What is the future of ribavirin therapy for hepatitis C?

• Ribavirin has been an essential part of chronic hepatitis C therapy for approximately 10 years.
• HCV therapy is evolving towards interferon-free regimens with direct-acting antiviral therapy.
• Ongoing clinical trials show that therapy without interferon and ribavirin is possible.
• With the demonstrated potency of new therapies, usage of ribavirin may be limited to resource poor settings.
• Ribavirin may still play a role in future HCV therapies in combination with direct-acting antivirals.

With the introduction of direct-acting antiviral (DAA) therapy against hepatitis C virus (HCV) infection, the field is rapidly evolving towards interferon-free regimens with high sustained virologic response (SVR) rates. The ultimate goal of therapy in chronic HCV infection should include an easily dosed all-oral regimen that is highly effective, inexpensive, pan-genotypic, safe and tolerable, with minimal to no resistance. Various investigational DAA regimens are currently under evaluation with and without ribavirin (Rbv). With the projected arrival of improved therapies over the next 5 years, the future role of Rbv comes into question. Despite being plagued by the lack of understanding of its mechanism of action and significant side effects such as anemia, Rbv has been a part of the standard-of-care therapies in chronic HCV infection for more than 10 years. As we look towards the future HCV therapy, Rbv may still have utility in the care of patients infected with HCV because of its low cost and potentially added value in combination with other DAAs. This article forms part of a symposium in Antiviral Research on “Hepatitis C: next steps toward global eradication.”