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Shiffman M.L.,Health News
Current Gastroenterology Reports | Year: 2010

Treatment for chronic hepatitis C virus (HCV) infection is the combination of a peginterferon and ribavirin. Although a fixed duration of treatment (24 weeks for patients with genotypes 2 and 3 and 48 weeks for patients with all other genotypes) has been advocated, the best results are likely to be achieved when the duration of therapy is adjusted based on the time to response. According to the principles of response-guided therapy, patients with rapid virologic response have a high rate of sustained virologic response (SVR) and a low rate of relapse, and can be treated for 24 weeks regardless of genotype. In contrast, patients who become HCV RNA undetectable at a slower rate need a longer duration of therapy. Direct-acting antiviral agents are currently being developed to treat patients with HCV genotype 1. These agents will significantly increase rapid virologic response when used with peginterferon and ribavirin; according to the concepts of response-guided therapy, such treatment will yield high rates of SVR with 24 to 28 weeks of treatment. © 2010 Springer Science+Business Media, LLC. Source

Shiffman M.L.,Health News
Current Hepatitis Reports | Year: 2011

The treatment of chronic HCV has traditionally been for a fixed duration based on genotype. We now recognize that patients respond to treatment along different time lines. This appears to be secondary to various clinical, histologic, and genetic host factors. The time that it requires for a patient to become HCV RNA undetectable after initiating treatment is now recognized as one of the most important determinants of sustained virologic response. This information can be used to adjust the duration of peginterferon and ribavirin, either shorter or longer, and allows therapy to be tailored to the specific needs of each patient. This concept is referred to as response-guided therapy. © 2010 Springer Science+Business Media, LLC. Source

Shiffman M.L.,Health News
Liver International | Year: 2016

Chronic hepatitis C virus (HCV) infection affects an estimated 123 million persons worldwide and is the leading cause of cirrhosis and hepatocellular carcinoma in most countries. Approximately 75% of persons with chronic HCV were born between the years 1945-1965 and screening of patients in this birth cohort is now advocated. Unfortunately, these recommendations are not readily applied and a sizable population of infected persons who could benefit from treatment fall outside the birth cohort. Universal screening for HCV would be optimal. However, the primary limitation once patients are identified is accessing treatment which remains restricted in most countries. © 2016 John Wiley & Sons A/S. Source

Shiffman M.L.,Health News | Benhamou Y.,Sercive dHepatologie
Liver International | Year: 2015

Chronic hepatitis C virus (HCV) causes chronic liver injury and can lead to cirrhosis and hepatocellular carcinoma (HCC). HCV can also interact with the immune system to cause several HCV related disorders including essential mixed cryoglobulinemia, vasculitis, dermatitis, glomerulonephritis and lymphoma. A strong association between HCV and diabetes mellitus also exists. These extrahepatic features may lead to increased fatigue and a reduced quality of life. It is now possible to cure most patients with chronic HCV using oral antiviral therapy. Many of these HCV-related disorders and symptoms can be cured when HCV is eradicated. However, some patients may have irreversible injury to extrahepatic sites, cirrhosis that cannot resolve, an increased risk for HCC, persistent fatigue and a reduced quality of life, despite achieving sustained virological response. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd. Source

Shiffman M.L.,Health News | Benhamou Y.,Sercive dHepatologie
Liver International | Year: 2013

The current standard of care (SOC) for patients with chronic HCV genotype 1 is a combination of either boceprevir or telaprevir with peginterferon (PEG-IFN) and ribavirin (RBV). Although it is effective in a high percentage of patients, this treatment is associated with significant adverse events (AEs). The next generation of protease inhibitors, simeprevir and faldaprevir, will also be used with PEG-IFN/RBV. Interferon-free therapy with sofosbuvir appears promising and on the horizon for patients with genotypes 2 and 3, but may still be many years away for patients with HCV genotype 1. The factors which should be considered when deciding whether to treat a patient with HCV and mild fibrosis with the current SOC now, or to delay treatment until less toxic and/or more effective therapy is available is discussed. © 2012 John Wiley & Sons A/S. Source

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