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Can Peginterferon and Ribavirin Be Eliminated from Therapy
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Jules Levin, NATAP
There is controversy regarding whether or not we will be able to eliminate pegIFN or peg/RBV from future treatment regimens. Many well known treating researchers at EASL who I spoke with are very confident that with a regimen of at least 3 oral drugs we can cure HCV for many if not all patients without peg/RBV. Eugene Schiff, considered the 'grandfather' of HCV in the field, and at the University of Miami Hospital, said to me he is sure that within 5 years we will have a conmpletely oral regimen of at least 3 maybe 4 oral drugs that can cure HCV without peg/RBV. Ira Jacobson expressed to me similar thoughts but just a little more cautious. Some think that perhaps ribavirin will be needed and some think that we may not be able to eliminate peg/RBV. Studies are planned to examine this. Myself and others have doubts we can eliminate peg/RBV due to the immune stimulation it provides by stimulating an interferon and immune response that perhaps is necessary to achieve a cure and stop therapy. The others feel that once you potently suppress viral replication by several drugs working in different ways (PI, NRTI, NNRTI, NS5A etc) and with a potent reduction in viral load by say 9 to 10 logs, which could occur with 3 drugs, this will allow the immune system to kick in since the presence of HCV and its replication prevents the immune system from kicking in. So once you eliminate viral replication, suppression by 10 logs, the immune sytem will kick in.
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