Format

Send to

Choose Destination
Drugs. 2017 Jul;77(10):1043-1055. doi: 10.1007/s40265-017-0753-x.

Resistance Mechanisms in Hepatitis C Virus: implications for Direct-Acting Antiviral Use.

Author information

1
Division of Infectious Diseases, IRCCS Ospedale San Raffaele, Via Stamira d'Ancona 20, 20127, Milan, Italy. bagaglio.sabrina@hsr.it.
2
Division of Infectious Diseases, IRCCS Ospedale San Raffaele, Via Stamira d'Ancona 20, 20127, Milan, Italy.

Abstract

Multiple direct-acting antiviral (DAA)-based regimens are currently approved that provide one or more interferon-free treatment options for hepatitis C virus (HCV) genotypes (G) 1-6. The choice of a DAA regimen, duration of therapy, and use of ribavirin depends on multiple viral and host factors, including HCV genotype, the detection of resistance-associated amino acid (aa) substitutions (RASs), prior treatment experience, and presence of cirrhosis. In regard to viral factors that may guide the treatment choice, the most important is the infecting genotype because a number of DAAs are genotype-designed. The potency and the genetic barrier may also impact the choice of treatment. One important and debated possible virologic factor that may negatively influence the response to DAAs is the presence of baseline RASs. Baseline resistance testing is currently not routinely considered or recommended for initiating HCV treatment, due to the overall high response rates (sustained virological response >90%) obtained. Exceptions are patients infected by HCV G1a when initiating treatment with simeprevir and elbasvir/grazoprevir or in those with cirrhosis prior to daclatasvir/sofosbuvir treatment because of natural polymorphisms demonstrated in sites of resistance. On the basis of these observations, first-line strategies should be optimized to overcome treatment failure due to HCV resistance.

PMID:
28497432
DOI:
10.1007/s40265-017-0753-x
[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Springer
Loading ...
Support Center