Dr. Erika Kancler
In the United States, hepatitis C virus (HCV) is the most common bloodborne infection with an estimated prevalence of 3.2 million people. Although new cases of HCV are declining since the 1980s there are still approximately 17,000 new cases diagnosed each year.
There are multiple risk factors, however, in the United States the most common mode of transmission is intravenous drug use. Among infected individuals, approximately 55-85% will develop a chronic HCV infection. In this population, the risk of cirrhosis of the liver is 15-30% within 20 years and morbidity can be significant. HCV infection has become the most frequent reason for hepatologic consultation and the single leading indication for hepatic transplantation, accounting for 30% of such procedures in the United States.
Until late 2013, the treatment of choice for chronic HCV was pegylated interferon-α plus ribavirin, which achieved a cure rate of 54%-63%. Recently, novel antiviral drugs that specifically target HCV have provided better options in HCV treatment. Use of ledipasvir, an HCV NS5A replication complex inhibitor in combination with sofosbuvir, a nucleotide analog HCV NS5B polymerase inhibitor, in patients with chronic HCV, achieves high rates of sustained viral response (SVR) with just 12-weeks of treatment. A fixed-dose combination of ledipasvir-sofosbuvir (90mg/400mg), or Harvoni® was approved for treatment of chronic HCV genotypes 1,4,5, and 6. Although extremely successful, the use of this medication is inhibited by high costs, upwards of $90,000 for each 12-week treatment.
Taylor, J, Johnson C. Effect of Early Intervention with Combination Ledipasvir/Sofosbuvir (Harvoni®) in Patients with Chronic Hepatitis C Virus Infection. http://commons.lib.jmu.edu/pacapstones/15. Published October 13, 2016.