title: Chronic hepatitis C genotype 1 virus: who should wait for treatment?
abstract: Elucidation of the natural history of chronic hepatitis C (CHC) and the identification of risk factors for its progression to advanced liver disease have allowed many physicians to recommend deferral treatment (triple therapy) in favour of waiting for new drug availability for patients who are at low risk of progression to significant liver disease. Newer generation drugs are currently under development, and are expected to feature improved efficacy and safety profiles, as well as less complex and shorter duration delivery regimens, compared to the current standards of care. In addition, patients with cirrhosis and prior null responders have a low rate (around 15%) of achieving sustained virological response (SVR) with triple therapy, and physicians must also consider the decision to wait for new treatments in the future for these patients as well. Naïve patients are the most likely to achieve a close to 100% SVR rate; therefore, it may be advisable to recommend that patients with mild to moderate CHC should wait for the newer therapy options. In contrast, patients with advanced fibrosis and cirrhosis will be those with the greatest need for expedited therapeutic intervention. There remains a need, however, for establishing definitive clinical management guidelines to maximize the benefit of waiting for new drugs and minimize risk of side effects and non-response to the current triple therapy.
authors.affiliation: Cristiane Valle Tovo, Angelo Alves de Mattos, Department of Gastroenterology, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre 90430-080, Brasil.
authors.forename: Cristiane Valle
authors.initials: CV
authors.lastname: Tovo
authors.affiliation: Cristiane Valle Tovo, Angelo Alves de Mattos, Department of Gastroenterology, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre 90430-080, Brasil.
authors.forename: Angelo Alves
authors.initials: AA
authors.lastname: de Mattos
authors.affiliation: Cristiane Valle Tovo, Angelo Alves de Mattos, Department of Gastroenterology, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre 90430-080, Brasil.
authors.forename: Paulo Roberto Lerias
authors.initials: PR
authors.lastname: de Almeida
mesh_terms: D000998:Antiviral Agents / Q000627:therapeutic use*; D005838:Genotype; D016174:Hepacivirus / Q000235:genetics; D019698:Hepatitis C, Chronic / Q000188:drug therapy* / Q000821:virology; D006801:Humans; D007372:Interferons / Q000627:therapeutic use; D012254:Ribavirin / Q000627:therapeutic use; D057832:Watchful Waiting
chemical_list: D000998:Antiviral Agents; D012254:Ribavirin; D007372:Interferons
keywords: Chronic hepatitis C; Cirrhosis; Hepatitis C virus; Protease inhibitors; Treatment of hepatitis C