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Hepatitis C: new clues to better vaccines?
  1. Marian E Major
  1. Correspondence to Dr Marian E Major, Laboratory of Hepatitis Viruses, Division of Viral Products, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, MD 20993, USA; marian.major{at}fda.hhs.gov

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HCV is a major public health problem in the USA and worldwide with the majority of acute infections progressing to chronicity in the absence of therapy. HCV infection is recognised as one of the major causes of liver disease, and is associated with the majority of liver transplantations in most countries. There have been tremendous advances in antiviral drug treatment for HCV over recent years, and current therapies can clear infections in the vast majority of people treated.1 However, treatment success can be limited by a range of factors, not least of which include the cost of therapy, which makes access to treatment challenging for many both within the USA and elsewhere. For these reasons, safe, effective and affordable prophylactic vaccines against HCV remain the best long-term hope for bringing the global epidemic under control. Such vaccines will also help to circumvent issues such as drug resistance, drug–drug interaction in patients with HIV coinfection, susceptibility of treated individuals to reinfection and drug side effects.

There is strong evidence that an effective HCV vaccine to prevent chronic infection is attainable. A form of protective immunity has been demonstrated in studies of both chimpanzees and humans that have been exposed to the virus after recovering from primary infections.2 ,3 Although HCV RNA can be detected in these secondary infections, the kinetics are different due to rapid control of viral …

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