title: Antiviral therapy for "difficult-to-treat" hepatitis C virus-infected patients.
abstract: OBJECTIVE
  To review the updated research on direct antiviral agents (DAAs)-including regimens for hepatitis C virus (HCV), and focus on "difficult-to-treat" HCV-infected patients.
  
  
  METHODS
  The literature concerning DAAs and hepatitis C cited in this review was collected from PubMed and Google Scholar databases published in English up to July 2013.
  
  
  METHODS
  Data from published articles regarding HCV and DAAs in clinical trials and in clinical use were identified and reviewed.
  
  
  RESULTS
  It was recognized that some "difficult-to-treat" patients would still exist, even though stronger treatments using such as DAAs, including telaprevir and boceprevir, which lead to higher sustained virological response rates, are available. Such patients include those with advanced fibrosis/cirrhosis, elderly persons, children, HCV-human immunodeficiency virus co-infected patients, HCV-infected recipients, and so on.
  
  
  CONCLUSIONS
  Certain "difficult-to-treat" patients would still exist, even though stronger treatment is available. Although evidence from clinical trials is still lacking, interferon-sparing regimens could have stronger effects for eradicating HCV in such cases.
authors.affiliation: Department of Gastroenterology and Nephrology, Chiba University, Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, Japan. Email: kanda2t@yahoo.co.jp.
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Kanda
authors.forename: Osamu
authors.initials: O
authors.lastname: Yokosuka
authors.forename: Masao
authors.initials: M
authors.lastname: Omata
mesh_terms: D000998:Antiviral Agents / Q000494:pharmacology / Q000627:therapeutic use*; D016174:Hepacivirus / Q000187:drug effects / Q000472:pathogenicity*; D019698:Hepatitis C, Chronic / Q000188:drug therapy*; D006801:Humans
chemical_list: D000998:Antiviral Agents