What Untapped Opportunities Remain for the Treatment of Genotype-3 Infections?

Affecting at least 170 million people worldwide, chronic hepatitis C virus (HCV) is a serious public health crisis. The highly mutable virus has at least six major subtypes worldwide. Genotype 3 is an aggressive and very prevalent strain found in up to half of the viremic cases in some major European markets. Some studies report that, compared with other HCV genotypes, patients infected with HCV genotype 3 are prone to develop progressively more-severe liver fibrosis that can lead to accelerated liver disease progression, decompensated cirrhosis, and, eventually, death. Prior to the December 2013 U.S. launch of the first HCV-specific nucleotide polymerase inhibitor sofosbuvir (Gilead’s Sovaldi), the standard of care for all HCV genotype-3 infections was a 24-week course of peg-IFN-α and ribavirin, both of which are associated with serious side effects and are contraindicated in many HCV-infected patients. Although interviewed experts are very eager to treat their HCV genotype-3-infected patients with sofosbuvir, they note that treatment guidelines recommend either an expensive 24-week course of the IFN-free combination of sofosbuvir plus ribavirin or a 12-week course of sofosbuvir plus peg-IFN-α and ribavirin. They also point out that relatively few antivirals are being developed for HCV genotype-3 infection and that critical unmet need remains for this indication, particularly for patients contraindicated to ribavirin and/or interferon.