The latest of a set of new therapies to treat hepatitis C virus (HCV) infections are so effective they could reduce the need for liver transplantation dramatically.
That’s the view of Professor Geoff McCaughan, Head of the Liver Injury and Cancer research program at the Centenary Institute, and Director of the Royal Prince Alfred Hospital’s liver transplant program. And he has put it forward in a deliberately speculative paper on the frontiers of liver transplantation released in the Journal of Hepatology, one of the world’s most important liver publications.
“In a decade or so, I think the third wave of the new HCV therapies that incorporate direct antiviral agents (DAAs) might make it possible for the supply of livers in Australia to meet the demand for transplants,” Professor McCaughan says, “particularly if we increased our levels of donation to match those of Spain or Croatia.
DAAs are drugs which stop the proliferation of viruses. Their emergence is the product of the many years of research into treatments for HIV infection. But they are now having a significant impact on many other viral diseases. And against HCV, the latest of these therapies—the third wave—have become a real game changer, says Geoff McCaughan.
The first two waves of DAA therapies demanded the concurrent use of interferon. The third does not and the difference is critical. With interferon doctors found significant drug-drug interactions leading to side effects that took a heavy toll on patients. “In potential transplant patients, they had to used very carefully,” Geoff McCaughan says.
But the third wave not only avoids this problem, but only needs to be taken for a relatively short time. What’s more, preliminary evidence suggests the new treatment can all but clear the virus from about 90 per cent of patients. This opens up the possibility, according to Professor McCaughan, of curing HCV sufferers with mild and moderate liver disease before there is any need for transplantation. And that would leave only those with severe liver disease and liver cancer needing transplants.
As third-wave DAA-based therapies are only now beginning to be trialled in potential liver transplant patients, we will only know for sure in about 18 months if this promise will be realised.