COMMENTARY

A Future Without Hepatitis C?

The Liver Meeting 2014: American Association for the Study of Liver Diseases (AASLD)

William F. Balistreri, MD

Disclosures

December 16, 2014

In This Article

Current and Emerging Treatment Strategies

Research presented at The Liver Meeting 2014, the 65th annual meeting of the American Association for the Study of Liver Diseases (AASLD), highlighted the swift pace of progress in the successful development of an expanding variety of targeted therapeutic strategies for use in patients with chronic hepatitis C virus (HCV) infection.

Novel agents directed against HCV were shown to be highly effective in the entire spectrum of patient populations, including the previously difficult-to-treat "special" situations:

Patients with decompensated cirrhosis;

Patients with recurrence of HCV post–liver transplant;

Patients with HIV coinfection;

Previous nonresponse to antiviral therapy;

Patients with HCV genotype 3 infection; and

Older and younger patients.

Revolutionary drug strategies now incorporate a cocktail of agents blended to take advantage of synergistic mechanisms of action.

Of the more than 2000 abstracts presented at the meeting, roughly 25% were devoted to the topic of HCV and the current status of antiviral therapy and drug development. What was presented at the meeting was a dense, ever-changing menu of new agents. Several have already reached the market, while others are in the advanced stages of preapproval clinical development ( Table ).

These all-oral, interferon (IFN)-free combinations are reported to achieve sustained virologic response (SVR) rates > 90%. With the availability of these safe and highly effective (yet costly) drugs, the clinical question becomes "treat selectively or treat everyone?"

Keeping Up-to-Date

At this year's meeting of IDWeek, a large number of HCV-related abstracts were also presented, reflecting the growing link between hepatologists and infectious disease experts.

Attendant to the flurry of information emerging from such scientific conferences and the growing number of related peer-reviewed publications, clinicians require up-to-date, credible, and unbiased guidance on the treatment of their patients with HCV. The AASLD and the Infectious Diseases Society of America (IDSA) have collaborated on a Web-based resource for rapid formulation and dissemination of evidence-based, expert-developed HCV guidance. The shared goals are to guide clinicians in providing individualized care for their patients by choosing the most appropriate treatment regimen and to help them understand and address patient- and provider-related barriers to best outcomes.

Treatment Trial Results

Several studies presented at The Liver Meeting reflect the efficacy and safety of specific agents and combinations for HCV treatment. It's beyond the scope of this article to cover all relevant studies from the meeting, but the bottom-line message from all of the clinical trials was similar: "Agent X (fill in the blank) leads to achievement of high SVRs." The following offers a glimpse of some of the therapeutic options available to clinicians in the future.

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