Marek Rác, Peter Jarčuška
Rapid progress and the availability of new treatment regimens have dramatically changed therapeutic strategies and
management of patients with hepatitis C. The development and availability of new direct acting antivirals (DAAs) has
been a revolution in the treatment of chronic hepatitis C. The scope of antiviral therapy has evolved from pegylated interferon
plus ribavirin to interferon-based strategies with DAAs and finally to interferon-free regimens with combination
of DAAs. New treatment regimens have become shorter, safer, and even more effective with high levels of sustained
virological response (SVR). The decision which regimen is the most appropriate for the patient is multi-factorial.
Host, viral factors and comorbidities may influence treatment choice, as well as the chance to achieve a sustained virological
response. Decisions how to treat consists not only of the efficacy, safety, but big role is played by cost and availability
of the treatment. Today chronic hepatitis C can be cured with modern treatment strategies in almost every patient.
Chronic HCV infection leads to systemic and complex disease, which outcome can be affected by many factors.
New DAAs allow effective antiviral treatment even in patients with comorbidities or extrahepatic manifestations. Optimal
management of HCV infection and associated conditions will remain a difficult challenge for clinicians even in a new
DAAs era. We cannot always reverse the consequences of advanced disease after a delayed diagnosis and treatment in
liver cirrhosis or extra-hepatic manifestations despite achieving the eradication of the virus and cure of HCV infection.
Today the problem remains in the lack of screening for infected persons and limited access to treatment.