Nature INSIGHT Review Article: The Challenges Of Hepatitis C

Raffaele De Francesco and Giovanni Migliaccio argue that the chronic nature of HCV infection means that the disease, which is estimated to affect 170 million people worldwide, will continue to be a global health threat for years to come.

The biggest concern in the field of HCV treatment is of the virus becoming drug-resistant, which it can do quickly, owing to the low fidelity of HCV replication. The authors describe the problems faced by a lack of small-animal models for HCV and, until recently, an inability to infect cultured cells with the virus. Looking to the future, De Francesco and Migliaccio argue that RNA interference, nucleic-acid-based antiviral agents and inhibitors of important molecules should all be investigated as the basis of new treatments.

Several new drugs are close to the clinical trial stage, and it is vital to their success that they not only combat HCV but prevent the emergence of new mutant strains of the disease.

Elsewhere in the Insight, Michael Houghton and Sergio Abrignani investigate the prospects for a vaccine that have recently emerged, following the discovery of natural immunity to HCV and the efficacy of vaccine treatment in chimpanzee models. This knowledge, coupled with studies showing that some individuals can clear the virus while others need antiviral treatment, could help to improve the outcome of work towards vaccines. David Bowen also looks at the immunological response to the virus, and in particular, the role of T cells.

The Insight also features reviews on how HCV combats immune responses, new systems for culturing the virus, past and future directions for antiviral therapies, and the need for liver transplantation in HCV patients.

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