Treat and be Proactive.
Today some 3.2 million Americans are living with chronic Hepatitis C, a viral infection of the liver that may last a few weeks or become a serious lifelong condition. Most of these people don’t feel sick or know they have this illness. The good news is that new therapies and resources can lead to a complete cure and Hep C’s eventual eradication.
Lorna Dove, MD, MPH, a leading expert at NYP/Columbia’s Center for Liver Disease and Transplantation, describes the importance of screening, and the revolutionary advances in Hep C treatment.
Who is at risk for Hep C?
Hep C is contagious and can be transmitted through contact with an infected person’s blood. Though not generally acquired through sexual contact, risk increases with the number of sexual partners. Before 1992, some people were infected after receiving blood transfusions–though today blood banks routinely screen for the Hep C virus. Today many people are infected with Hep C after sharing of needles and other equipment used to take illicit drugs. Because there are so many ways to be exposed to Hep C it’s important to get tested.
What does this involve?
These days, you don’t have to raise any of these tough subjects with your doctor to get screened. Hep C can be detected by a simple blood test, easily done by primary care physicians. It is recommended for all baby boomers born between 1945 and 1965, a population known to have a higher rate of the disease. For this age group, Hep C screening has become routine care like getting a mammogram or colonscopy.
If Hep C is found, most patients will then be referred to a specialist (hepatologist) for treatment.
What happens if Hep C isn’t discovered early? How will it progress?
Hep C can cause fibrosis or scarring in the liver. Over time, it can lead to cirrhosis, or permanent liver damage. About 20 to 25 percent of all individuals with Hep C will end up with cirrhosis, and some go on to develop liver cancer.
The virus can also affect other organ systems reducing a patient’s overall lifespan.
In addition, it can impair kidney function and make it hard to manage diabetes. The goal of treatment is to prevent any of these problems from developing.
What are the latest treatments for Hep C?
Our drug arsenal changed dramatically in the past three years. We have moved from interferon-based treatment, which was hard to tolerate, to new antiviral regimens that are more than 90 percent effective with minimal side effects. This has revolutionized our approach.
How do the latest drugs work?
These medications target patients with different genotypes (the genetic material found within the virus). We have identified six genotypes. Seventy-five percent of Hep C patients in the United States are genotype 1 and we have an array of proven drugs that work very well for them.
The newest medication, Epclusa, is approved for all Hep C patients, but is especially effective for those with genotype 3, the patients who are hardest to treat. The FDA approved this drug in the last year and, for this group, it’s a big advance.
How do you tailor treatment to each patient’s needs?
Before these antivirals were developed, we had one drug (interferon) and tried to make it work for everyone. Now we take a much deeper patient history and tailor our approach to the individual. Among the questions we consider: Has the patient been treated in the past and failed to respond? How much liver disease or fibrosis is present, if any? Is there evidence of cirrhosis, or liver damage, occurring over the past few months or years? We put all these factors into an equation then look for the best regimen.
The American Association for the Study of Liver Disease and the Infectious Disease Society of America have a website with recommendations that help us to tailor treatment for each person. If there are three equivalent options, our choice of treatment may be dictated by patient’s insurance plan.
What are the side effects of the new anti-virals? Are they easy to take?
For most of these drugs, the side effects are pretty minor and include headache, fatigue, a little rash. One regimen, however, requires the addition of ribavirin, a drug that can cause anemia and more serious fatigue.
What’s unique about the kind of care offered at the Center for Liver Disease and Transplantation?
The Center has a multidisciplinary program, which means we look at Hep C from many different angles. We have seven hepatologists (liver experts), an infectious disease consultant who checks for co-infections, and a psychiatrist who helps patients deal with personal issues. Dedicated nurses assist us, gathering the information we need to get patients access to the best treatment and get reimbursed by their insurance. Our team cares for at least 500 individuals with Hep C every year.
In 2016, the Center also introduced a new technology called Fibroscan, an imaging technique that allows us to assess the condition of a patient’s liver without having to do a surgical biopsy.
Finally, our nationally recognized experts have performed over 2,000 liver transplants and are known for their care of patients with serious liver disease.
What is the outlook for patients with Hep C?
Our new therapies for Hep C are not just eliminating complications and producing more than a 90 percent cure rate, they are reducing our patients’ anxiety as well. In the past we used to “watch and wait” and carefully monitor certain individuals because drugs for Hep C were hard to take and we weren’t sure how well they would work. As a result, many people felt they were living with a time bomb and, in the meantime, worried that they might transmit Hep C to their loved ones.
Now our approach is to treat and be proactive. This is because we have medication that is easier to tolerate and we can pinpoint, with great accuracy, which drugs an individual will respond to. This represents a revolution in patient care.