Michael S. Saag, MD

As we’ve talked about in many editorials over the last several years in HCV Next, the hepatitis C treatment revolution followed in the wake of the pioneering work done in HIV, especially with regard to drug discovery and development.

In 1989, I was privileged to be part of a relatively small multicenter group that submitted a paper to The New England Journal of Medicine on non-A, non-B hepatitis. The paper focused on the use of interferon and, in the final stages of preparation of our study for publication, serum testing showed that almost all the study patients had the newly described hepatitis C virus.

The trouble in engaging difficult to reach populations is, well, that they are difficult to reach.

We are witnessing history. The explosion of new drugs into the hepatitis C marketplace has been both breathtaking and transformative. But, in HCV, we have peaked. Everything that happened in HCV, happened faster and more intensively than HIV but it follows the same storyline, with one exception: Drug pricing matters in HCV.

The approval of two new regimens for treating hepatitis C comes as a very welcome development in the field. It is great news for patients and providers because both regimens offer new options for therapy.


When we think about the possibility of universal screening, we can dance around, trying to dig out baby boomers or injection drug users, we can look at different risk factors or select populations, but I’m not satisfied with that. We need to go for full blown eradication, and if we are going to do that, we must screen them and get them into treatment.

Sitting among the sessions at the International Liver Congress in Amsterdam, I had the distinct feeling that we are reaching an end to the era of revolutionary change in hepatitis C, but there remained impressive data, engaging debates and ongoing research given to us to better serve our patients. For those of us long involved in this field, we rejoice with our patients, often on a daily basis, and we intend to remain heavily engaged in addressing the remaining issues even as we heed the clarion call to immerse ourselves ever more deeply in the attempts to conquer other prevalent liver diseases.

As we continue to see the success of direct-acting antiviral therapy in treating hepatitis C virus, we must be aware of any potential complications from the underlying liver disease after successful treatment, especially hepatocellular carcinoma.

In her editorial, Nancy S. Reau, MD, FAASLD, AGAF, provides an impassioned plea for us to engage in activities that re-establish control of our profession and our practices. Her instructions are simple: Become informed; become involved. Most of us struggle daily with finding time to balance the flood of demands on our time at work and at home. Adding yet another set of activities to the mix likely feels overwhelming.

A recent report questioning the safety of direct-acting antivirals in the treatment of hepatitis C garnered much attention due to its coverage in the New York Times; enough attention that our patients who have read the Times article have begun to question these treatments, including even some who have already been cured and are needlessly concerned about the potential for late-appearing side effects.