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Crit Rev Microbiol. 2018 Mar;44(2):143-160. doi: 10.1080/1040841X.2017.1329277. Epub 2017 May 25.

Real-world challenges for hepatitis C virus medications: a critical overview.

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a Department of Pharmacology and Toxicology, College of Pharmacy , Umm Al Qura University , Al-Abidiyah , Makkah , Saudi Arabia.
c Applied and Functional Genomics Laboratory, Centre of Excellence in Molecular Biology , University of the Punjab , Lahore , Pakistan.
b Viral Hepatitis Program, Laboratory of Medicine , University of Washington , Seattle , WA , USA.
d Department of Gastroenterology and Hepatology , Fatima Memorial College of Medicine and Dentistry , Shadman , Lahore , Pakistan.


From 2010, the landscape of hepatitis C therapeutics has been changed rapidly, and today we are standing at a cusp of a pharmacological revolution where highly effective and interferon (IFN)-free direct acting antivirals (DAAs) are already on the market. Such treatment paradigms attain 90-95% sustained virologic response (SVR; undetectable viral load at week 12 or 24 at the end of therapy) rates in treated individuals compared to 50-70% with treatment completion of dual-therapy-pegylated interferon (PEG-IFN) and ribavirin (RBV). As the major goal now for the hepatologists, clinicians, physicians, and health care workers is likely to eradicate hepatitis C infection in parallel to treatment, the demand is for a one-size-fits-all pill that could be prescribed beyond the limitations of hepatitis C genotype, viral load, previous treatment history, advanced hepatic manifestations (fibrosis, cirrhosis) and antiviral drug resistance. Although the new treatment strategies have shown high cure rates in clinical trials, such treatment paradigms are posing dilemmas too in real-world clinical practice. Therapy cost, treatment access to low and middle-income countries, treatment-emergent adverse events, lack of effective viral screening and disease progression simulation models are potential challenges in this prospect. This review article deeply overviews the challenges encountered while surmounting the burden of hepatitis C around the world.


IFN-free antivirals; care widening models; disease burden simulation models; real-world challenges; risk-stratified approaches; therapy cost and access; treatment-emergent severe adverse events

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