worldwide and in 2018 it is still a major health problem. Since 2011, anti-HCV therapy with availability of direct-acting antiviral drugs has revolutionized the clinical response and paved the way to eradication strategies. However, despite the high rate of sustained virological response, treatment failure may occur in a limited percentage of patients, possibly due to resistance-associated substitutions (RASs), either emergent or pre-existent even in minority viral populations. Clearly this problem may impair success of eradication strategies. With this background, several questions marks still exist around HCV treatment, including whether pan-genotypic treatments with complete effectiveness in any clinical conditions really exist outside clinical trials, the actual cost-effectiveness of genotyping testing, and utility of RAS detection in viral quasispecies by next generation sequencing approach. In this review, we describe these critical points by discussing recent literature data and our research experience.