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Gordon Nary

July 1998

Since the industrial revolution, we have had an insatiable appetite for the new. The inherent worth of a person or an object is often devalued in our desperate search for the new, regardless of its value. Middle-aged men discard their wives and partners for the newness of firm flesh. The 1998 Lexus is traded in on a 1999 Lexus for no significant engineering or safety difference simply because it is a newer model. Fashion editors have declared grey the new black. Restaurant critics have declared traditional comfort food "in" and nouvelle cuisine "out." Even some AIDS activists infected with the "new" virus, have labeled D4T the new AZT, a phrase that must be abhorred by both Bristol-Myers Squibb and Glaxo Wellcome.

As media and subsequently public interest in the global HIV/AIDS pandemic begins to wane, hepatitis C virus (HCV) infection is becoming the new disease du jour. US News & World Report's June 22 cover story was "Hepatitis C -- The Next Epidemic." Comparisons between the two pandemics are inevitable. There are significant comparisons and differences between the two pandemics. The World Health Organization estimates that three percent of the global population is HCV-infected. Although HCV is not as infectious or as relentless as HIV, up to 85 percent of the global population infected with HCV are projected to develop chronic hepatitis C. This abstract statistic can be converted into 170 million chronic carriers of HCV who are at risk for developing cirrhosis of the liver, liver failure, and hepatocellular carcinoma. As with HIV, an estimated 90 percent cannot afford treatment and, as with HIV, there is no effective vaccine against HCV.

While we have learned much about the transmission of both HIV and HCV through unscreened blood, inadequately sterilized transfusion equipment, and needle-sharing among injection drug-users, our knowledge of other forms of HCV transmission, especially sexual, perinatal, and cutaneous, is limited. The socioeconomic impact of the new HCV pandemic is unknown, but like HIV, the costs will be high and we may soon see HCV competing against HIV for limited global healthcare resources. When effective HCV and HIV vaccines are developed, the competition for limited funds to purchase vaccines for less-industrialized nations may result in a competition between the two vaccines. The potential consequences of another major US epidemic has resulted in increased funding for HCV research. The FDA's recent approval of the first combination therapy for chronic HCV disease now offers a more effective option for treatment. When combined with the increased public awareness generated by the media, these factors portend a more proactive consumer demand for HCV screening and treatment. Since the most vulnerable populations at risk for HCV are the traditionally medically underserved, demands for access to new HCV treatments may soon force the federal and state governments to implement some form of HCV drug assistance for the medically indigent, similar to the AIDS Drug Assistance Program (ADAP).

Our editorial board recommended that we expand the Journal's focus to include other life-threatening diseases. This issue marks our first hepatitis issue and we are committed to integrating important hepatitis updates in upcoming issues of the Journal.

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