Treatment of Chronic Hepatitis C in the Age of Direct-Acting Antivirals with Emphasis on First Generation Inhibitors of HCV NS3/4A Protease

The past standard-of-care (SOC) for treatment of the chronic hepatitis C virus (HCV) was the combination of peginterferon with ribavirin (P + R). Sustained virologic response (SVR) for patients with HCV, genotype 1, was less than 50%. The new emerging SOC, Triple Therapy, using direct-acting antivirals (DAAs) with P + R will improve SVR for HCV genotype 1 infection to approximately 75%. Telaprevir and boceprevir are inhibitors of HCV NS3/4A serine protease and will be the first DAAs for treatment of patients with chronic hepatitis C. The treatment provider must effectively manage dosage and adherence to the regimen to avoid emergence of resistant variants of HCV. Close monitoring of patients, awareness of drug interactions, management of known telaprevir and boceprevir side effects, and strategies for reduction or discontinuation of individual drugs in the treatment regimen will be critical to ultimate success of triple therapy.