HCV Test & Treat

Written by Jules Levin of NATAP

'HCV Test & Treat' is different than HIV test & treat which clearly has limitations but HCV test & treat does not suffer from the limitations that HIV test & treat does. To begin with HCV therapy is short-term, it will be as little as 24 weeks or in the future perhaps 16 weeks for the hard to treat genotype 1 patients...cure rates will be 100% in the future...and HCV is curable as alluded to above so there will not be lifetime therapy as in HIV......the cost of HCV therapy is actually much less than the cost of HIV therapy which is lifetime....HAART costs $15,000 per year for a patient but 10 years of HAART costs $150,000 and it is still considered highly cost effective. With the aging of the HCV+ patient population rates of liver cancer (HCC) and decompensated or very advanced liver disease is causing increased rates of expensive sickness & hospitalizations & increasing death rates, all of which will continue on the uptrend unless we implement HCV test & care(or treat) in the future. ItÕs widely recognized that 80% of HCV-infected in the USA are untested & undiagnosed, and itÕs estimated that at least 5 million people in the USA have HCV but the prevalence I estimate might be higher. The goal of large-scale HCV testing is firstly to get patients diagnosed and into care, whether or not they should be treated is another question because 20 new drugs are in development now, the average cure or SVR (Sustained Viral Response) rates are 75-80% in the clinical studies for the 2 new HCV protease inhibitors approved this year boceprevir & telaprevir in combination with pegintereron+ribavirin. It is hoped and from proof-of-concept studies that we will be able to eventually eliminate peginterferon and ribavirin eventually from therapy, which we expect will consist of several, 2 or 3 or 4, orally administered HCV antiviral drugs, like in HIV, so this will overcome one of the key barriers to taking therapy for patients, having to take peginterferon. Before we will be able to eliminate both pegING & ribavirin, studies are now looking at therapy with ribavirin but without peginterferon, so we hope & expect that these new regimens without pegINF but including ribavirin will be successful. But ultimately not too far in the future, within 5 years I think, it is expected that for many if not for all patients, particularly genotype 1, but also for other genotypes, 100% cure or SVR rates will be the achievable for all treatable patients. So if we can start now HCV testing projects and put patients into care they can be treated at the appropriate time as deemed by their care provider, whether that is now, perhaps because they have advanced disease and shouldn't wait for more effective therapy, or at some later time when therapy is more effective. Jules Levin

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