title: New hepatitis C therapies for special patient populations.
abstract: BACKGROUND
  Chronic hepatitis C virus (HCV) infection has become a curable disease. More than 90% sustained virologic response rates have been obtained with 8-24 weeks of treatment with distinct combinations of direct-acting antivirals (DAA) in most registration trials. However, outcomes in real-world patients tend to be lower and treatment of special patient populations is often challenging.
  
  
  METHODS
  We address the treatment of chronic hepatitis C with DAA in major special patient populations, such as HIV-positive persons, transplant recipients, patients with advanced cirrhosis, renal insufficiency, hepatitis B or D coinfection, injection drug users (IDUs) and prior DAA failures.
  
  
  CONCLUSIONS
  Drug interactions between DAA and medications given to persons with HIV infection or transplant recipients can result in treatment failure and adverse events. Severe organ dysfunction as in kidney insufficiency or decompensated cirrhosis may lead to DAA overexposure and toxicities. Dysfunctional social circumstances and behavior are associated to poor drug adherence and increased risk for HCV re-infection in active IDUs. Finally, DAA response might be impaired by viral interference in patients with hepatitis B or D coinfection or drug resistance in HCV either at baseline or after prior DAA failures.
authors.affiliation: a Infectious Diseases Unit , La Paz University Hospital , Madrid 28046 , Spain.
authors.forename: Vincent
authors.initials: V
authors.lastname: Soriano
authors.affiliation: b Department of Internal Medicine , La Luz Clinic , Madrid 28035 , Spain.
authors.forename: Pablo
authors.initials: P
authors.lastname: Labarga
authors.affiliation: c Department of Internal Medicine , Puerta de Hierro Research Institute & University Hospital , Majadahonda 28035, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: de Mendoza
authors.affiliation: d Department of Infectious Diseases , University Hospital Crosshouse , Kilmarnock , UK.
authors.forename: José V
authors.initials: JV
authors.lastname: Fernández-Montero
authors.affiliation: a Infectious Diseases Unit , La Paz University Hospital , Madrid 28046 , Spain.
authors.forename: Isabella
authors.initials: I
authors.lastname: Esposito
authors.affiliation: c Department of Internal Medicine , Puerta de Hierro Research Institute & University Hospital , Majadahonda 28035, Spain.
authors.forename: Laura
authors.initials: L
authors.lastname: Benítez-Gutiérrez
authors.affiliation: a Infectious Diseases Unit , La Paz University Hospital , Madrid 28046 , Spain.
authors.forename: José M
authors.initials: JM
authors.lastname: Peña
authors.affiliation: a Infectious Diseases Unit , La Paz University Hospital , Madrid 28046 , Spain.
authors.forename: Pablo
authors.initials: P
authors.lastname: Barreiro
mesh_terms: D000998:Antiviral Agents / Q000627:therapeutic use*; D060085:Coinfection; D004347:Drug Interactions; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy; D016174:Hepacivirus; D006509:Hepatitis B / Q000150:complications; D006526:Hepatitis C / Q000150:complications / Q000188:drug therapy* / Q000635:transmission; D019698:Hepatitis C, Chronic / Q000150:complications / Q000188:drug therapy; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000188:drug therapy; D016031:Liver Transplantation; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy; D051437:Renal Insufficiency / Q000150:complications; D015819:Substance Abuse, Intravenous / Q000150:complications
chemical_list: D000998:Antiviral Agents
keywords: Daclatasvir; HCV; HIV; hepatitis B; kidney insufficiency; paritaprevir; simeprevir; sofosbuvir; transplantation