Current Therapies for Chronic Hepatitis C

McKenzie C. Ferguson, Pharm.D.


Pharmacotherapy. 2011;31(1):92-111. 

In This Article

Abstract and Introduction


Hepatitis C virus affects more than 180 million people worldwide and as many as 4 million people in the United States. Given that most patients are asymptomatic until late in the disease progression, diagnostic screening and evaluation should be performed in patients who display high-risk behaviors associated with acquisition of hepatitis C. Chronic hepatitis C is associated with cirrhosis, hepatic failure, and death; therefore, treatment is aimed at reducing these complications, as well as improving quality of life and minimizing adverse effects. The American Association for the Study of Liver Diseases Practice Guidelines on the Diagnosis, Management, and Treatment of Hepatitis C represent the gold standard for guidance on the management of hepatitis C. Standard treatment for hepatitis C is peginterferon alfa in combination with ribavirin. Currently, two pegylated interferon products are approved by the U.S. Food and Drug Administration for the treatment of hepatitis C. The duration of therapy with peginterferon and ribavirin is dictated by viral genotype and virologic response. Additional therapies are under investigation for treatment of chronic hepatitis C and show early promise of comparative efficacy and fewer adverse effects. Special considerations in certain populations, including patients coinfected with human immunodeficiency virus, those with end-stage renal disease, injection drug users, pregnant women, and pediatric patients, should guide treatment decisions.


Hepatitis C virus (HCV), a single-stranded RNA virus, is the most common chronic blood-borne illness in the United States. Approximately 4 million people in the United States have chronic infection. Although reported surveillance data likely reflect accurate trends, they also likely underestimate the true burden of disease.[1] Hepatitis C virus was officially recognized in 1989 and had previously been referred to as non-A, non-B hepatitis.[2] Most patients who develop acute hepatitis C will develop chronic infection, and as many as 30% of chronic HCV infections are from unknown causes.[3]

The incidence of acute hepatitis C has declined since the 1980s and 1990s and has stabilized since 2003 (Figure 1), possibly as a result of increased education and public awareness of transmissible risk factors.[1,4,5] Routine blood screening, implemented in 1992, has also contributed to the declining frequency. The HCV rates in people aged 25–39 years, typically those with the highest rates of infection, have decreased 90% from 1990 to 2007. In addition, the historically higher frequency in men is declining, with similar rates now reported for both sexes. Currently, the prevalence of chronic infection is highest in persons aged 40–49 years. Rates during 2004–2007 were similar among racial-ethnic groups except for American Indians and Alaskan Natives, in which the incidence increased. Previous prevalence data showed higher rates in non-Hispanic blacks.[1]

Figure 1.

Incidence of acute hepatitis C infection in the United States between 1982 and 2007.5


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