Management of Hepatitis C Genotype 1 Monoinfection

Makia Dove, PharmD Candidate; Clarice Carthon, PharmD Candidate; Monika N. Daftary, PharmD, BCPS, AAHIVP


US Pharmacist. 2014;39(4):75-79. 

In This Article

Abstract and Introduction


Hepatitis C is a common cause of end-stage liver disease in the United States. Historically, standard treatment for hepatitis C virus (HCV) genotype 1 was peginterferon alfa plus ribavirin. Treatment remained unchanged until 2011, when the direct-acting antivirals (DAAs) boceprevir and telaprevir were approved by the FDA. Standard treatment of HCV genotype 1 now consists of peginterferon alfa, ribavirin, and a DAA. The addition of a DAA to standard treatment helped shorten the duration of therapy, but the initially approved agents were not without adverse effects (AEs). In late 2013, two additional DAAs—simeprevir and sofosbuvir—were approved by the FDA. Both of these agents feature improved dosing-frequency and AE profiles.


One of the most common causes of hepatitis is hepatitis C virus (HCV) infection. In the United States, 3.2 million people have chronic HCV infection, which is the most common blood-borne infection.[1] The prevalence of hepatitis C is 3.25% in persons born between 1945 and 1965, and 50% to 75% of these individuals are unaware that they have hepatitis C.[2] This population constitutes three-fourths of all chronic HCV infections among U.S. adults.[2] In 2011, there were 1,229 reported cases of acute HCV infection—a 44% increase from 2010.[3] In the U.S., chronic HCV infection is the most common reason for liver transplantation. Five percent to 20% of HCV-infected individuals develop cirrhosis over a period of 20 to 30 years, and 1% to 5% die of cirrhosis or liver cancer.[1]

HCV is classified into six different genotypes (numbered 1–6), with each genotype divided into subtypes. HCV genotype 1, which is the most common cause of hepatitis C infection in the U.S., is the most difficult form to treat.[4]