Current treatments for hepatitis C virus (HCV) are quite effective, with a cure rate inching toward 100 percent. However, there are certain subpopulations that fail direct-acting antiviral (DAA) therapy and others who have yet to be diagnosed — up to 50 percent of people with the virus, according to some estimates.

The challenges of treating patients who fail or are at risk for failing DAA therapy will be addressed during Sunday’s AASLD State-of-the-Art Lecture Hepatitis C: If One Pill Cures All, Why Aren’t All Patients Cured? Michael Fried, MD, FAASLD, professor of medicine and director of hepatology at the University of North Carolina at Chapel Hill, will present the one-hour lecture.

“We are talking about the last 5 to 7 percent of patients, at most, who are relapsing after treatment stops. In general, when you look at all the regimens that we have, they are quite effective across the board. But there are probably ways to optimize treatment for certain patient populations to maximize those responses even further,” said Dr. Fried, who will discuss current treatment regimens, new HCV therapies that will soon be available and approaches to treating the most difficult cases where current therapies fail.

The varied nature of hepatitis C means that certain patient populations — notably those with resistance-associated variants, prior treatment experience and the presence of decompensated cirrhosis — have a higher chance of relapse after therapy.

“Patients who have decompensated cirrhosis, for example, generally have lower response rates to these medicines than patients with compensated cirrhosis, and certainly lower than those who don’t have cirrhosis at all,” Dr. Fried said. “However, there are ways you can improve the likelihood of response in that population.”

Dr. Fried’s research at the University of North Carolina is focused on antiviral agents for chronic hepatitis B and hepatitis C. He is co-principal investigator of the HCV-TARGET international network studying HCV therapies used in clinical practice, and co-principal investigator of PRIORITIZE, a pragmatic clinical trial of HCV therapeutics.

During Sunday’s presentation, Dr. Fried will highlight emerging research that addresses how to manage challenging HCV patients, including new therapies in the works.

“Treatment can be optimized by either changing the duration of therapy or adding ribavirin, or sometimes doing both. Understanding those issues can further maximize response to treatment,” he said.

Selecting the appropriate treatment to optimize sustained virologic response across broad patient populations, including the treatment-naïve and those who have failed prior DAA therapy, is critical, he said. Newer regimens, including options that may be released by the end of the summer, will offer additional treatment modalities for those few patients who fail current DAA therapy.

“We should still have healthy respect for how we are treating hepatitis C. We are not quite at one-size-fits-all,” Dr. Fried said. “Using resources like the AASLD/Infectious Diseases Society of America treatment recommendations [hcvguidelines.org], can certainly help us choose the right regimens and evaluate patients appropriately to optimize their success.”

Please refer to the DDW Mobile App or the Program section in Sunday’s DDW Daily News for additional details on this and other DDW^® events.