Treatment of chronic hepatitis C: What is new?

Hepatitis C Virus infection is a global problem that leads to development of chronic hepatitis, cirrhosis and hepatocellular carcinoma. So far this infection was being treated with interferon and ribavirin combination which has a large number of adverse effects. Last few years have seen availability of a large number of new molecules that are revolutionising the treatment of hepatitis C. Some of these newer drugs like sofosbuvir have been called game changer because they have changed the way we think of HCV treatment. The cost and availability of these newer drugs in India remains a problem so far. Efforts are on to bring these drugs within the reach of people at an affordable cost, but it is not clear as to how much time it will take. Till then, in our setting, we may continue to recommend the treatment that was standard of care for whole world before these game changers came in. In fact we also explore cheaper options, which are equally effective to make treatment within reach of poorer patients. It may be prudent to withhold treatment for patients with low levels of fibrosis (F1 or F2, with genotype 1 or 4 infection), and for patients who are non-responders to initial therapy, Interferon intolerant, those with decompensated liver disease, and patients in special populations such as stable patients after liver and kidney transplantation, HIV co-infected patients and those with cirrhosis of liver.