Newer therapeutics for hepatitis C

Chronic hepatitis C affects over 180 million people and is responsible for 3-4 million new infections each year worldwide (1). Most newly infected patients go on to develop persistent liver disease characterize by viremia and progressive liver fibrosis (2). Over time, many chronically infected patients develop liver cirrhosis, hepatocellular carcinoma and liver failure. Chronic hepatitis C remains the premier cause for liver transplantation in the Western World (3). Chronic hepatitis C is a curable disease with people achieving sustained virologic response (SVR: absence of plasma HCV RNA 12 weeks after stopping treatment). Until recently, treatment for hepatitis C included use of pegylated interferon-α (IFN-α) and ribavirin, which resulted in modest cure rates, despite having significant dose limiting adverse reactions (4). Recently, new class of antiviral agents termed directly acting antiviral agents (DAA) have been shown to achieve high rates of cure for HCV without the use of IFN-α (5). However, wide use of such DAA only regimens is restricted by cost and availability of new providers with expertise in management of hepatitis C (6). Hence, it is ideal if we can develop more affordable agents with antiviral efficacy for the treatment of hepatitis C infection.