Emerging strategies for pegylated interferon combination therapy

Several advances afford promise for improving the management of hepatitis C virus (HCV) infection. Current therapies primarily target the immune system; the now proven ability to culture the entire virus in vitro could ultimately facilitate the identification of therapies directly targeting viral replication. Several therapies are presently in development. Taribavirin hydrochloride (Viramidine®, Valeant Pharmaceutical International, Singapore), a ribavirin prodrug, has shown promise, although the rate of sustained virologic response with this agent has been disappointing. The next generation of antivirals will consist of protease and polymerase inhibitors, a number of which are undergoing investigation, initially as monotherapy and subsequently in combination with pegylated interferon and ribavirin. Challenges include the prevention of recurrent HCV infection in liver-transplant recipients and development of a safe and effective HCV vaccine.