Not so long ago, treating hepatitis C was a decidedly bleak affair. And the prospect of curing the potentially life-threatening virus, or infection — which causes liver disease and inflammation of the organ — was a longshot. As a result, many patients opted to forgo treatment.
Dr. Mark Sulkowski, a professor of medicine at Johns Hopkins University School of Medicine and medical director at the Johns Hopkins Infectious Disease Center for Viral Hepatitis, got involved in the treatment of hepatitis C in the mid-1990s. “At that time, we were giving injections of interferon — which is one of your body’s natural viral fighters; we gave these injections Monday, Wednesday and Friday for a period of up to 48 weeks, or nearly a year,” he recalls. “These treatments were universally linked to side effects, including flu-like symptoms, depression, weight loss and other abnormalities of bloodwork — and the cure rate … was between 6 and 15 percent — so a very ineffective treatment.”
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Today, thanks to significant medical breakthroughs that include a new generation of medications approved within the last couple years that are highly effective in addressing the most common strains of hepatitis C, the vast majority of patients who undergo treatment can be cured. “They do not involve the older medication interferon,” Sulkowski says. “They are oral medications, generally given for a period of 12 weeks, that lead to a cure of chronic hepatitis C in more than 95 percent of people treated.” The drugs are also much better tolerated, experts say, with common side effects including fatigue, headache and nausea.
In some cases, health insurance coverage has lagged for new hepatitis C drugs, including the brand names Sovaldi and Harvoni. One recent study found that almost half — about 46 percent — of Medicaid patients in Pennsylvania, New Jersey, Delaware and Maryland were denied treatment with the pricey new antiviral drugs, which can run $90,000 for a 12-week treatment regimen. World Health Organization research published in PLOS One in May similarly found that the drugs are unaffordable to people in many countries; Solvaldi costs $101,000 in Poland and $64,600 in the U.S. for a 12-week regimen.
However, Medicare and private insurers tended to cover the vast majority of patients, ensuring the new drugs are accessible for many patients. Even so, many aren’t undergoing treatment for another reason: Most of the estimated 3.2 million people living with chronic hepatitis C don’t feel ill or know they are infected, according to the Centers for Disease Control and Prevention.
Though typically asymptomatic, it’s doing damage just the same. The virus is literally making billions of copies of itself every day, replicating like crazy, resulting in inflammation of the liver, says Dr. Ira Jacobson, chairman of department of medicine at Mount Sinai Beth Israel in New York City. “Hepatitis C silently causes progressive scar tissue in your liver, culminating in cirrhosis,” he says. Progressive liver damage can lead to liver failure or liver cancer.
Though the virus wasn’t discovered until 1989, public health data suggest it was being transmitted decades prior to that time. Baby Boomers are at higher risk for hepatitis C than the general population, with nearly 1 in 20 infected by the virus, Sulkowski notes. The CDC recommends all Americans born between 1945 and 1965 undergo a simple, one-time blood test for hepatitis C. “If that test is positive, although certainly that is not information anyone would want to hear — that you have hepatitis C — it does empower that person to make health care choices that can improve their health and perhaps even save their lives,” he says.
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Patients with more advanced liver disease and cirrhosis — or scarring of the liver — may need to undergo a liver transplant. But given long waits for organs, some die before they’re matched with a donor organ. “There have been many transplant programs that donate hepatitis C-positive livers to hepatitis C-positive recipients,” Jacobson says. “The principle being that it would be a shame to deprive somebody with hepatitis C of the opportunity for transplant in the era of organ shortages when you may not be changing their outlook, because they already have the infection.”
In short, research finds those with hepatitis C who receive hepatitis-C positive livers fare as well as those who receive livers that are negative for the virus. Using hepatitis C-positive livers opens up a pool of organs that increases the chances a patient gets the liver he or she needs, says Dr. Zobair Younossi, chairman of the department of medicine and vice president of research for Inova Health System, based in Falls Church, Virginia. Of course, he adds, these organs are still checked for other issues, such as scarring and fat, which could compromise the organ’s quality.
Success has increased the proportion of hepatitis C-positive organs used for transplant to treat patients with hepatitis C, from 3 percent in 1995 to 9 percent in 2013. “Usually these organs were used for patients who didn’t have a lot time to wait,” Younossi says. “For example, liver cancer patients with hepatitis C tended to get more hepatitis C-positive organs.” As with those patients treated with drugs alone, he says the vast majority — more than 95 percent– of those with hepatitis C who receive a liver transplant and are treated with medication are cured. “We live in a golden age of hepatitis treatment today,” he says.
That makes it all the more important, experts say, that those at risk for hepatitis C, including Baby Boomers, and anyone who received a blood transfusion before July 1992 — when the blood supply was not screened for hepatitis C — seek medical attention to determine if they may have the virus. In addition, doctors say it’s important not to wait to discuss treatment options. A resurgence of injection narcotic use has also lead to infections in young adults under the age of 30 in the U.S., Sulkowski says. But health providers are quick to point out that any stigma associated with hepatitis C is beside the point, given that the virus can be transmitted in numerous ways — and that ultimately addressing the issue can improve a person’s outcome and quality of life.
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“Nowadays, the critical point is that we think of just about every patient with hepatitis C as a potential treatment candidate, who we actively want to treat in the near future, so that we can cure them,” Jacobson says.
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Taking Steps to Cure Hepatitis C originally appeared on usnews.com
