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New drugs make treating hepatitis C faster and easier

In a minority of men, unchecked hepatitis C infection leads to liver damage or cancer. These drugs can quash the virus.

If you were born between 1945 and 1965, health experts now recommend that you be tested for infection with the hepatitis C virus (HCV). Statistically, baby boomers are more likely than other adults to have HCV. The virus can remain in the liver for decades without causing symptoms. The damage it does can progress to fatal liver failure or cancer.

Until recently, it was difficult to sell men on being screened for HCV infection. The treatment required weekly injections of one drug and oral doses of one or two others. Treatment could take nearly a year, bringing side effects from the injected drug (called peginterferon) such as depression, anxiety, irritability, anemia, and fatigue.

“The existing therapies were almost as feared as the disease itself,” says Dr. Raymond Chung, director of hepatology at Massachusetts General Hospital and an associate professor of medicine at Harvard Medical School.

Two studies published April 24, 2014, in the New England Journal of Medicine mark the latest advance in HCV testing and treatment. Two new combinations of oral drugs cleared the virus in a larger number of people—95% or more compared with 50% to 60% with the older treatments—without the need for injectable interferon. The treatment lasted only 12 weeks, in contrast to 48 weeks for the older method. Also, most people tolerate the oral drugs well. The most common side effects are moderate headache, nausea, and fatigue.

But there are also downsides to screening. HCV doesn’t always progress to liver damage, so being tested could lead to diagnosis with an infection that would have never caused serious harm.

The case for mass screening

HCV is transmitted via exposure to blood. Men who never injected drugs could have still contracted HCV from a transfusion. Men who had multiple sex partners are at higher risk of having HCV.

HCV infection: What happens?

Most people infected with the hepatitis C virus do not progress to liver failure or cancer, but a small number can. For every 100 people infected with the virus, here is what happens over a period of 20 to 30 years:

  • 20 clear the virus with their own immune defenses.

  • 80 develop a long-term (chronic) infection in the liver.

  • 20 suffer liver scarring (cirrhosis) with declining liver function.

  • Eventually, 1 to 5 people of the original 100 infected could die from liver failure or liver cancer.

The longer HCV remains in the liver, the more likely a person is to develop irreversible scarring of the liver (cirrhosis), liver failure (requiring a transplant), or liver cancer. Boomer-based screening targets those at greatest risk of a long-term (chronic) infection. A man born in 1945 could have been harboring the virus for more than 50 years.

Screening pros and cons

Full-scale testing of baby boomers would dramatically increase the pool of those who might benefit from treatment with the new oral drugs. “This strategy will really home in on those who are at greatest risk of disease,” Dr. Chung says. But choosing to be tested for HCV comes with both pros and cons you need to be aware of.

The downsides of being tested:

  • Testing could make you aware of an infection that may not have harmed you if you never knew about it. Out of 100 people initially infected with HCV, up to 20 develop liver damage over 20 to 30 years. Up to five of those people could die from liver failure or cancer. That leaves a larger number who do not progress to serious illness.

  • Diagnosis with HCV can be emotionally upsetting and stigmatizing. The virus is associated with injected drug use, even though not everyone is infected that way. Being HCV-positive could affect your eligibility for life insurance.

The benefits of testing:

  • Although chronic infection may not cause any symptoms, it can still be spread to others, such as health care workers.

  • Once a person progresses to cirrhosis or significant liver damage, eradicating the virus doesn’t lower the lifetime risk of liver disease as much as it would if the person had been treated earlier.

Dr. Chung thinks the pros outweigh the cons. “The downside of finding out you are positive is more than counterbalanced by the fact that you will have access to a curative treatment.”

Price remains an obstacle

Currently, the cost of treatment with oral HCV drugs tops $80,000. “The irony is that we have solved the scientific challenge of HCV, but now the bottleneck lies in getting those pills to the patient,” Dr. Chung says.

If a man is diagnosed with HCV, there is no guarantee that his insurance provider will pay for the new oral HCV drug regimens. Competition among drug manufacturers may help to drive down costs.

Posted by: Dr.Health

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