In Reply Dr Chavez-Tapia and colleagues raise an important clinical question. Is SVR the appropriate clinical end point with new treatments for HCV or should clinical outcomes be assessed? Clinical outcomes of HCV include progression of liver fibrosis, decompensated liver disease, occurrence of hepatocellular carcinoma, and mortality, all of which take years to develop. In the interferon era of HCV therapeutics, occurrence of SVR was correlated with improved liver-related and overall outcomes, including hepatocellular carcinoma.1,2 Long-term follow-up studies of patients who achieve SVR need to be performed to evaluate whether interferon-free directly acting antiviral therapy reduces these outcomes. Our systematic review of the literature on advances in treatment regimens used to treat HCV cannot address this issue. However, we agree that measuring and defining the effect of treatment with directly acting antivirals for HCV on mortality is the next step and would help determine the value of treatment for various populations of patients (eg, those with various stages of liver disease, patients coinfected with human immunodeficiency virus, children). In addition, further delineation of the effect of therapy on the transmission of HCV is necessary from a public health perspective to understand and define the benefit of SVR on curtailing disease spread.
Kohli A, Kottilil S. Assessment of Outcomes of Hepatitis C Treatment—Reply. JAMA. 2014;312(23):2571. doi:10.1001/jama.2014.14905