Recent Advance in the Treatment of hepatitis C virus infection for special populations
HCV infection is one of the primary causes of liver cirrhosis, hepatocellular carcinoma and liver transplantation (LT). The rate of HCV infection is high in patients on hemodialysis, as well as in patients infected with the human immunodeficiency virus (HIV). In liver-transplanted patients with HCV infection, recurrent HCV infection of the transplanted liver is universal, and re-infected HCV causes rapid progression of liver fibrosis. In patients with HCV/HIV or HBV/HCV co-infection, liver fibrosis progresses more rapidly. Thus, there is an urgent need for prompt treatment of HCV infection in those special populations (HIV/HCV or HBV/HCV co-infection, HCV infection after LT, and dialysis patients). However, IFN-based therapy for HCV could not achieve a high rate of sustained viral response (SVR) and cause severe adverse events (AEs) in special populations. Direct-acting antivirals (DAAs) has recently been developed and clinical trials have shown that IFN-free DAA-based therapies provide significantly better safety and therapeutic efficacy. Initially, the majority of DAA trials excluded special populations, and thus the efficacy and safety of IFN-free DAA therapy in special populations remained unclear. Thus, we conducted clinical study of DAAs for special populations in real world setting, and show the high efficacy and safety even in special populations (J Gastroenterol?2016, 2018,2018, 2019, 2019, Hep Res 2017, Intern Med.2019,2019, J Hepatol. 2017, JVH 2018). In addition, we showed the optimized retreatmen for patients with the emergence resistant-associated variants (RAVs) after failure of DAA therapy (J Gastroenterol 2017, Hep Res 2019). These recent evidences have revolutionized anti-HCV treatment and provided adequate therapeutic strategies for dialysis patients, patients with HIV or HBV co-infection, and patients with recurrent HCV infection after LT.