Hepatitis C: The End of the Beginning and Possibly the Beginning of the End
Authors: Harvey J. Alter, T. Jake Liang
Journal: Annals of Internal Medicine (2012)

Editorials21 February 2012Hepatitis C: The End of the Beginning and Possibly the Beginning of the EndHarvey J. Alter, MD and T. Jake Liang, MDHarvey J. Alter, MDFrom National Institutes of Health, Bethesda, MD 20892. and T. Jake Liang, MDFrom National Institutes of Health, Bethesda, MD 20892.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-156-4-201202210-00014 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Not since the initial cloning of the hepatitis C virus (HCV) in 1989 and the subsequent development of assays to detect silent carriers (1) and protect the blood supply (2) have data on this infection been so exciting. Before 1990, HCV was an incurable, prevalent chronic infection and had only a 10% cure rate with early interferon monotherapy. Sustained virologic response (SVR) rates—which are tantamount to cure—increased to approximately 25% by adding ribavirin and 45% when pegylated interferon was combined with ribavirin (3). In 2011, the first HCV-specific protease inhibitors were licensed after clinical trials showed that these drugs, combined ...References1. Choo QL, Kuo G, Weiner AJ, Overby LR, Bradley DW, Houghton M. Isolation of a cDNA clone derived from a blood-borne non-A, non-B viral hepatitis genome. Science. 1989;244:359-62. [PMID: 2523562] CrossrefMedlineGoogle Scholar2. Alter HJ, Purcell RH, Shih JW, Melpolder JC, Houghton M, Choo QL, et al. Detection of antibody to hepatitis C virus in prospectively followed transfusion recipients with acute and chronic non-A, non-B hepatitis. N Engl J Med. 1989;321:1494-500. [PMID: 2509915] CrossrefMedlineGoogle Scholar3. Hoofnagle JH, Seeff LB. Peginterferon and ribavirin for chronic hepatitis C. N Engl J Med. 2006;355:2444-51. [PMID: 17151366] CrossrefMedlineGoogle Scholar4. Poordad F, McCone J, Bacon BR, Bruno S, Manns MP, Sulkowski MS, et al; SPRINT-2 Investigators. Boceprevir for untreated chronic HCV genotype 1 infection. N Engl J Med. 2011;364:1195-206. [PMID: 21449783] CrossrefMedlineGoogle Scholar5. Zeuzem S, Andreone P, Pol S, Lawitz E, Diago M, Roberts S, et al; REALIZE Study Team. Telaprevir for retreatment of HCV infection. N Engl J Med. 2011;364:2417-28. [PMID: 21696308] CrossrefMedlineGoogle Scholar6. Zeuzem S, Buggisch P, Agarwal K, Marcellin P, Sereni D, Klinker H, et al. The protease inhibitor GS-9256 and non-nucleoside polymerase inhibitor tegobuvir alone, with RBV or peginterferon plus RBV in hepatitis C. Hepatology. 2011;:. [PMID: 22006408] MedlineGoogle Scholar7. Chayama K, Takahashi S, Toyota J, Karino Y, Ikeda K, Ishikawa H, et al. Dual therapy with the NS5A inhibitor BMS-790052 and the NS3 protease inhibitor BMS-650032 in HCV genotype 1b-infected null responders. Hepatology. 2011;:. [PMID: 21987462] MedlineGoogle Scholar8. Pawlotsky JM, Chevaliez S, McHutchison JG. The hepatitis C virus life cycle as a target for new antiviral therapies. Gastroenterology. 2007;132:1979-98. [PMID: 17484890] CrossrefMedlineGoogle Scholar9. Mitchell AE, Colvin HM, Palmer Beasley R. Institute of Medicine recommendations for the prevention and control of hepatitis B and C. Hepatology. 2010;51:729-33. [PMID: 20186842] CrossrefMedlineGoogle Scholar10. Ghany MG, Nelson DR, Strader DB, Thomas DL, Seeff LB; American Association for Study of Liver Diseases. An update on treatment of genotype 1 chronic hepatitis C virus infection: 2011 practice guideline by the American Association for the Study of Liver Diseases. Hepatology. 2011;54:1433-44. [PMID: 21898493] CrossrefMedlineGoogle Scholar11. Liu S, Cipriano LE, Holodniy M, Owens DK, Goldhaber-Fiebert JD. New protease inhibitors for the treatment of chronic hepatitis C. A cost-effectiveness analysis. Ann Intern Med. 2012;156:279-90. LinkGoogle Scholar12. Ly KN, Xing J, Klevens RM, Jiles RB, Ward JW, Holmberg SD. The increasing burden of mortality from viral hepatitis in the United States between 1999 and 2007. Ann Intern Med. 2012;156:271-8. LinkGoogle Scholar13. Davis GL, Alter MJ, El-Serag H, Poynard T, Jennings LW. Aging of hepatitis C virus (HCV)-infected persons in the United States: a multiple cohort model of HCV prevalence and disease progression. Gastroenterology. 2010;138:513-21, 521.e1-6. [PMID: 19861128] CrossrefMedlineGoogle Scholar14. Culver DH, Alter MJ, Mullan RJ, Margolis HS. Evaluation of the effectiveness of targeted lookback for HCV infection in the United States-interim results. Transfusion. 2000;40:1176-81. [PMID: 11061852] CrossrefMedlineGoogle Scholar15. Rein DB, Smith BD, Wittenborn JS, Lesesne SB, Wagner LD, Roblin DW, et al. The cost-effectiveness of birth-cohort screening for hepatitis C antibody in U.S. primary care settings. Ann Intern Med. 2012;156:263-70. LinkGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From National Institutes of Health, Bethesda, MD 20892.Disclosures: None disclosed. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M12-0093.Corresponding Author: Harvey J. Alter, MD, Department of Transfusion Medicine, National Institutes of Health, Building 10/Room 1C-711, 10 Center Drive, Bethesda, MD 20892; e-mail, [email protected]cc.nih.gov.Current Author Addresses: Dr. Alter: Department of Transfusion Medicine, National Institutes of Health, Building 10/Room 1C-711, 10 Center Drive, Bethesda, MD 20892.Dr. Liang: Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, 10 Center Drive, Room 9B16, Bethesda, MD 20892. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoThe Cost-Effectiveness of Birth-Cohort Screening for Hepatitis C Antibody in U.S. Primary Care Settings David B. Rein , Bryce D. Smith , John S. Wittenborn , Sarah B. Lesesne , Laura D. Wagner , Douglas W. Roblin , Nita Patel , John W. Ward , and Cindy M. Weinbaum The Increasing Burden of Mortality From Viral Hepatitis in the United States Between 1999 and 2007 Kathleen N. Ly , Jian Xing , R. Monina Klevens , Ruth B. Jiles , John W. Ward , and Scott D. Holmberg New Protease Inhibitors for the Treatment of Chronic Hepatitis C Shan Liu , Lauren E. Cipriano , Mark Holodniy , Douglas K. Owens , and Jeremy D. 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