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Paper text:
the treatment of chronic hepatitis c virus ( hcv ) infection has seen tremendous advances over just a quarter of a century , since 1989 when the virus was discovered ( 1 ) , to the present day , when the infection can be cured , which is something quite unique in viral infections and even in modern medicine ( 2 ) .
the interferon ( ifn ) monotherapy used in the late 1980s ( 3 ) was followed by dual therapy ( recombinant ifn alpha + ribavirin ) at the end of the 1990s ( 4 ) , then , in 2001 , by pegylated interferons ( peg - ifn ) + ribavirin ( 5 ) , and the use of 1st generation direct acting antivirals ( daas ) in 2011 ( 6 , 7 ) , culminating with a new wave of daas in 2013 ( 8) , administered in different combinations without interferon . these therapeutic improvements were presented in the hepatogastroenterology literature as  milestones  ,  a new era  , and nowadays as  revolutionary  .
dual therapy with pegifn + ribavirin is currently the only treatment for chronic hcv infection in romania as well as in other eastern european countries , where genotype 1 is present in over 95% of infected patients , and the rate of sustained virological response ( svr ) is around 50% or even less ( 9 ) .
triple therapy ( pegifn + ribavirin + telaprevir or boceprevir ) was approved in 2011 by the food and drug administration ( fda ) and the european medicines agency ( ema ) , yet it was not made available in romania and some neighboring countries . however ,
triple therapy had only a short lifetime from its launching to the moment when it was not anymore recommended both by the european association for the study of the liver ( easl ) and the american association for the study of the liver disease ( aasld ) ( 2014 ) , mainly because of the arrival of the new  revolutionary  highly effective and safe daas on the market .
the year 2013 announced an unprecedented therapeutic victory with several new daas having different viral targets , including ns3 protease inhibitors , nucleoside / nucleotide analogues and non - nucleoside inhibitors of the rna - dependent polymerase and ns5a inhibitors , some already approved by the ema and/or fda in 2013 ( sofosbuvir and simeprevir ) and 2014 ( daclatasvir ; abbvie s viekira pak ( ombitasvir and ritonavir boosted paritaprevir plus dasabuvir ) ; harvoni ( ledipasvir + sofosbuvir ) ) , with more to expect in 2015 and in the next two to three years .
all these new daas were proved to be amazingly efficient ( 90% - 100% svr ) , safe , and well tolerated , while all oral , ifn - free combinations cure and even eradicate hcv infection ( 10 , 11 ) .
a  contagious  enthusiasm spread among the authors of hundreds of articles ; almost all with opening statements such as  the advent of the new daas has revolutionized the treatment of hcv infection  , and some with closing remarks as  hcv could be cured and even eradicated  . according to the dictionary ,  to revolutionize 
means  to completely change the way something is done , thought about , or made  ( macmillan english dictionary ) .
does this mean that the standard care of dual - and triple - therapy should be dropped ? logically and ethically , once agreed that hcv infection can be cured and even eradicated with the new daas treatment , the answer is  yes  and it is strongly sustained by professional societies guidelines ( aasld and easl ) .
what does this therapeutic  revolution  mean for us and other eastern european countries ?
for sofosbuvir , the initial cost was 84000 usd per 12-week course , and 1000 usd per pill , making it one of the most ( if not the most ) expensive drug product ever marketed . at such prices
, our country , other eastern european countries and many other low- and middle - income countries from all over the world , where the hcv pandemic is mainly concentrated ( 85% of the patients ) can not afford the new treatments . in europe
, there have always been significant socioeconomic disparities between some western  rich  countries ( e.g. germany , france , uk etc . ) and eastern lower middle - income countries ( e.g. romania , bulgaria etc . ) .
all of us , physicians and patients , still remember the grim times of the berlin wall , symbol of the differentiation made , among other things , in terms of health care facilities , including the access to new treatments , between eastern and western european countries . paradoxically , 25 years after the political revolution that led to the fall of the berlin wall , the therapeutic revolution has now raised a new  wall  for eastern european patients , restricting their access to therapy , while in some western countries , such as germany or france , with large health budgets
even with a very strong will from the part of the governments , most of the eastern european countries could not afford to purchase the new treatments at the current price for all who need it , simply because this would mean spending their entire annual health budget .
consequently , the gap in the therapeutic approach will widen between the rich countries in western and northern europe and those in the east .
no one will understand and accept the high sale price of the new daas , despite producers attempts to justify it ( costly research programs etc . ) , considering that manufacturing costs are very low ( between 68 and 136 usd for sofosbuvir , 10 and 30 usd for daclatasvir , and 130 and 270 usd for simeprevir ) . unless companies producing daas , make their drugs widely affordable
, hcv infected patients from eastern europe will never benefit from equitable access to treatment .
unfortunately , gilead s voluntary licensing with indian - based generic companies , allowing the production and sale of their new daas , sofosbuvir and ledipasvir , in 91 countries ( mostly low - income and only few middle - income countries ) , excluded all eastern european countries from receiving affordable treatment ( 12 ) .
a common attitude together with concerted efforts of eastern european governments , non - governmental organizations , public health officials , clinical care providers , patient advocacy groups , media representatives and the community at large are needed to negotiate agreements with pharmaceutical companies to make these new life - saving treatments accessible and affordable ( 13 ) .
the situation of hcv therapy today is similar to the debates in 2000 on human immunodeficiency virus infection and acquired immune deficiency syndrome ( hiv / aids ) treatment , when the initial price of triple antiretroviral therapy was very high ( unaffordable for millions of infected people ) . over the last 15 years
, generic competition has driven prices down by 99% , and this should be a lesson for today s battle against the exorbitant prices of the new hcv treatment ( 14 ) .
egypt has shown that commitment from the part of the government and tough negotiations with gilead brought them a 99% discount on the us price of sofosbuvir ( 15 ) .
hepatitis c virus infection can be cured and even eradicated by new treatments and this undeniable truth has become more contagious than hcv infection itself , to such a degree that nobody can stay in its way . rarely , if ever , has mankind seen a curative therapy for a chronic viral infection as for hepatitis c. it would be unimaginable and unforgivable for the present generations if this medical triumph would be wasted and hcv patients , as citizens of low- and middle - income countries , are left excluded from new treatments on grounds related to high prices and financial constraints .
we , physicians and patients , from both eastern and western europe , share the same dreams and goals : to cure and eradicate hepatitis c. in other words , we should all be treated like in a real family ( gens una sumus ) and have equal access to new therapy throughout europe and ideally , worldwide .
hepatitis c can be cured and even eradicated by new  revolutionary  treatments 
 . however , at present exorbitant prices , eastern european countries can not afford the new treatments , while in western rich and developed countries ( e.g. germany and france ) they are already available . 
 concerted efforts of governments , public health officials , and the community at large , are needed to negotiate agreements with pharmaceuticals companies to make the new treatments accessible and affordable . when science has demonstrated that hepatitis c can be cured 
 , it would be unforgivable if millions of infected patients from eastern parts of the continent were denied access to new treatment on grounds of high prices and financial constraints .