HIV and ID Observations

April 16th, 2018

Hepatitis C Positive Organ Donors — Coming Soon to a Transplant Center Near You

There’s one immutable fact in solid organ transplantation — the number of patients awaiting transplant exceeds the number of available organs. This shortage means that ethical, medically safe strategies to increase the donor pool are always a high priority. One such strategy would be to allow transplants from people who have chronic hepatitis C. If the thought of […]

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October 1st, 2017

With Several Wrong Predictions Behind Me, Here’s One I Got Right

As I’ve mentioned before, I’ve been wrong on several predictions that ultimately came to pass. Whoppingly wrong. A partial list: Cameras in cellphones are a short-lived gimmick. My kids still tease me about that one. Buying clothing — and especially shoes — on the internet will never catch on. C’mon, you can’t try things on! How do you know […]

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July 19th, 2017

Mystifying Cochrane Library Review on HCV Therapy Elicits Strong Response from IDSA

Last month, the Cochrane Review published a controversial paper on HCV therapy that left many ID doctors and hepatologists perplexed. After reviewing 138 randomized clinical trials using directly acting, non-interferon based therapies, they came to the following conclusions: The use of sustained virologic response (“SVR”) — or “cure”, if you want to use plain English — as a […]

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January 29th, 2016

Elbasvir/Grazoprevir Combination Pill for HCV a Welcome New Option — With a Few Buts

As expected, there’s a new option for HCV therapy, the combination pill elbasvir/grazoprevir (EBR/GZR, brand name Zepatier, more on this below), and it’s indicated for genotypes 1 and 4. For those mechanistically inclined, elbasvir is an NS5A inhibitor (like ledipasvir), and grazoprevir is a protease inhibitor (like simeprevir). This is the second one-pill, once a day option […]

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November 18th, 2015

Are There Remaining Challenges in HCV Therapy?

Prompted by (yet more) spectacular HCV study results, I posted the following questions on Twitter: Is velpatasvir/sofosbuvir the endgame for HCV? And what will HCV researchers do now? https://t.co/vL2A9FOttR @NEJM — Paul Sax (@PaulSaxMD) November 18, 2015 To which I got this reply from one of our very energetic second-year ID fellows: @PaulSaxMD @NEJM what about coinfected patients, […]

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July 31st, 2014

Simeprevir, Sofosbuvir, and the Limitations of the COSMOS

These are exciting times for hepatitis C treatment, as the approval of simeprevir and sofosbuvir in late 2013 have made curing this disease a whole lot easier. Since that sentence barely conveys the transformative nature of this medical advance, allow me this tortured analogy: Before simeprevir and sofosbuvir, curing hepatitis C was like making a transatlantic […]

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July 30th, 2014

Hepatitis Day “Celebration” and a Reminder

July 28 is “World Hepatitis Day” (how do they choose the dates for these things?), and I wrote a bit over on the Oxford University Press site on the incredible progress we’ve made already — with more to come. Definitely plenty of reasons to celebrate — safe and effective immunizations for hepatitis A and B, treatment […]

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March 29th, 2014

Opening Day ID Link-o-Rama

Several ID/HIV tidbits to keep you entertained until Sunday night’s opening “day” — for baseball that is. (I hear there’s some sort of basketball tournament going on as well.) Away we go! Female-to-female sexual transmission of HIV is extremely uncommon — though one such case was diagnosed at our hospital over 20 years ago — but this most recent report from Texas […]

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June 11th, 2013

Both Simeprevir and Sofosbuvir Likely Approved by 2014 — Clinical/Ethical/Pharmacoeconomic Dilemmas Loom

As expected, simeprevir, and now also sofosbuvir, are being given “priority review” by the FDA. With the 6-month rule under the Prescription Drug User Fee Act — usually just said as “pah-DOOF-ah” — that means there’s a good chance we’ll have both of these anti-HCV drugs some time in late 2013. Which also means HCV treaters will soon […]

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April 23rd, 2013

Two Papers, Four Sofosbuvir Studies, and Soon the End of “Interferonologists”

Today, as the The International Liver Congress is about to start, two papers are published in the New England Journal of Medicine on sofosbuvir, the investigational anti-HCV nucleotide submitted to the FDA for approval earlier this month. Each paper actually includes within them two studies. (For some reason, all the studies sound like 1950s science fiction magazines.) […]

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