Published online by Cambridge University Press: 19 January 2018
AS GLOBAL AS GLOBAL GETS
Hepatitis C virus (HCV) and the diseases it triggers, hepatitis C and its sequelae cirrhosis (a chronic degenerative disease marked by inflammation and scarring of the liver) and cancer of the liver, represent a truly global public health issue. As a drama built of both innovative science and intense corporate competition, the race to find a cure for this viral infection, which features many failures and financial gambles on unproven drug candidates, must rank as one of the most controversial in the recent past. Yet the story is still not over. With the availability of novel curative therapies, sometimes at high prices, what is at stake is no longer a cure but instead a means of getting that cure to those who need it. It is a present-day story at the interface of scientific discovery and big business that portends similar struggles likely to ensue as further advances are made in alleviating human disease burden.
Although HCV has not attracted the same public attention as HIV and tuberculosis, the World Health Organization (WHO) estimates that two percent of the world's population, some 130–150 million people, have chronic HCV infections, and roughly 700,000 of those affected die each year from the two most common life-threatening diseases associated with long-term infection with the virus: liver failure and liver cancer. In the USA, the Centers for Disease Control and Prevention (CDC) estimates that there are between 2.7 and 3.9 million cases of chronic HCV. The fact that anywhere between 2.7 and 3.9 million people are estimated to have the condition is of particular concern because many of those infected do not know they are: new infections are often asymptomatic, or if associated with symptoms they are so mild that medical care is not sought. Only 20–30 percent of newly infected individuals experience symptoms such as “fatigue, abdominal pain, poor appetite or jaundice” sufficient to prompt medical attention. This means that while only 2,194 cases of new, acute HCV infection were reported to the CDC in 2014, it is probable that upward of 30,500 individuals were actually infected. Given that an acute infection becomes chronic 75–85 percent of the time, the number of cases left unreported is worrying because it is the chronic infections that make HCV the leading cause of cirrhosis and liver cancer.