**Author details**

as it only required 12 weeks of therapy [94]. Current guidelines put in place by the AASLD-ISDA recommend treatment of genotype 1 infection with combination SOF and SIM. For genotype 2 or 3, SOF or RBV alone is recommended [47]. These recommendations are likely subject to change given approval of LED as well as favorable results of a trial looking at ritonavir-boosted paritaprevir, coformulated with ombitasvir, plus dasabuvir [95]. The treatment of post-LT patients with more advanced cirrhosis (Child-Pugh B or C) continues to require further study; however, preliminary results reveal that even in this highly difficult-totreat group, an SVR of 81% could be achieved [94]. Other regimens continue to be under

It is anticipated that all-oral DAA regimens will be both highly effective as well as highly tolerated in the liver transplant setting. Continued research evaluating safety profiles of these medications should be done, but in the meantime, given the amount of evidence currently available and in accordance with current guidelines, the initiation of a sofosbuvir-based

As alluded to in the sections above, DAA research is producing large quantities of favorable data, particularly in genotypes prevalent in Europe and the United States. Numerous clinical trials have been completed. More trials are ongoing or are recruiting. Naturally, head-to-head trials are needed to differentiate between many of the already known successful regimens, but few will agree to this in the short term. Future research should aim to improve the currently available classes of HCV drugs with the goal of limiting significant side effects. Specifically, we hope that all newly developed NS3-4A protease inhibitors, nucleoside/nucleotide ana‐ logues, nonnucleoside inhibitors of HCV NS5B, and NS5A inhibitors share a similar highpotency, pan-genotypic antiviral activity, and high barrier to resistance. In the distant future,

perhaps DAAs will have lost their utility as research on vaccination continues [96].

Therapy for HCV has seemed to exponentially grow over the past 4 years. Because of DAAs, IFN-free as well as all-oral regimens are being used to treat HCV. In addition to this, ribavirinfree regimens are also available. Thus far, these highly effective therapies have proven to provide fewer side effects and achieve better results, all the while in less time. Hope for cure and eradication remains paramount and is now achievable. With appropriate allocation of resources, physician training, and available treatment, the cure of HCV is possible. Doing so will drastically decrease overall health care costs, improve quality of life, and decrease the

regimen in this patient population is highly recommended.

investigation at this time.

70 Recent Advances in Liver Diseases and Surgery

**7. Future therapy**

**8. Summary**

number of liver transplants needed.

Eric Hilgenfeldt1\* and Roberto J. Firpi2

\*Address all correspondence to: eric.hilgenfeldt@medicine.ufl.edu

1 Department of Internal Medicine, University of Florida College of Medicine, Gainesville, FL, USA

2 Department of Gastroenterology, Hepatology and Nutrition, University of Florida College of Medicine, Gainesville, FL, USA
