November 10, 2015
Prompted by (yet more) spectacular HCV study results, I posted the following questions on Twitter:
-- Paul Sax (@PaulSaxMD) November 18, 2015
To which I got this reply from one of our very energetic second-year ID fellows:
-- Philip Lederer (@philiplederer) November 18, 2015
OK, OK, I know what you're wondering -- don't you two have anything better to do than fool around with a financially struggling social media platform?
Sure we do -- but after years and years of "not getting" Twitter, I now (thanks to Phil) see some of the benefits, namely the rapid exchange of information and ideas, in a particularly efficient form.
But back to the topic at hand, which is the HCV regimen used in these latest studies published in the New England Journal of Medicine. All include the pan-genotypic NS5A inhibitor velpatasvir with the already-approved nucleotide sofosbuvir, given as a single pill once daily.
The results really make you wonder what more we can do to make HCV treatment better. We are definitely at the flat part of the response curve, and fortunately it has plateaued way up there, with 95% or higher cure rates for all but the sickest HCV patients, along with exceedingly rare adverse effects.
So are there remaining issues? Yes, sort of -- but none of them is as pressing as the obligatory elephants in the room, which are cost and access. Let's start with Phil's proposed challenges, plus a few others:
So what about the second part of that tweet?
And what will HCV researchers do now?
I don't know -- become experts in implementation research? Switch to steatohepatitis? Study how to cure hepatitis B? Learn how to juggle clubs?
Paul Sax is Clinical Director of Infectious Diseases at Brigham and Women's Hospital. His blog HIV and ID Observations is part of Journal Watch, where he is Editor-in-Chief of Journal Watch AIDS Clinical Care.
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