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Hepatology-infectious disease collaboration brings further breakthrough
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Late in the month of October and early in the month of November, the Infectious Diseases Society of America and the American Association for the Study of Liver Diseases hold their national meetings. Over the last several years, these meetings have become the preeminent opportunity for investigators within the respective disciplines of ID and hepatology to come together and review the most current information on the treatment of hepatitis viruses and other related conditions in highly rigorous and interactive scientific forums.
Historically, the two disciplines of the study of hepatitis viruses have existed relatively separately and were not naturally collaborative. However, with the advent of direct-acting agents for hepatitis C, the two scientific communities have engaged in a way that is quite dynamic and exciting.
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The IDSA had a lot of experience in the treatment of other virologic diseases including herpes viruses, HIV and respiratory viruses. AASLD members had been mostly engaged, appropriately, with the study of viruses that cause liver disease, most notably hepatitis B and hepatitis C.
With this new focus on hepatitis C, the societies came together in the development of joint guidelines, which are recognized now as preeminent guidelines around the world (they can be found at www.hcvguidelines.org). Both societies should be lauded for this modern approach to publishing guidelines in real time and placing them on the Web, where the rapid changes in treatment can be reflected almost immediately as new drugs are approved.
The remarkably collaborative nature of this joint venture and the success of the leadership of both societies in embracing technology to better patient treatment is a paradigm that other diseases and disciplines should follow. While we are all proud of this accomplishment, it is important that we build on it for similar overlapping scientific interests, including the study of hepatitis B and other gastrointestinal and liver pathogens.
Further proof of success emerging from cooperation between ID and hepatology comes in an area that was not thought possible prior to the DAA revolution — namely, the ability to transplant an HCV-positive kidney (and ultimately a nonfibrotic liver) into an HCV-negative recipient. Like all major advances in science, the impact of DAAs ripples into realms previously thought immutable and results in breakthroughs that emerge as quantum leaps beyond what we had ever imagined.
Currently, nearly 100,000 patients need kidney transplants and are on transplant waiting lists because we do not have sufficient numbers of organs available. Yet, as many as 500 potential kidney donors are rejected each year solely based on the fact they are infected with HCV.
At the University of Pennsylvania, HCV-positive kidney donor organs are being transplanted into HCV-negative recipients. In this particular case, the focus is on kidney transplants with the recipient receiving Zepatier (grazoprevir/elbasvir, Merck) soon after transplantation to prevent the recipient from being infected with HCV or, if transiently infected, to clear the infection within the first 3 months post-transplant.
Based on all available evidence, this approach should be successful, and when proven to be effective, it will revolutionize how HCV-positive kidneys and, ultimately in my opinion, liver transplants, will proceed into the future. This is great news for those people waiting for organ donation.
In countries such as South Africa, where HIV has infected a large number of people in the population, those HIV-positive patients who develop renal failure often are unable to survive due to lack of dialysis capacity in the country.
Transplant of HIV-positive kidneys to HIV-positive recipients has saved hundreds of lives through an innovative program initiated at the University of Capetown in 2008. With this experience emerging from the infectious disease community and being embraced by the kidney and, ultimately, liver community for organ transplants into the future, we see yet another example of how collaboration between these well-respected and effective disciplines can have more power working together.
Editor’s note: A version of this editorial ran in HCV Next.
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Michael S. Saag, MD, is a professor of medicine in the division of infectious diseases and director of the Center for AIDS Research at the University of Alabama at Birmingham. He is also a Co-Chief Medical Editor of HCV Next.
Disclosure: Saag reports no relevant financial disclosures.