EDITORIAL
Pr Stanislas Pol (Necker Hospital - Paris) & Pr François Raffi (Nantes)
Spectacular advances in HCV treatment has been achieved in less than a decade – 2011-2018 - and today pan-genotypic single tablet short-duration regimens with good tolerability can achieve success, i.e. complete and definitive cure, in almost all situations. Although universal treatment is generally recommended, there remain obstacles in achieving global control of the HCV epidemic, including cost issues, difficulties in policy implementations, in HCV testing, in access to care or in optimal treatment for special populations: a large number of patients are undiagnosed or not treated for HCV. Thus, HCV cure remains worldwide a reality for few and a dream for many.
HCV cure does not imply immune protection and reinfection remains an important challenge in population with high-risk behaviours, needing specific counselling and regular testing. It can be anticipated that, due to optimal efficacy and coverage of the various HCV genotypes by the current antiviral armentarium, the HCV pipeline is going to rapidly shrink, as illustrated by the recent halt in development of many new compounds (namely, two triple combinations that were presented at the last AASLD in November 2017 with encouraging results). Still, a better assessment of long-term clinical outcomes and monitoring of HCV infected patients being cured is warranted, especially in those with moderate or advanced fibrosis. In summary, offering the best care and cure for HCV infection will continue to be necessary in the coming years and this is particularly true in low or intermediate income countries where the prevalence of HCV is the highest (around 14% in Mongolia or Egypt where less than 1% of the infected population has been treated).
The objective of HCV-trials.com website was to guide clinicians in the « jungle » of new HCV drugs and help them with the different and numerous trials published within a short period (156 between 2013 and early 2018), by providing comprehensive slide kits accurately reflecting and summarizing the efficacy, safety and virologic data.
Following HCV saga, big academic and pharmaceutical efforts are now engaged towards finding new drugs for HBV control and ultimately cure, and to improve or restore the various components of NASH.
The Scientific Committee of the website has therefore decided to create 2 new slide kits sections:
- Clinical Outcome after SVR, where published cohorts and studies will be summarized;
- NASH, with, to start, a summary of current knowledge, and as soon as results come out, presentations of clinical studies of candidate drugs in phase 2B and 3; HCV cure will be the rule but backward (cascade from screening to care) and forward some limitations are persisting: more than one third of SVR patients experience weight gain and are exposed to a liver risk related to comorbidities.
We hope that HCV-trials.com website will continue to efficiently illustrate and provide useful educational tools on this new story.
Do not hesitate to communicate on this tool with your colleagues, and your trainees.