Hepatitis C virus management: potential impact of nanotechnology
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REVIEW
Open Access
Hepatitis C virus management: potential impact of nanotechnology Mostafa H. Elberry1,2, Noureldien H. E. Darwish1,3 and Shaker A. Mousa1*
Abstract Around 170–200 million individuals have hepatitis C virus (HCV), which represents ~ 3% of the world population, including ~ 3–5 million people in the USA. According to the WHO regional office in the Middle East, Egypt has the highest prevalence in the world, with 7% prevalence in adults. There had been no effective vaccine for HCV; a combination of PEG-Interferon and ribavirin for at least 48 weeks was the standard therapy, but it failed in more than 40% of the patients and has a high cost and serious side effects. The recent introduction of direct-acting antivirals (DAA) resulted in major advances toward the cure of HCV. However, relapse and reduced antiviral efficacy in fibrotic, cirrhotic HCV patients in addition to some undesired effects restrain the full potential of these combinations. There is a need for new approaches for the combinations of different DAA and their targeted delivery using novel nanotechnology approaches. In this review, the role of nanoparticles as a carrier for HCV vaccines, anti-HCV combinations, and their targeted delivery are discussed. Keywords: Hepatitis C virus, Drug delivery system, HCV genotypes, Nanoparticles
Background From the time of its discovery in 1989, hepatitis C virus (HCV) has been known globally as the primary reason for chronic liver disease [1]. HCV persistent infection is accompanied by liver cirrhosis, hepatocellular carcinoma, end stage liver disease and finally death [2]. Up to 3% of the world’s population, about 200 million individuals, is estimated to have HCV infection [3]. Among all the people infected with HCV, there are at least six genotypes [4] as a result of the high error rate of RNA-dependent RNA polymerases during HCV replication [5]. Genotype 1 (G1) is the most predominant in the world (~83.4 million people) followed by G3 (~54.3 million), then G2, G4 and G6 (~15.6 million), and G5 (~1.4 million) [6]. HCV transmission mainly occurs through contaminated blood and blood products transfusion, injection drug use, hemodialysis and organ transplantation; however unprotected sexual intercourse and birth from an infected mother have also been documented as other modes of transmission [7, 8].
* Correspondence: [email protected] 1 The Pharmaceutical Research Institute, Albany College of Pharmacy and Health Sciences, Rensselaer, NY 12144, USA Full list of author information is available at the end of the article
Until 2011, the standard treatment was a blend of subcutaneous pegylated interferon (PEG-IFN) in addition to oral ribavirin (RBV), administered for 24 or 48 weeks [9]. The cure rate depends on the viral genotypes. IFN-alpha and RBV failed to eliminate HCV in 50–60% of patients infected with G1 and G4 and about 20% of patients with G2 and G3 [10]. Development of a new, specifically targeted antiviral therapy for HCV was a must to overcome the shortcomings of PEG-IFN/RBV therapy. Th
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