Treatment of hepatitis C in difficult-to-treat patients

The availability of potent and safe direct-acting antiviral agents has substantially improved the treatment of chronic hepatitis CPatients who are 'difficult-to-treat' can now be cured, including those with advanced cirrhosis before and after liver transplantation; studies in patients with kidney failure and after kidney transplantation are underwayCombinations of NS5B inhibitors (sofosbuvir, dasabuvir) with new protease inhibitors (simeprevir, paritaprevir) and NS5A inhibitors (ledipasvir, daclatasvir, ombitasvir) are becoming the standard of care for all patients with HCVIn patients post-liver transplantation, sofosbuvir, ledipasvir and daclatasvir are safe but protease-containing regimes should be avoided in patients with decompensated liver diseaseThe optimal treatment duration and the need for ribavirin require further studiesMore effective antiviral agents than those currently available are needed for patient with cirrhosis who are infected with HCV genotype 3a