The role of triple therapy for patients with HCV genotype 1

The present standard of care (SOC) therapy of chronic hepatitis C virus (HCV) infections is pegylated interferon-alpha in combination with ribavirin (RBV). In HCV genotype 1 (G1) infections, undetectable HCV RNA in serum is achieved in 40% to 60% of patients after 48 weeks of treatment. Recently published phase III studies (SPRINT-2, ADVANCE, ILLUMINATE, RESPOND-2, and REALIZE) in G1 patients have shown that combined treatment with new direct acting antiviral (DAA) drugs such as boceprevir and telaprevir and pegylated interferon-alpha (PEG-IFN-α)/RBV are more efficacious in inducing a sustained Virologic response (SVR) than the current SOC. The impact of triple therapy with such new protease inhibitors in the management of HCV G1 liver infections is herein reviewed. Triple therapy with add-on directly acting antiviral (DAA agents) has been demonstrated to increase SVR rates, shorten treatment duration, and improve outcomes in patients likely to exhibit a poor response - black individuals and patients with evidence of bridging fibrosis or cirrhosis. A lack of universal response in all genotypes and a somewhat increased burden of adverse effects observed are problems still to be overcome.