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.

Read Video Transcript »

Break It Down: Treatments for Hep C (Transcript)

[Intro]

Hepatitis C, also called Hep C, is a viral infection that can cause inflammation and eventually serious damage to the liver. The virus is most commonly spread through human contact with infected blood. The symptoms of Hep C are usually very mild to undetectable, so you may have no idea that you’re infected. Left untreated, chronic hepatitis C can lead to cirrhosis of the liver or liver cancer, both of which can be fatal.

[Risks]

The people most at risk for contracting Hep C are users of illegal intravenous drugs, particularly persons who share needles with someone who’s infected. Medical professionals are also at risk when they come in contact with an infected person who’s bleeding or has an open wound. Historically, blood transfusions and organ transplants exposed people to Hep C, but modern screening processes have largely eliminated that risk in the United States. In rare instances, the virus can be spread through unprotected sexual contact or by sharing personal hygiene items, such as toothbrushes and razors.

About 15 to 20 percent of people infected with hepatitis C don’t require medical treatment and suffer no long-term damage to their health. But if your immune system doesn’t resolve the problem on its own, Hep C enters a chronic phase where the infection begins to damage the liver. However, there still may be minimal or no symptoms. Because of this, chronic Hep C can go unnoticed for years, or only be discovered from a blood test.

[Treatments]

Treatments for Hepatitis C are evolving quickly and vary based on the specific genotype, or version, of the virus. The current standard of care is use of an anti-viral medication, called a polymerase inhibitor, to help eradicate the infection. This therapy is combined with ribavirin, which is an immune system booster. A third medication, called interferon, is sometimes added. These treatments can take from 12 to 24 weeks. The good news is that a large percentage of persons with chronic hepatitis C respond positively and can be cured.

The latest treatments for Hepatitis C utilize what are called “direct-acting antivirals.” These medications, which include protease inhibitors, target specific aspects of the virus and prevent it from replicating. These newer antivirals are packaged with other drugs, such as ribavirin, into multi-drug cocktails that attack the infection on several fronts. These newest treatments are up to 96% effective, even among patients who didn’t respond to prior therapies. All of these treatments carry a risk for side effects. Your doctor will tailor the therapy based on how long you’ve had hepatitis and if you’re also being treated for another condition, such as HIV.

As in most things medical, some patients respond better than others, and some strains of the disease are harder to fight than others. If hepatitis C progresses to the point that the liver is no longer able to function, liver transplantation may be the only viable course of action.

It’s important to note that many people with chronic hepatitis C live perfectly normal lives. Clinicians and scientists wish that this disease was more predictable, but for now, that is simply not possible. Even with the latest therapeutic advances, every effort should be made to avoid becoming infected by the hepatitis C virus.

Sources:

http://www.ncbi.nlm.nih.gov/pubmed/23886001

http://www.reuters.com/article/2013/12/10/us-abbvie-study-hepatitisc-idUSBRE9B90KL20131210

http://www.hepmag.com/articles/2512_18756.shtml

http://www.hepmag.com/drug_list_hepatitisc.shtml