Hepatitis C virus (HCV) infection affects 3 to 4 million people in the United States and is a major cause of liver failure, hepatocellular carcinoma, and liver transplantation.1 Prior to 2011, the combination of pegylated interferon and ribavirin was the best available therapy for HCV. When treated with this combination of medicines, approximately half of patients with genotype 1 disease, the most prevalent type of HCV in the United States, clear the virus from their bloodstream and achieve a sustained virologic response that greatly reduces their risk of progressive liver disease. However, pegylated interferon and ribavirin require a year of therapy and often produce substantial adverse effects that reduce adherence; in addition, many patients are not eligible for this therapy because of medical or psychiatric comorbidities.2 In 2011, introduction of the first-generation, direct-acting antiviral drugs boceprevir (Victrelis; Merck & Co) and telaprevir (Incivek; Vertex Pharmaceuticals Inc) substantially improved rates of sustained virologic response when used in combination with pegylated interferon and ribavirin to treat patients with genotype 1 infections. This improvement brought new challenges, however, including additional adverse effects, stringent dosing requirements, and high pill burdens.3
Fifty percent of infected patients are treated (n = 270 525).
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