Even with the remarkable success of curative antiviral therapy, Dr. Chung, who reviewed Dr. Rosen’s article at Contagion®
’s request, agreed that lingering questions beckon for answers in the HCV research field. The risk of further liver disease progression, including development of liver cancer in patients who have been cured of the virus, is the most pressing question.
“The answer has important ramifications for the monitoring of patients after cure of the infection, since many will have significant scarring that may continue to progress,” said Dr. Chung, director of hepatology at Massachusetts General Hospital and an associate professor at Harvard Medical School.
Historically, disease elimination of all previously controlled infections, including smallpox and polio, has required vaccination. For most infections, simple and effective treatment is inadequate to result in substantial control, Dr. Rosen noted in the commentary.
“Syphilis is the best example, for which a single dose of penicillin (which literally costs pennies and that we have had since 1945) is curative in early stages,” he wrote. “Not only have we not eradicated syphilis, rates of infection have increased in many places within the United States in recent years.”
Preventing HCV with vaccination would have the most impact on at-risk populations—for example, individuals who inject drugs. For more than three decades, injectable drug use has been the primary means of transmitting HCV, but other risk factors include inadvertent exposure through medical procedures, such as dialysis.
Illnesses stemming from HCV are the top cause of death among individuals who inject drugs. In this group, the incidence of HCV is 10-fold higher than HIV infection, ranging from 60% to 90%.
Advocating for a team-oriented scientific approach, Dr. Rosen stressed that transformative advances will depend on continued support and collaboration between federal and nonfederal sources.
“Clearly,” he wrote in the commentary, “innovative research is the vital component in order to move from the DAA era to the post-elimination/endgame era of HCV, a process not aided by the public declaration that the HCV ﬁeld is dead.”
Susan Kreimer, MS, is a medical journalist with more than 2 decades of experience. Her coverage has informed consumers, physicians, nurses, and health system executives. Ms. Kreimer holds a master’s degree in journalism from Columbia University and lives in New York City.
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