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Ideas and Opinions |16 September 2014

Treatment of Hepatitis C Virus Infection: Is It Time for the Internist to Take the Reins?

Shyam Kottilil, MD, PhD; Mary Wright, MD, MPH; Michael A. Polis, MD, MPH; Henry Masur, MD

Article, Author, and Disclosure Information
Author, Article, and Disclosure Information
  • From the Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, and National Institutes of Health Clinical Center, National Institutes of Health, Bethesda, Maryland.

    Financial Support: By the intramural program of the National Institutes of Health Clinical Center and National Institute of Allergy and Infectious Diseases.

    Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M14-0741.

    Corresponding Author: Henry Masur, MD, Critical Care Medicine Department, National Institutes of Health Clinical Center, 10 Center Drive, Room 2C145, Bethesda, MD 20892.

    Current Author Addresses: Dr. Kottilil: Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, 9000 Rockville Pike, Building 10/11N204, Bethesda, MD 20892.

    Dr. Wright: Division of Clinical Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, 8 West Drive, MSC 2665, Building 15B1, Room 0204, Bethesda, MD 20892.

    Dr. Polis: Division of Clinical Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Room 1118, 6700B Rockledge Drive, Bethesda, MD 20892.

    Dr. Masur: Critical Care Medicine Department, National Institutes of Health Clinical Center, 10 Center Drive, Room 2C145, Bethesda, MD 20892.

    Author Contributions: Conception and design: S. Kottilil, M.A. Polis, H. Masur.

    Analysis and interpretation of the data: S. Kottilil, M.A. Polis, H. Masur.

    Drafting of the article: S. Kottilil, M. Wright, M.A. Polis, H. Masur.

    Critical revision of the article for important intellectual content: S. Kottilil, M. Wright, M.A. Polis, H. Masur.

    Final approval of the article: S. Kottilil, M.A. Polis, H. Masur.

    Provision of study materials or patients: S. Kottilil.

    Statistical expertise: S. Kottilil.

    Obtaining of funding: S. Kottilil, H. Masur.

    Administrative, technical, or logistic support: S. Kottilil, H. Masur.

    Collection and assembly of data: S. Kottilil.

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FULL TEXT
For the first time since the identification of hepatitis C virus (HCV) in 1988, communitywide eradication of HCV infection seems possible. With the U.S. Food and Drug Administration's approval in late 2013 of simeprevir and sofosbuvir, 2 direct-acting oral anti-HCV drugs, the time has come to launch major initiatives to reduce the effect of this infection on individuals and on our communities. Who should lead the charge to initiate and manage treatment: subspecialists, internists, or both?
Globally, 230 million persons are infected with HCV, including 2.7 to 3.9 million persons in the United States (1, 2). Spontaneous resolution occurs in only 20% of HCV-infected individuals, and many chronically infected persons progress to cirrhosis (20% over 25 years) and develop hepatocellular carcinoma (20% of cirrhotic patients). Over the past 2 decades, HCV infection was treated first with parenteral interferon-α alone, then with pegylated interferon-α plus oral ribavirin, and more recently with oral boceprevir or telaprevir added to pegylated interferon plus ribavirin. Although each successive regimen incrementally reduced long-term complications of HCV infection, the regimens were lengthy (24 to 48 weeks), were only modestly effective, and were poorly tolerated (often because of depression and anemia and leukopenia). Thus, fewer than 10% of eligible patients have received treatment (3, 4).
In addition to simeprevir and sofosbuvir, many direct-acting oral anti-HCV drugs are in late development stages. Direct-acting regimens without interferon and ribavirin, administered for only 6 to 12 weeks, have yielded response rates greater than 90% with excellent tolerability and safety...
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Kottilil S, Wright M, Polis MA, Masur H. Treatment of Hepatitis C Virus Infection: Is It Time for the Internist to Take the Reins?. Ann Intern Med. 2014;161:443–444. doi: 10.7326/M14-0741

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Published: Ann Intern Med. 2014;161(6):443-444.

DOI: 10.7326/M14-0741

15 Citations

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