It must be unusual for a single generation of docs to witness the glorious progress we have seen in the ability to control conditions that helped define a clinical epoch. Last week, the ABC Newsletter reported on two studies in the New England Journal of Medicine that described a treatment administered once daily for HCV infection with very well tolerated, all-oral drug regimens; these stand to replace some dauntingly toxic, injectable standard cocktails. They afforded apparent cure of infection in more than 90 percent of enrolled patients. The responses were independent of virus strain and other predictors of a poor response. Many giddily predict that we are seeing the coffin lid nailed down on a bug that is a leading cause for liver transplantation in this country and of end stage liver disease worldwide. Similarly, stepwise improvements since the mid-1990s in the ability to control- if not cure – HIV infection, have turned an infection associated with millions of grizzly deaths into a chronic process that under the right circumstances is held at bay with a single daily pill.
These two infections influenced not only the lives of those of us who pursued infectious diseases careers, but also dominated blood banking and transfusion medicine. In the space of a few years, we went from being “good guys,” facilitating some of the signature achievements in late 20th century medicine – think heart surgery and treatment of cancer – to “vectors” in lethal epidemics. Reactions from the blood community, after some denial, were incredibly effective. They included better approaches to donor selection, the development of spectacularly successful in vitro tests, testing algorithms with computers to manage them, and integration into our genomes of good manufacturing practices (to the benefit of a larger range of issues than these two infections). Maybe as important for the future is our acute appreciation of the vulnerability of our core products to emerging agents. I hope that we are now anticipating and preempting or managing threats instead of always reacting.
But outside of our silo, what about the larger targets for the advances in our ability to treat these infections – the more than 150 million folks chronically infected with HCV and the 35 million with HIV infection, most living in the developing world? They lack access to these “miracles” that cost many tens of thousands of dollars. As is often true in medicine, the science was the easy part and the hard part will be mustering the political and economic will to provide access to the masses that currently have none.
Louis Katz, MD, Executive Vice President, Scientific, Medical, Technical, Quality, and Regulatory; LKatz@americasblood.org