The recent introduction of direct-acting antiviral agents to the armamentarium for treating patients chronically infected with hepatitis C virus (HCV) genotype 1 has improved the efficacy of antiviral treatment,1-3 but it also presents new challenges. As advanced and complex therapies evolve, ancillary staff will have to overcome a steep learning curve to ensure that patients are appropriately managed and successfully complete their treatment.
The selection of candidates for treatment is critical. The documentation of a patient's previous experience with interferon-based therapy, including dose reductions, side effects, and responses (null response, partial response, or relapse), is important in planning the treatment and estimating the chance of a response. Potential drug-drug interactions must be addressed; this may require changing or discontinuing some medications. These issues are described in other articles of this issue of Clinical Liver Disease.
This article presents practical guidelines for implementing antiviral treatment and monitoring patients throughout the course of the treatment. Triple-drug therapy is expensive and labor-intensive for both the provider and the patient. Considerable time and effort can be saved by the development of standardized protocols and flow sheets, familiarity with the drug approval process, patient education, and patient support services. Although these issues may seem mundane and require a considerable investment of time, they ultimately provide the most efficient way of administering therapy and optimizing outcomes.