How is HCV treated?

Hepatitis C treatment is a combination of two drugs, pegylated

interferon and ribavirin. Pegylated interferon is a man-made version
of a chemical messenger made by the human body. Interferon
stimulates the immune system to fight viruses, so it has antiviral and
immunologic activity. Pegylation means that a small molecule has
been attached to interferon to keep it in the body longer, to make
dosing more convenient, and to render treatment more effective.
There are two types of pegylated interferon (PegIFN):
alpha-2a (manufactured by Roche, trade name Pegasys), and
alpha-2b (manufactured by Schering Plough, trade name
PEG-Intron)

HCV treatment and CD4 cell count

Although interferon can cause a temporary drop in your CD4 count,
(but not your CD4 percentage), the three major HCV treatment trials
for coinfected people did not find more opportunistic infections (OIs)
in people with low (under 200/mm3) CD4 cell counts.
There have been some reports of Candida esophagitis (a fungal
infection of the esophagus), and tuberculosis among coinfected
people during HCV therapy. In some cases, prophylaxis (drugs that
protect against certain OIs) may be recommended.
CD4 cell counts usually return to the pretreatment levels within a few
months after HCV treatment has ended.

Interferon-based treatment does not work for everyone and is limited by side effects that are severe
enough that many people postpone or stop treatment. There are many new oral HCV-specific antiviral
drugs currently in development, but for at least the next few years, they must be used in combination with
pegylated interferon and ribavirin. Waiting for better treatments may be a good option for people who
dont need HCV treatment now. This includes people with mild liver damage.
For a long time, research into HCV was difficult because the virus couldnt be grown in laboratories. This
changed recently when researchers successfully developed new models to study the viral life cycle, which
makes it easier to develop drugs that stop viral replication.
Many new treatments for hepatitis C are being researched. Some are oral drugs with similarities to HIV
medications (protease and polymerase inhibitors), though they will not be active against HIV. These new
drugs are being studied first in people with HCV monoinfection. Treatment activists continue to advocate
for earlier trials in coinfected people; as a result, some companies have begun planning pre-approval
studies of their HCV drugs in coinfected people.

As with HIV drugs, combination therapy may be essential in order not to develop resistance. A high level
of adherence (better than 95%) is also likely to be important. HCV makes trillions of copies per day, which
increases the likelihood of mutations that cause drug resistance. In fact, resistance to HCV antivirals has
already been reported, even in people who have never been treated with them. In order to avoid
resistance, people currently need to use new drugs in combination with pegylated interferon and ribavirin.
Hopefully interferon-free regimens will be possible when drugs targeting different steps in the HCV
lifecycle can be combined. But interferon may remain necessary; experts are debating whether antiviral
therapy alone will be sufficient, or if immune stimulation with pegylated interferon will still be required to
treat HCV. Many look to HIV as a model: antiviral therapy can suppress, but not eradicate HIV. Ribavirin
will stay on board as well; studies using a new drug without ribavirin reported lower sustained virologic
response rates, and higher relapse rates in ribavirin-sparing arms.