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3. Better Options for Treating HCV Genotype 3 and Advanced Liver Disease

This year saw the emergence of new and better treatment options for people with hepatitis C virus (HCV) genotypes other than 1 and for those with advanced liver disease.

The advent of direct-acting antivirals in interferon-free regimens has brought about a revolution in hepatitis C treatment, starting with the U.S. Food and Drug Administration (FDA) approval of Janssen's simeprevir (Olysio) and Gilead Sciences' sofosbuvir (Sovaldi) in 2013, and Gilead's sofosbuvir/ledipasvir coformulation (Harvoni) and AbbVie's paritaprevir-based "3D" regimen (Viekira Pak) in 2014. But these options are most effective against HCV genotype 1.

At the AASLD Liver Meeting in November researchers reported that Bristol-Myers Squibb's daclatasvir (Daklinza) plus sofosbuvir and a coformulation of sofosbuvir and Gilead's new NS5A inhibitor velpatasvir cured more than 90% of people with hard-to-treat HCV genotype 3. In July the FDA approved daclatasvir as a treatment for genotype 3.

Studies presented at the Liver Meeting and the EASL International Liver Congress in April also showed good results for people with advanced liver disease including decompensated cirrhosis.

The next treatment option due out of the pipeline is Merck's grazoprevir/elbasvir coformulation (Zepatier). Studies presented at the International Liver Congress showed cure rates of 90% or better for previously untreated people (C-EDGE Treatment-naive), prior non-responders to interferon-based therapy (C-EDGE Treatment-experienced), people with HIV/HCV coinfection (C-EDGE Co-infected), and patients with advanced liver disease (C-SALT). A study at AASLD showed this combo works also well for people who inject drugs (C-EDGE CO-STAR).

Further back in the pipeline, a new combination from Abbvie -- ABT-493 + ABT-530 -- also appears promising.

Studies presented in 2015 began to show the first evidence that interferon-free therapy has an impact on liver disease progression, including fibrosis regression and the need for liver transplants -- but people who wait too long may not fully recover. These and other studies support expert recommendations that all people with hepatitis C should be considered eligible for treatment before they develop advanced disease.

Next: 4. Getting to Zero -- Progress Toward Ending HIV Epidemic