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Editorial - If Hepatitis C therapy is so great, why isn’t everyone doing it?

Editorial
If Hepatitis C therapy is so great, why isn’t everyone doing it? 
Robert S. Brown, Jr., M.D., M.P.H

Am J Transplant. [Epub ahead of print]

First published: 04 June 2018

https://doi.org/10.1111/ajt.14960
In this issue of the journal, Drs. Axelrod et al. aimed to investigate the impact of direct-acting antiviral agents for Hepatitis C (HCV) on liver and kidney transplant outcomes and cost for HCV positive patients.

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Given that hepatitis C therapy is recommended for all patients who do not have a short life expectancy, certainly all transplant recipients should be treated for hepatitis C in the early post-transplant period prior to developing any significant liver disease in the liver allograft or progressive disease in the renal transplant recipient. Early therapy would also prevent any cases of cholestatic hepatitis. Given that hepatitis C therapy is likely cost-effective in the non-transplant setting, it would certainly be cost-effective in the transplant setting. One would hope that we are doing better with pangenotypic lower cost DAA options with fewer drug-drug interactions now available. Given the WHO's recommendation for HCV elimination by 2030, the fact that the transplant community has not been able to eliminate HCV in our transplant recipients remains a concern. Better education of our providers, advocacy for our patients, and better access to medications are the only solution to this problem. I certainly hope we get there soon.

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