The Era of Direct-Acting Antivirals: The Evolving Role of Interferon and Ribavirin for the Treatment of Chronic Hepatitis C

The burden of disease related to chronic hepatitis C (CHC) continues to increase annually. While our experience with treating CHC began less than 30 years, steady progress has been made in the ability to successfully treat patients, reducing morbidity and mortality. Until recently, the main players in therapy of CHC were interferon and ribavirin. Unfortunately, response to this therapy is successful only in a selected group of patients, leaving a sizeable portion of patients with CHC untreated or with ineffective retreatment options after having failed prior therapy. An in depth understanding of the hepatitis C virus has ushered in the dawn of a new era of therapy for CHC. Two drugs, telaprevir and boceprevir, have recently been approved by the Food and Drug Administration. Many others hold great promise and are in the early phases of drug development. Here, we will review the history of hepatitis C therapy, mechanism of action drugs approved for or in development, current data on clinical safety and efficacy of these agents as well as the role of patient preference in CHC therapy. We will conclude with current recommendations for the treatment of patients with CHC and the evolving role of interferon and ribavirin.