Volume 132, Issue 1, Pages 5-6 (January 2007) Combination Therapy With Telaprevir and Pegylated Interferon Suppresses Both Wild- Type and Resistant Hepatitis C Virus  Les Lang  Gastroenterology  Volume 132, Issue 1, Pages 5-6 (January 2007) DOI: 10.1053/j.gastro.2006.12.011 Copyright © 2007 AGA Institute Terms and Conditions

Figure 1 Telaprevir + Peg-IFN prevent replication of wild-type and resistant virus. After initial infection of a hepatocyte, HCV begins to replicate and at some frequency the viral polymerase will incorporate the wrong nucleotide in the RNA, generating viral variants. When the mutation occurs at a site that is associated with drug resistance, shown here in red, the variant released will be resistant to that drug. With high levels of replication in an untreated patient, point mutations at each position in the genome arise at least once every day, so resistant virus is constantly being generated. Therefore, most drug-resistant variants likely pre-exist within the viral quasispecies and are selected from within this heterogeneous environment upon application of selective drug pressure. Treatment with a specifically targeted antiviral therapy for HCV (STAT-C), telaprevir, profoundly inhibits replication of wild-type virus and resistant virus is relatively more fit and can be selected in the presence of the drug. However, with the addition of Peg-IFN to the telaprevir treatment, replication of both wild-type and resistant replication is inhibited. Gastroenterology 2007 132, 5-6DOI: (10.1053/j.gastro.2006.12.011) Copyright © 2007 AGA Institute Terms and Conditions