Review of Treatments in Hepatitis C Virus Genotype 1 Individuals

Khushminder Rai


Hepatitis C is a treatable liver disease. Although the prevalence of individuals infected with hepatitis C virus (HCV) in Canada is low, approximately a quarter of those infected are unaware of their status. This makes diagnosis and treatment difficult. HCV genotypes 1-3 are more prevalent in Canada. Treatment with interferon (IFN) and ribavirin (RBV) has been standard of care therapy since 2002 in Canada and 1998 in US. This therapy includes a weekly subcutaneous injection and twice daily oral tablets and is associated with some significant side effects such as anemia which may require erythropoietin or transfusion treatments in some patients. Therefore, new oral only treatments are being tested which will allow shorter duration of therapy, improved sustained virologic response (SVR) rates, and a lower pill burden.




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Hepatitis C; treatment; protease inhibitors; polymerase inhibitors


Myers RP, Ramji A, Bilodeau M, Wong S, Feld JJ. An update on the management of chronic hepatitis C: consensus guidelines from the Canadian Association for the Study of the Liver. Can J Gastroenterol. 2012;26(6):359–75.

Hanley JP, Haydon GH: The biology of interferon-I and the clinical significance of anti-interferon antibodies. Leuk Lymphoma 1998;29:257–68.

Bacon BR, Gordon SC, Lawitz E, Marcellin P, Vierling JM, Zeuzem S, et al. Boceprevir for previously treated chronic HCV genotype 1 infection. N Engl J Med. 2011;364:1207-17.

Nguyen MH, Keeffe EB. Prevalence and treatment of Hepatitis C virus genotypes 4, 5, and 6. Clin Gastroenterol Hepatol. 2005;3(10):S97–S101.

Fernández-Montero JV, Soriano V. Future perspectives in the treatment of chronic Hepatitis C. Spanish J Prison Health 2011;13:21-9.

Taylor DR, Shi ST, Lai MMC. Hepatitis C virus and interferon resistance. Microb Infect. 2000;2:1743−56.

Hoofnagle JH. Management of hepatitis C: current and future perspectives. J Hepatol. 1999;31(Suppl.1):264–68.

Lau JYN, Tam RC, Liang TJ, Hong Z. Mechanism of action of ribavirin in the combination treatment of chronic HCV infection. Hepatology 2002;35(5):1002–9.

Mukherjee S. Hepatitis C treatment and management. In: Medscape Reference[Online]. 2012 [cited 2012 Sep 14]. Available from: URL:

Fried MW, Shiffman ML, Reddy KR, Smith C, Marinos G, Gonçales FL Jr., et al. Peginterferon alfa-2a plus ribavirin for chronic hepatitis C virus infection. N Engl J Med. 2002;347(13):975–82.

Hadziyannis SJ, Sette Jr. H, Morgan TR, Balan V, Diago M, Marcellin P, et al. Peginterferon-α2a and ribavirin combination therapy in chronic Hepatitis C. Ann Intern Med. 2004;140:346–55.

Repchinsky C, editor. Pegasys. In: Compendium of Pharmaceuticals and Specialties [online version (e-CPS)]. Ottawa: Canadian Pharmacists Association; 2012 [cited 2012 Aug 30]. Available from: URL:

Manns MP, McHutchison JG, Gordon SC, Rustgi VK, Shiffman M, Reindollar R, et al. Peginterferon alfa-2b plus ribavirin compared with interferon alfa-2b plus ribavirin for initial treatment of chronic hepatitis C: a randomised trial. Lancet 2001;358:958–65.

Papafragkakis H, Rao MS, Moehlen M, Dhillon S, Martin P. Depression and pegylated interferon-based hepatitis C treatment. Int J Infereron Cytokine Mediator Res. 2012;4:25–35.

Repchinsky C, editor. Victrelis. In: Compendium of Pharmaceuticals and Specialties [Online(e-CPS)]. Ottawa: Canadian Pharmacists Association; 2012 [cited 2012 Aug 30]. Available from: URL:

Product monograph. Incivek [Online]. 2012 [cited 2012 August 31]. Available from: URL:

Kwo PY, Lawitz EJ, McCone J, Schiff ER, Vierling JM, Pound D, et al. Efficacy of boceprevir, an NS3 protease inhibitor, in combination with peginterferon alfa-2b and ribavirin in treatment-I patients with genotype 1 hepatitis C infection (SPRINT-1): an open-label, randomised, multicentre phase 2 trial. Lancet 2010;376:705–16.

Poordad F, McCone J, Bacon BR, Bruno S, Manns MP, Sulkowski MS, et al. Boceprevir for untreated chronic HCV genotype 1 infection. N Engl J Med. 2011;364:1195–206.

Fowell AJ, Nash KL. Telaprevir: a new hope in the treatment of chronic Hepatitis C? Adv Ther. 2010;27(8):512–22.

Jacobson IM, McHutchison JG, Dusheiko G, Di Bisceglie AM, Reddy KR, Bzowej NH, et al. Telaprevir for previously untreated chronic hepatitis C virus infection. N Engl J Med. 2011;364:2405–16.

Sherman KE, Flamm SL, Afdhal NH, Nelson DR, Sulkowski MS, Everson GT, et al. Response-guided telaprevir combination treatment for hepatitis C virus infection. N Engl J Med. 011;365:1014–24.

Zeuzem S, Andreone P, Pol S, Lawitz E, Diago M, Roberts S, et al. Telaprevir for retreatment of HCV Infection. N Engl J Med. 2011;364:2417–28.

Buhler S, Bartenschlager R. New targets for antiviral therapy of chronic hepatitis C. Liver Int. 2012;32(Suppl.1):9–16.

Flisiak R, Horban A, Gallay P, Bobardt M, Selvarajah S, Wiercinska-Drapalo A, et al. The cyclophilin inhibitor Debio-025 shows potent anti-hepatitis C effect in patients coinfected with hepatitis C and human immunodeficiency virus. Hepatology 2008;47:817–26.

Coelmont L, Hanoulle X, Chatterji U, Berger C, Snoeck J, Bobardt M, et al. DEB025 (Alisporivir) inhibits hepatitis C virus replication by preventing a cyclophilin A induced cis-trans somerisation in domain II of NS5A. PloS ONE 2010;5(10):e13687.

Chevaliez S, Hezode C, Soulier A, Costes B, Bouvier-Alias M, Rouanet S, et al. High-dose pegylated interferon-α and ribavirin in nonresponder hepatitis C patients and relationship with IL-28B genotype (SYREN trial). Gastroenterology 2011;141:119–27.

Gane EJ, Roberts SK, Stedman CAM, Angus PW, Ritchie B, Elston R, et al. Oral combination therapy with a nucleoside polymerase inhibitor (RG7128) and danoprevir for chronic hepatitis C genotype 1 infection (INFORM-1): a randomised, double-blind, placebo-controlled, dose-escalation trial. Lancet 2010;376:1467–75.

Boehringer Ingelheim news release [Online].2012 [cited 2012 Sep 19]. Available from: URL: