Curing the preponderance of patients treated for hepatitis C virus (HCV) is one of medicine’s most notable milestones, but research in this area appears to be grinding to a halt, according to a commentary
in the first 2017 issue of Hepatology.
With HCV dominating the subspecialty of hepatology for the past 25 years, some scientists believe that research should turn its attention and monetary resources to more urgent needs.
Other experts disagree with that viewpoint. “The mission for HCV eradication is far from accomplished,” Hugo R. Rosen, MD, FACP, FAASLD, head of gastroenterology and hepatology at the University of Colorado Anschutz Medical Campus in Denver, noted in the commentary.
“HCV is cured with 12 weeks of treatment or less in more than 95% of patients,” Dr. Rosen, who is also professor of medicine, immunology and microbiology, and Waterman Chair in Liver Research, told Contagion®.
“However, many patients do not even know they have HCV infection, and the majority will not have access to the newer medications.”
While unaware of their infection, they remain at risk for transmission and disease progression, including cirrhosis and liver cancer. Previous risk-based screening strategies had failed to detect more than half of all HCV infections, so a significant surge in the number of patients developing these complications is expected in the next few decades as the population ages.
In anticipation of this future epidemic, in 2012 the Centers for Disease Control and Prevention expanded screening guidelines to include a one-time HCV test to all individuals born between 1945 and 1965.
“Considering the ﬁrst step toward improving health outcomes and preventing HCV transmission is identiﬁcation of those with active infection, it seems odd to abandon research into HCV in the wake of direct-acting antivirals (DAAs),” Dr. Rosen contended in the commentary in Hepatology,
a journal of the American Association for the Study of Liver Diseases (AASLD).
For patients who have failed to respond to all-oral DAA combination therapies, hope is on the horizon. Longer retreatment with the same class of drugs or the addition of the antiviral medication ribavirin may be effective in some individuals, although with decreased antiviral efﬁcacy. Currently, resistance testing is guiding the selection of the strongest retreatment possibilities.
“DAAs have revolutionized HCV treatment, but HCV will still be an important problem,” Dr. Rosen told Contagion®.
Some unanswered questions require additional study despite funding uncertainty.
HCV is the world’s most prevalent blood-borne viral infection for which a vaccine does not exist. To eliminate HCV infection on a global scale, vaccine development needs to become a public health priority.
“Efforts should continue in this regard,” said Raymond T. Chung, MD, co-chair of the HCV Guidance Panel
, a collaboration between AASLD and the Infectious Diseases Society of America (IDSA).