What Is Hepatitis C?
Hepatitis C (or HCV) is a blood-borne virus that causes inflammation of the liver. This inflammation can lead to permanent liver damage. Hepatitis C is contracted only through direct contact with the blood of an infected person. Possible routes of infection include:
- sharing IV drug needles with an infected person
- contaminated needles at unlicensed tattoo, body piercing, or acupuncture facilities
- accidental needle stick or blood contact in a healthcare setting
- being born to an infected mother
Blood screening measures against hepatitis C have been in place in the United States since 1992. For this reason, new cases of infection due to contaminated blood transfusions or organ transplants are very rare in the U.S.
What Treatments Are Currently Available?
Some hepatitis C patients are fortunate in that they don’t need any treatment at all. In these cases, the body’s own immune system is enough to knock out an acute hepatitis C infection. Many patients, however, will need medical intervention to become healthy again.
The standard course of treatment for hepatitis C includes various combinations of antiviral medications over the course of at least several weeks, and up to a year or more. These drugs are designed to:
- rid your body of the virus
- slow down or prevent inflammation and damage to the liver
- prevent or reduce the odds of developing cirrhosis or liver cancer
Historically, the drugs most commonly used for hepatitis C treatment are interferon and ribavirin. Interferon is actually a naturally occurring protein that the body makes in response to viruses and bacteria. Unfortunately, when interferon is administered, it usually causes several unpleasant side effects. These side effects may be severe enough to cause patients to stop or refuse treatment. Some side effects of interferon treatment include:
- flu-like symptoms, including fever, muscle aches, and headache
- nausea, vomiting, and diarrhea
In December 2013, sofosbuvir (Sovaldi) was approved by the U.S. Food and Drug Administration as the cornerstone for the first non-interferon containing combination treatment for some genotypes of hepatitis C. It is approved for treatment of genotypes 1-4, which includes the vast majority of infected patients in the US. Although it is very expensive, it can be a very effective regimen for many hepatitis C patients.
A liver transplant may be required if irreversible, end-stage liver damage is present. Donor livers can come in one of two forms: a whole organ from a deceased donor, or a portion of the organ from a living donor. It is important to note that a transplant does not equal a cure (recurrence of HCV post-transplant is universal at present). Antiviral medications will need to be considered at some point post-transplant, because the virus will come back in the new, healthy liver.
What New Treatments Are Out There?
New drugs have been developed that can provide more effective, efficient treatment with fewer side effects. These drugs, many of which are still being researched, are called oral directly acting antiviral agents (DAAs). They directly and specifically target the hepatitis C virus in every stage of its lifecycle. This is very different from the historic standard of care (interferon) that worked by activating the patient’s immune system.
Sofosbuvir (Sovaldi) is a DAA that was approved by the U.S. Food and Drug Administration in December 2013. It can be used without interferon, has fewer side effects, and can cure patients in a matter of weeks. Unfortunately, sofosbuvir is a very costly treatment. The price can be difficult for many hepatitis C patients to bear, particularly if they don’t have prescription drug coverage.
There are several other drugs currently in development that target different parts of the hepatitis C lifecycle. Researchers are hopeful that a combination of these drugs will be found that cures every genotype of hepatitis C efficiently and without the use of interferon. One new drug cocktail still in clinical trials comes from drug maker AbbVie, Inc. The drug combination is made up of a protease inhibitor and a NS5A inhibitor. It works by preventing the hepatitis C virus from replicating. A follow-up study is currently recruiting participants at clinicaltrials.gov. This is a Phase 3 trial that hopes to build upon the previous success of the drug combination.