Chronic hepatitis C virus (HCV) infection affects 130-170 million people worldwide and is a major cause of end-stage liver disease and liver transplantation. For difficult to treat HCV genotype 1 infection, a new treatment era has started with the approval of NS3/4A protease inhibitors telaprevir and boceprevir. Although triple therapy with these protease inhibitors together with pegylated interferon alpha (PEG-IFN-α) and ribavirin (RBV) will significantly improve treatment, there are many patients who will not benefit from this advancement. Virologic null-responders to previous IFN-based therapy and IFN-intolerant patients need the development of more effective and IFN-free therapies.
Due to error prone replication and the high viral turnover, at least two direct acting antiviral agents (DAAs) will be required for eradication of the virus. Recently, interferon-free regimens have been explored successfully. Furthermore, first promising data about the potency of quadruple therapies with two directly acting antiviral agents, PEG-IFN-α and RBV, were presented recently.