Intended for healthcare professionals

Clinical Review State of the Art Review

Antiviral treatment of hepatitis C

BMJ 2014; 349 doi: (Published 07 July 2014) Cite this as: BMJ 2014;349:g3308
  1. Eoin R Feeney, clinical research fellow1,
  2. Raymond T Chung, director of Hepatology and Liver Center2
  1. 1Division of Infectious Diseases, Massachusetts General Hospital, Boston, USA
  2. 2Division of Gastroenterology, Massachusetts General Hospital, Boston MA 02114, USA
  1. Correspondence to: R T Chung RTCHUNG{at}


Hepatitis C virus (HCV) infection is a substantial health problem worldwide. Most patients infected with HCV remain chronically infected, with an increased risk of cirrhosis and hepatocellular carcinoma. Although they are associated with toxicities and low sustained viral response rates, interferon alfa and ribavirin have been the mainstay of treatment until recently. New direct acting antivirals, specifically designed to inhibit three viral proteins (the NS3/4A protease, the NS5A protein, and the NS5B RNA dependent RNA polymerase) are now becoming available. The NS3/4A inhibitor simeprevir and NS5B inhibitor sofosbuvir have recently been licensed and can reduce the length of antiviral treatment, improve response rates, and allow for interferon-free regimens for some HCV genotypes. Several other newer direct acting antivirals have shown promise in clinical studies and are likely to be licensed soon. These agents seem to facilitate the use of shortened courses of combination interferon-free therapy, which are associated with high (>95%) sustained response rates and relatively few toxicities. These regimens have also been successful in patients who were previously difficult to treat, including those with cirrhosis, HIV coinfection, and those who have undergone liver transplantation. The high cost of these agents may be the biggest challenge to their implementation worldwide.


  • Contribution and guarantor statement: ERF and RTC both performed the literature searches and planned and wrote the manuscript. Both authors are guarantors.

  • Competing interests: We have read and understood BMJ policy on declaration of interests and declare the following interests: ERF: grant support—Harvard University Center for AIDS Research (NIH/NIAID fund 5P30AI060354-09). RTC has received consultancy fees from Abbvie and payment for clinical trials from Gilead Sciences, Mass Biologics, and Vertex; grant support: NIH DK098079, DA033541, and AI082630.

  • Provenance and peer review: Commissioned; externally peer reviewed.

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