Hepatitis C – von der individuellen Heilung zur weltweiten Elimination?

With the implementation of highly effective direct acting antivirals (DAAs), global control or even elimination of chronic hepatitis C virus (HCV) infection might have come into reach. In fact, DAA therapy leads to complete virus elimination, defined as sustained viral response (SVR), in the vast majority of patients. Moreover, in patients without cirrhosis, the risk of developing HCC after DAA therapy is significantly reduced. For viremic patients who have already received DAA therapy, a distinction must be made between relapse and reinfection. The rate of new infections remains high and many infected individuals are undiagnosed. In order to come closer to the WHO goal of eliminating HCV worldwide by 2030, programs are needed to identify and treat all HCV-infected individuals. Strategies are missing in most countries to achieve this goal. Generic DAA therapies are available in some countries and appear to have similar cure rates compared to those obtained with the original drugs. The high variability of HCV, the numerous strategies of the virus to escape the immune response, and the lack of a suitable small animal model are key hurdles for vaccine development. Currently, the efficacy of two vaccine candidates is being investigated in clinical trials. The development of a protective vaccine is important, despite available therapy, to sustainably reduce the rate of new infections both in developing countries and in people with risk behavior.

Transhyoid Resection of Tongue Base and Tonsil Tumors

Advanced lesions of the oropharynx are known to have increased survival with surgical excision combined with radiation therapy. Traditional surgery involves either a mandibular resection or, more recently, a mandibular sparing approach primarily through a lip-splitting incision. At our institution posterior oropharyngeal lesions are approached via a combined intraoral and transhyoid technique. Nineteen sequential procedures using this approach were compared with a similar number of previous, stage-matched controls in an attempt to obtain valid comparable information. No significant difference between the groups was noted with respect to surgical margins. A significant difference was, however, seen with respect to the need for flap closure with none required in the transhyoid group and five in the mandibulotomy group. Furthermore, a statistical difference was observed with respect to the presence of significant complications in favor of the transhyoid group. These results indicate that similar cure rates can be achieved with lower morbidity by use of a transhyoid pharyngotomy approach to tumors of the oropharynx.