Long-term effects of antiviral therapy in patients with chronic hepatitis C

Future therapies for chronic hepatitis C

Therapy for hepatitis C has been fairly stagnant for the past decade, but the past few years have seen major progress and evolution, beginning with the approval of two HCV protease inhibitors in 2011. In spite of considerable improvements in response rates with these agents, a need for additional agents with improved potency and tolerability remains. Toward this goal and over the course of just a few months, the HCV therapy pipeline has already become crowded with direct-acting antivirals, host-targeted agents and unique interferons, all of which are positioned to be part of the next wave of therapeutic options. The ultimate goal of this push for new agents is to achieve a safe and straight forward yet highly effective therapy for hepatitis C that is widely embraced and readily available. Particularly among the 'baby boomer' population, it is predicted that over the next few years, more patients with currently quiescent infections will be newly diagnosed, and those currently diagnosed will be at increased risk of long-term complications of infection, and thus in need of treatment. A simple and safe treatment paradigm will become a necessity. This Review chronicles the latest developments in hepatitis C therapy and the potential effect these new treatments could have on delivery of care to patients infected with HCV.

Future classes of hepatitis C virus therapeutic agents

Recent advances in understanding of the molecular characteristics of the hepatitis C virus have led to the development of novel antiviral therapeutics. Direct-acting antivirals are designed to inhibit viral targets, whereas host-targeted antivirals block host factors that are used by the virus for its own life cycle. The rapid development of agents in multiple classes has led to the promise of shorter therapy duration, an improved side effect profile, and eventually interferon-sparing regimens. This article reviews novel hepatitis C virus therapeutics in development, including mechanism of action, efficacy, and adverse effects.

The blood transcriptional signature of chronic hepatitis C virus is consistent with an ongoing interferon-mediated antiviral response

Blood transcriptional profiling is a powerful tool for understanding global changes after infection, and may be useful for prognosis and prediction of drug treatment responses. This study characterizes the effects of chronic hepatitis C virus (HCV) infection on gene expression by analyzing blood samples from 10 treatment-naïve HCV patients and 6 healthy volunteers. Differential expression analysis of microarray data from peripheral blood mononuclear cells (PBMCs) identified a 136-gene signature, including 66 genes elevated in infected individuals. Most of the upregulated genes were associated with interferon (IFN) activity (including members of the OAS and MX families, ISG15, and IRF7), suggesting an ongoing immune response. This HCV signature was also found to be consistently enriched in many other viral infection and vaccination datasets. These genes were validated using a second cohort composed of 5 HCV patients and 5 healthy volunteers, confirming the upregulation of the IFN signature. In summary, this is the first study to directly compare blood transcriptional profiles from HCV patients with healthy controls. The results show that chronic HCV infection has a pronounced effect on gene expression in PBMCs of infected individuals, and significantly elevates the expression of a subset of IFN-stimulated genes.