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      Real-world effectiveness and safety of glecaprevir/pibrentasvir for the treatment of chronic hepatitis C infection: data from the German Hepatitis C-Registry

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          Epidemiology and natural history of HCV infection.

          Worldwide, an estimated 130-170 million people have HCV infection. HCV prevalence is highest in Egypt at >10% of the general population and China has the most people with HCV (29.8 million). Differences in past HCV incidence and current HCV prevalence, together with the generally protracted nature of HCV disease progression, has led to considerable diversity in the burden of advanced liver disease in different countries. Countries with a high incidence of HCV or peak incidence in the recent past will have further escalations in HCV-related cirrhosis and hepatocellular carcinoma (HCC) over the next two decades. Acute HCV infection is difficult to detect because of the generally asymptomatic nature of the disease and the marginalization of at-risk populations. Around 25% of patients with acute HCV infection undergo spontaneous clearance, with increased rates among those with favourable IL28B genotypes, acute symptoms and in women. The remaining 75% of patients progress to chronic HCV infection and are subsequently at risk of progression to hepatic fibrosis, cirrhosis and HCC. Chronic hepatitis C generally progresses slowly in the initial two decades, but can be accelerated during this time as a result of advancing age and co-factors such as heavy alcohol intake and HIV co-infection.
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            EASL Recommendations on Treatment of Hepatitis C 2016.

            (2017)
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              Current therapy for chronic hepatitis C: The role of direct-acting antivirals

              One of the most exciting developments in antiviral research has been the discovery of the direct-acting antivirals (DAAs) that effectively cure chronic hepatitis C virus (HCV) infections. Based on more than 100 clinical trials and real-world studies, we provide a comprehensive overview of FDA-approved therapies and newly discovered anti-HCV agents with a special focus on drug efficacy, mechanisms of action, and safety. We show that HCV drug development has advanced in multiple aspects: (i) interferon-based regimens were replaced by interferon-free regimens; (ii) genotype-specific drugs evolved to drugs for all HCV genotypes; (iii) therapies based upon multiple pills per day were simplified to a single pill per day; (iv) drug potency increased from moderate (∼60%) to high (>90%) levels of sustained virologic responses; (v) treatment durations were shortened from 48 to 12 or 8 weeks; and (vi) therapies could be administered orally regardless of prior treatment history and cirrhotic status. However, despite these remarkable achievements made in HCV drug discovery, challenges remain in the management of difficult-to-treat patients.
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                Author and article information

                Contributors
                Journal
                Alimentary Pharmacology & Therapeutics
                Aliment Pharmacol Ther
                Wiley
                02692813
                April 2019
                April 2019
                March 15 2019
                : 49
                : 8
                : 1052-1059
                Affiliations
                [1 ]Section of Hepatology; University Hospital Leipzig; Leipzig Germany
                [2 ]UBN/Practice; Berlin Germany
                [3 ]IFI Studien und Projekte GmbH; Hamburg Germany
                [4 ]Praxisonkologie Bremen; Bremen Germany
                [5 ]Practice Dr. med. C. John; Berlin Germany
                [6 ]Practice PD Dr. med. G. Teuber; Frankfurt Germany
                [7 ]Gastroenterologische Schwerpunktpraxis; Augsburg Germany
                [8 ]Center for HIV and Hepatogastroenterology; Düsseldorf Germany
                [9 ]AbbVie Germany GmbH & Co. KG; Wiesbaden Germany
                [10 ]Katholisches Klinikum Oberhausen, St. Josef-Hospital, Klinik für Innere Medizin, Akademisches Lehrkrankenhaus der Universität Duisburg-Essen; Oberhausen Germany
                Article
                10.1111/apt.15222
                30874328
                d9787983-2fdb-4a1c-b067-43c8a7d49320
                © 2019

                http://doi.wiley.com/10.1002/tdm_license_1.1

                http://onlinelibrary.wiley.com/termsAndConditions#vor

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