Remaining HCV Issues during the DAA Era

During Digestive Disease Week, a speaker referred to hepatitis C as a "historically interesting disease," a reference to the high rates of effectiveness of direct-acting antiviral (DAA) therapy. This comment prompted Hugo Rosen, a hepatologist at the University of Colorado, to share some thoughts in Hepatology about current issues with hepatitis C. Rosen argues that we are far from eradicating hepatitis C virus (HCV), citing the need for a vaccine and syphilis as an infectious disease for which there is treatment but that has not been eradicated despite the availability of penicillin since the 1945 and its low cost. An additional challenge to HCV eradication is the high cost of DAA therapy.

Of course, HCV needs to be diagnosed before HCV treatment and prevention of transmission can even be attempted. And yet, more than half of those infected are even aware of their infection. In 2012, the Centers for Disease Control and Prevention expanded its HCV testing guidelines to include a one-time HCV test to all people born between 1945 and 1965 to address this issue. In addition, studies have estimated that there will be an increase in the number of patients experiencing HCV-related complications (e.g., cirrhosis hepatocellular carcinoma) in the next few decades as the population ages. Furthermore, given the novelty of DAA therapy, the risk of disease progression and HCC development following DAA-mediated sustained virologic response (SVR) is unclear. It is thought that ~40% of patients with decompensated cirrhosis still develop liver failure after achieving SVR.

-Sally Tran

Reference:
Rosen HR. "Hep C, Where Art Thou": What are the Remaining (Fundable) Questions in Hepatitis C Virus Research?" Hepatology. 2017;65(10):341-9. doi: 10.1002/hep.28848