We interviewed Dr. Amesh Adalja, an infectious disease specialist with the University of Pittsburgh Medical Center, about his experiences treating hepatitis C (HCV). An expert in the field, Dr. Adalja offers an overview of HCV, standard treatments, and exciting new treatments that could change the game for hepatitis C patients everywhere.
What Is Hepatitis C, and How Does It Differ from Other Types of Hepatitis?
Hepatitis C is a type of viral hepatitis that differs from some other forms of viral hepatitis in that it has a tendency to become chronic and can lead to liver cirrhosis, liver cancer, and other systemic disorders. It infects approximately 3.2 million individuals in the US and is also the leading cause for need for liver transplantation. It is spread via blood exposure such as blood transfusions (prior to screening), injection drug use and rarely through sexual contact. Hepatitis A does not have a chronic form, is vaccine preventable, is spread by the fecal-oral route, and does not lead to liver cirrhosis and/or cancer. Hepatitis B, also blood-borne and also able to cause liver cirrhosis and cancer, is vaccine preventable and more easily spread via sexual contact and from mothers to their children during pregnancy and birth. Hepatitis E is much like hepatitis A but, in rare cases, can become chronic, and also has a high rate of mortality in pregnant women.
What Are the Standard Courses of Treatment?
The courses of treatment for hepatitis C are completely dependent on which type of hepatitis C one is harboring. There are six genotypes of hepatitis C and some are easier to treat than others. In general, the treatment of hepatitis C involves a combination of two to three medications, typically including interferon, administered for at least 12 weeks.
What Kinds of New Treatments Are Gaining Ground, and How Effective Do They Seem to Be?
The most exciting new treatment is the antiviral drug sofosbuvir, which has been shown to not only be extremely effective, but also has the ability to drastically shorten courses of therapy from the much longer regimens prior to its introduction.
Sofosbuvir works by inhibiting the viral enzyme RNA polymerase. This is the mechanism by which the virus is able to make copies of itself. In clinical trials this drug, in combination, was shown to be highly effective at suppressing the virus quickly and durably, allowing significant shortening of the treatment regimen. Although other drugs have targeted this enzyme, the design of this drug is such that it is quickly and efficiently converted to its active form within the body, allowing potent inhibition of the enzyme. Sofosbuvir was approved by the FDA in 2013.
Also, in some cases, drug combinations that exclude interferon—dreaded for its unattractive side effect profile—can also be employed. [Though effective, interferon is notorious for causing depression and flu-like symptoms. Sofosbuvir was the first drug approved by the FDA for use without the co-administration of interferon in some cases.]
How Do These New Treatments Compare with the Standard Treatments?
The advantage, as I mentioned above, is that new regimens are shorter, more tolerable, and more effective. The disadvantage is that new drugs cost more. However, if one looks at the full context, which includes the drug development costs incurred, due to the ability to prevent the most dire—and costly—complications of hepatitis C infection, these new drugs are a very welcome addition to the arsenal.
How Should Patients Make Their Treatment Decisions?
I would recommend that patients make treatment decisions in collaboration with their physician after a discussion of the current status of their infection, the current status of their liver, and their ability to adhere to the medication.