Challenges remain in HCV treatment despite advances

High hepatitis C treatment costs with interferon-free regimens and ethical questions about re-treatment and resource allocation remain.

The high cost of new drugs to treat the disease coupled with a lack of a prophylactic vaccine and no research on potential vaccine candidates pose barriers.
The high cost of new drugs to treat the disease coupled with a lack of a prophylactic vaccine and no research on potential vaccine candidates pose barriers.

Between 90% to 100% of patients on newer interferon-free hepatitis C treatment regimens achieve sustained virologic responses, but progress in the way the disease is treated does not necessarily equate in progress toward eradication, according to a speaker at the 25th European Congress of Clinical Microbiology and Infectious Diseases.

The high cost of new drugs to treat the disease coupled with a lack of a prophylactic vaccine and no research on potential vaccine candidates still pose challenges to effectively eliminating hepatitis C virus (HCV), said Jean Michel Pawlotsky, MD, of Henri Mondor University Hospital in Creteil, France.

He added that treating patients with HCV who are on a liver transplant list may inadvertently be putting them at greater risk for liver decompensation from cirrhosis, even if the infection is cured, since the patient is still sick but no longer has the option to undergo transplant.

Other ethical concerns include whether or not to continue to treat high-risk populations, such as intravenous drug users and men who have sex with men who become reinfected with HCV after treatment. Determining how many times to treat a particular patient or wether it is more worth wile to spend money to treat patients a first time are important areas for future study, according to Pawlotsky. 

In the meantime, clinicians can focus on educating patients about the reasons why they are being treated and also about the importance of behavioral change. 

Disclosure: Dr. Pawlosky receives research support from Gilead, serves on the advisor boards for AbbVie, Achillion, Bristol-Myers Squibb, Gilead, Janssen, and Merck; and is a speaker and teacher for AbbVie, Bristol-Myers Squibb, Gilead, Janssen, Merck, and Roche.

Reference

  1. Powlotsky JM et al. Poster #K05. Presented at: ECCMID 2015. April 25-28; Copenhagen, Denmark.
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