Hepatitis C eradication: A unfulfilled promise
Joint Event on World Gastroenterological & World Congress on Gastroenterology and Endoscopy
October 30-31, 2017 | Toronto, Canada
David H Van Thiel
Rush University, USA
Keynote : J Gastroenterol Dig Dis
The development of direct acting antiviral agents (DAA) for the treatment of HCV provides an opportunity for eradication. Current DAA agents consist of 2 or 3 inhibitors of the HCV replication chain and high barriers to resistance. SVRs are achieved in 97 to 100% of patients treated in trials of patients with advanced disease and suggest that HCV can be eliminated. Eradication of in individuals with advanced disease is unlikely to result in elimination as these individuals are very ill and unlikely to infect others. If the promise is to be achieved, physicians, insurers and government agencies must make these agents available to a much wider group to include those with those with minimal or no liver disease. This latter group includes individuals with diabetes mellitus, membrano proliferative glomerulonephritis, thyroiditis, polyarthritis, cryoglobuinemia and other manifestations of HCV infection. Screening for hepatitis C is inadequate in these individuals as they are not aware that they are infected; have no manifestations of liver disease bringing them to the attention of their physicians and HCV antibody detection. Individuals with these diseases are the major source of continued infection and unknowingly are vectors of the disease. For HCV to be eliminated, current approaches have to change and mirror those for tuberculosis. The identification of a positive PPD is sufficient to initiate therapy. This approach to HCV has been ignored because the agents previously used were difficult for patients; were associated with a variety of adverse events; and required injections and prolonged therapy. Current DAA agents are taken orally; have minimal side effects and require a treatment for 8-12 weeks. With these changes, a much broader approach to treatment of HCV is available and can eradicate the disease at its origin rather than at its end-stage.
David H Van Thiel is a Professor of Medicine, a former president of the American Association for the study of liver disease and is widely recognized as one of the founding fathers if not, the father of medical liver transplantation worldwide. He attended Pomona College in Clairemont, California, and then entered Medical School at the University of California at Los Angeles graduating with honors in 1967. He has served as the chief of gastroenterology/hepatology at the University of Pittsburgh, Director of Hepatology at Loyola University Chicago, and Rush University, Chicago. He is currently in private practice of gastroenterology and hepatology with an emphasis on hepatology, which accounts for 80%-85% of his practice.