Hugh Pickens DOT Com writes: An estimated three to four million Americans are infected with "the silent killer," Hepatitis C, but most people who are infected do not know it because it can take decades for the virus to damage the liver sufficiently to cause symptoms. Now Andrew Pollack writes in the NYT that medicine may be on the brink of turning the tide against hepatitis C, a plague that kills more Americans annually than AIDS and is the leading cause of liver transplants. If the effort succeeds, it will be an unusual conquest of a viral epidemic without using a vaccine. “There is no doubt we are on the verge of wiping out hepatitis C,” says Dr. Mitchell L. Shiffman. Over the next three years new drugs are expected to come to market that will cure most patients with the virus, in some cases with a once-a-day pill taken for as little as eight weeks, and with only minimal side effects. The new drugs are specifically designed to inhibit the enzymes the hepatitis C virus uses to replicate, the same approach used to control HIV. But the big difference is that HIV forms a latent reservoir in the body, so HIV drugs must be taken for life to prevent the virus from springing back. Hepatitis C does not form such a reservoir, so it can be eliminated permanently. Many doctors are now “warehousing” their hepatitis C patients — urging them to forgo treatment until the new drugs are approved. But the new drugs are expected to cost from $60,000 to more than $100,000 for a course of treatment and some critics worry that the bill will be run up when huge numbers of people who would have done fine without them turn to the drugs. “The vast majority of patients who are infected with this virus never have any trouble,” says Dr. Ronald Koretz. "Since the vast majority of patients become infected after age 20, most patients infected with hepatitis C will have to die of something else before their livers fail."