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prove upon currently available treatments and allows for an expedited of caregivers – especially family members who must spend a signifi-
review process. Because of this status, the new DAA cocktail was ap- cant amount of time and money caring for and dealing with these
proved by the FDA earlier this summer. patients – are now relieved of that burden. It all adds up to a very
positive effect on the lives and economies of people on a micro scale
After decades of little progress and low cure rates in hepatitis C as well as on a greater scale for the entire country.
treatment, more significant advances were made in the mid-1990s
with cure rates in the 40 to 50 percent range, but much lower for With these excellent cure rates, Dr. Poordad and other researchers
the group with diseased livers. Interferon was a major part of those have shifted their focus to the five to seven percent of patients whose
treatments and it brought an entire range of flu-like side effects such virus resists the treatment. Dr. Poordad is also turning his attention
as muscle aches, fever, rashes, as well as other serious symptoms in- back to FLD, which is becoming more pressing thanks to the cure
cluding reduction in brain function, possible thyroid dysfunction, rate for hepatitis C. Fatty liver disease is not just an obesity problem.
other autoimmune difficulties and even bone marrow suppression. Fat metabolism in the liver is very complex, with many metabolic
These side effects were dangerous for patients, especially those facing transporters and enzymes that are genetically determined and are
advanced cirrhosis and other issues. problematic for many patients who suffer with FLD.

Progress increased in the late 1990s through the early 2000s; a time Non-alcoholic steatohepatitis (NASH) is liver inflammation and
of rapid growth and advancement as DAAs were discovered and cure damage caused by a buildup of fat in the liver. It is part of a group of
rates began to climb. Boceprevir, the first FDA approved DAA, came conditions called non-alcoholic fatty liver disease. We see hepatitis-
onto the market in 2011. In use with interferon, it nearly doubled like damage from the inflammation but it does not manifest in every
the cure rates to the 75 percent range; however it also carried all the patient as FLD. As well, some patients progress to cirrhosis and can-
interferon related side effects. It was within the past few years that cer and some do not. There is a great deal to be discovered, especially
researchers began leaving out the interferon and adding the other in the Hispanic population which is more prone to NASH and FLD.
DAAs after they saw virus counts in chimpanzees (the only other an-
imal that can get hepatitis) were greatly reduced. This led to proof- Dr. Poordad served as the co-director of liver transplantation at
of-concept studies, safety studies and other key measures for an FDA Johns Hopkins and chief of hepatology and liver transplantation at
approval track. Cedars-Sinai Medical Center in Los Angeles prior to his arrival here.
Dr. Lawitz was a specialist in gastroenterology and hepatology at
Recent treatments have been so effective that the FDA actually al- Brooke Army Medical Center and founded the very successful Alamo
lowed the terminology “cure” to be used in approval applications. Medical Research Center before both joined forces to form the TLI.
Because of recurrences in the virus, they previously would not allow Besides working at the TLI, Dr. Poordad teaches medical students,
the word to be used. Thanks to the new research, we have also seen residents and fellows and rotates on the liver transplant team at Uni-
advancement in the accepted definition of the word “cure.” Cur- versity Hospital System. Along with Dr. Lawitz and others within
rently, a cure for hepatitis C is defined as a “sustained virologic re- the School of Medicine, they are part of a team that is not just work-
sponse” – no detectable virus in the bloodstream of the patient – ing on the issues that affect Central and South Texas, but is making
three to six months post treatment. Unlike HIV or hepatitis B, which unprecedented progress in the fight against these and other diseases.
can become part of our genome and hence “non curable,” we know
hepatitis C cannot sustain itself unless it constantly replicates. All the best,

Benefits of higher cure rates Francisco González-Scarano, MD
There are many direct and indirect benefits to these new cure rates Dean, School of Medicine
Vice President for Medical Affairs
of hepatitis C. There will be less cirrhosis, which means there will be Professor of Neurology
less liver cancer and lower mortality. Fewer cancers means there is a John P. Howe, III, MD,
potential increase in organ availability for people who need trans- Distinguished Chair in Health Policy
plants for other reasons. This all contributes to a tremendous societal The University of Texas Health
benefit that not only will reduce the financial burden in Texas and Science Center at San Antonio
other areas, but also significantly improves the lives of all involved scarano@uthscsa.edu
in the equation. The patient benefits, of course, but the large circle

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