According to the World Health Organization, 130 to 150 million people worldwide suffer from chronic infections of hepatitis C (HCV), a bloodborne virus that primarily attacks the liver and can be spread through needle-sharing, contaminated medical equipment, and less often through sexual relations.

These sufferers are especially vulnerable to later liver damage, either through cirrhosis or cancer, and 350,000 to 500,000 people die as a result of these diseases every year. While there are available drug treatments for acute hepatitis C infection and its hardier chronic version, they vary in effectiveness, accessibility, and tolerance, often needing to be received via injection and coming saddled with side effects.

Soon enough, however, we might be looking at an entirely new playing field, with two studies in this month’s issue of the Journal of the American Medical Association (JAMA) reporting the extraordinary success of an experimental multi-drug oral therapy for chronic HCV infection, even among those who hadn’t responded to previous treatment.

The history of hepatitis C treatment has revolved around interferon therapy. While different in their specific functions, interferons are essentially a class of naturally occurring proteins that when released by the body, prompt the increased creation and fortification of immune cells needed to fight infection, and are named for their ability to interfere with viral infection. The drugs developed for hepatitis C infection have thus relied on promoting interferon activity or finding other indirect means to prevent the infection from taking root. While useful, they’ve come with their own aforementioned burdens.

But the past few years have marked a dramatic shift in drug development, with a new group of drugs created which directly target the hepatitis C virus, inhibiting or interfering with replication, hence the ever catchy term direct-acting antivirals (DAAs). The two JAMA studies specifically looked at a three-drug combination of these DAAs over a 12-week period on a variety of circumstances; people who were suffering from hepatitis C-associated cirrhosis; people who had never been exposed to drug therapy, and those whose previous treatments had failed.

In the cirrhosis group, totaling 202 patients, when given fixed doses of daclatasvir, asunaprevir, and beclabuvir, 93 percent of patients who hadn’t received treatment before were considered free of infection after 12 weeks, with an 87 percent clear rate of those previously treated. Notably, when the drug combination was paired with ribavirin, an existing drug, these percentages continued to increase, with 98 percent and 93 percent treatment rates respectively. Similar rates of around 90 percent were found in the larger study of 415 patients who weren’t suffering from cirrhosis, though there was no intervention of ribavirin included.

Perhaps most importantly, the drugs came free of severe side effects, a problem that has stymied past efforts to reach out to HCV sufferers. "Those with more advanced disease were unlikely to tolerate interferons, and many patients would decide against even getting treatment," said Dr. Andrew Muir in a press release, lead author of the cirrhosis study and chief of the division of gastroenterology at Duke Medicine, "For those who could tolerate it, it was only moderately effective."

These new interferon-free drug regimens have led to an outpouring of optimism among the medical community. "The development of interferon-free treatments has been a tremendous step forward in the standard of care," Muir said. "These drugs are highly effective and well-tolerated by patients at all stages of liver disease."

There’s a lot of ground to cover before we can wave the victory flag over hepatitis C, though, not only in certifying the safety and the effectiveness of these therapies (neither study was randomized nor controlled, but other studies involving these specific drugs have been), but in solving the underlying problems that surround hepatitis C care.

“Despite the progress and success of viral eradication, numerous questions remain unanswered, such as response based on race, still difficult-to-treat situations, such as patients with end-stage liver disease or undergoing hemodialysis, access to and affordability of these therapies, improvements in quality of life, and cost effectiveness,” wrote Dr. Hari Conjeevaram, a gastroenterologist at the University of Michigan Health System, who commented on the studies in an JAMA editorial. “ It is time to reflect on these challenges and find solutions because the influence of HCV infection on global society is an ongoing challenge.”

Still, for the millions of hepatitis C sufferers, it appears brighter days are looming ahead.


Muir A, Poordad F, Lalezari J, et al. Daclatasvir in Combination With Asunaprevir and Beclabuvir for Hepatitis C Virus Genotype 1 Infection With Compensated Cirrhosis. Journal of the American Medical Association. 2015

Poordad F, Sievart W, Mollison L, et al. Fixed-Dose Combination Therapy With Daclatasvir, Asunaprevir, and Beclabuvir for Noncirrhotic Patients With HCV Genotype 1 Infection. Journal of the American Medical Association. 2015