How will we manage acute HCV in men having sex with men in the era of all oral therapy?

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With the advent of direct-acting antivirals (DAAs), the treatment of chronic hepatitis C virus (HCV) infection (CHC) has been revolutionized. Modern interferon- and potentially also ribavirin-free combinations consisting of 2 or 3 direct-acting antivirals (DAA) promise sustained virological response rates (SVR) of above 90%. This coincides with much shorter treatment durations and a much more favorable toxicity profile. Some DAAs even work across all HCV genotypes (pangenotypic) [BMJ, 349, 2014, g3308]. And lastly, HCV treatment in HIV-coinfected patients will no longer differ from HCV-monoinfected patients as response rates under DAA in the setting of HCV–HIV coinfection have been as good as in HCV-monoinfected patients [J Hepatol, 61, 2014, 373]. Only drug–drug interactions with the new DAAs and concomitant antiretroviral therapy have to be accounted for due to shared metabolization pathways via the cytochrome p450 system.

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