drugs and for those infected with HIV see section 2.4. Excessive alcohol use is common in some populations infected with HCV and can accelerate disease.
WHO guidance on alcohol reduction is discussed in detail in Chapter 6.1.
2.7 Treatment of patients with HCV infection
HCV is a now a curable disease, and advances in HCV therapy have resulted in steadily higher cure rates. Identiication and treatment of chronic HCV infection
has a prevention beneit, as persons who are cured of HCV cannot transmit the virus to others. HCV cure is also beneicial for the patient’s health, as it
reduces the risk of development of HCC among persons at all stages of ibrosis by 75.
82,83
At the time of writing December 2013, six drugs are licensed for the treatment of HCV – standard interferon IFN or pegylated interferon alpha
PEG-IFN, ribavirin RBV, the protease inhibitors PIs boceprevir, simeprevir and telaprevir, and the nucleotide analog polymerase inhibitor sofosbuvir. The
limitations of treatment include high cost, the need for sophisticated laboratory tests and trained clinicians, as well as the limited eficacy and high toxicity of
some of the medicines. It is anticipated that the number of medicines for the treatment of HCV will expand rapidly over the coming years, and WHO plans to
periodically update these guidelines to include newly licensed drugs. Before treatment for HCV can be commenced, it is necessary to genotype the
virus as different genotypes require different types and durations of treatment, and the protease inhibitors boceprevir, simeprevir and telaprevir are licensed
only for genotype 1 infection. Current therapy for genotype 1 infection is a combination of PEG-IFN, RBV and a PI or nucleotide polymerase inhibitor, which
results in high rates of sustained virological response SVR; a negative HCV RNA test three or six months after the end of treatment.
84-87
Dual therapy with PEG- IFN and RBV or sofosbuvir with RBV is used for genotypes 2 and 3 infections.
88,89
Patients with genotype 4 infection treated with treated with sofosbuvir, PEG-IFN and RBV have similar response rates when compared with genotype 1-infected
individuals. Small studies of genotypes 5- and 6-infected patients have shown similar SVR rates to genotypes 2- and 3-infected ones.
90,91
Larger studies in these groups are required to conirm these results and to identify predictors of
response or non-response to treatment. Treatment with some HCV medicines may result in marked side-effects and
therefore careful patient assessment and close monitoring is required.
92,93,94
2.8 Cost–effectiveness of treatment
