Approximately 250,000 Canadians are known to be infected with the hepatitis C virus (HCV); however, there are likely others who are unaware they are infected. Although HCV will clear spontaneously in about 25% of individuals infected, the remainder will develop chronic HCV infection. There are six genotypes of HCV, and the treatment strategy can differ depending on the genotype. Genotype 1 infections account for 55% to 65% of HCV infections in Canada.
For many years, standard therapy for patients with genotype 1 chronic HCV infection had been pegylated interferon plus ribavirin. However, the direct-acting antiviral drugs telaprevir, boceprevir, simeprevir, and sofosbuvir have recently been developed for the treatment of HCV in combination with pegylated interferon plus ribavirin. All the drugs are approved for the treatment of genotype 1 infections, with the exception of sofosbuvir, which is approved for the treatment of chronic HCV infection of multiple genotypes. Daclatasvir, another direct-acting antiviral drug, has not yet been marketed in Canada.
A review of international evidence-based guidelines for the treatment of patients with genotype 1 chronic HCV infection will help to inform treatment decisions for these patients.
A limited literature search was conducted of key resources, and titles and abstracts of the retrieved publications were reviewed. Full-text publications were evaluated for final article selection according to predetermined selection criteria (population, intervention, comparator, outcomes, and study designs).
The literature search identified 155 citations, with 4 additional guidelines identified from other sources. After screening the abstracts, 5 guidelines met the criteria for inclusion in this review.
International guidelines for the treatment of patients with genotype 1 chronic HCV infection recommend a combination of:
- simeprevir or sofosbuvir with pegylated interferon plus ribavirin
- simeprevir or sofosbuvir with ribavirin (for patients not eligible to use interferon)*
- simeprevir with sofosbuvir*
- aclatasvir with pegylated interferon plus ribavirin or with sofosbuvir. *
These recommendations will likely change as newer agents become available.
*These treatments are currently not approved in Canada.