New Treatment Options for Hepatitis C in 2014
Most people are aware of the implications of being diagnosed with HIV, but few have any notion how to live with Hepatitis C. Both viruses are spread through some similar means, but for reasons beyond this blog post, HIV is in our usual lexicon, and Hepatitis C (HCV) is not. This is about to change thanks to new research that has and will lead to breakthrough treatments for this disease.
Between four and five million Americans currently have HCV—most were infected in the 1960s through the 1980s. Fifty percent of these HCV infections are caused by intravenous or other drug use (even casual experimentation decades ago), the rest are from blood transfusions, body modifications such as tattoos and piercings, and sexual transmission.
Those with HCV have up to a 37% risk of mortality due to liver failure. Hepatitis C starts insidiously as inflammation and scarring (fibrosis) but then can progress to cirrhosis and liver cancer (hepatocellular carcinoma). Because HCV is asymptomatic, up to 75% of cases aren’t diagnosed until it is too late. Unfortunately our screening procedures don’t work well in targeting populations at risk, because the risks occurred so long ago and may not even be remembered.
But, we are close to a tipping point. Due to the development of new drugs HCV will soon be curable in the vast majority of patients. The decades old therapy of interferon and ribavirin work in some, but require lengthy treatment and have hard-to-tolerate side effects.
The common drugs used to treat HCV and the ways in which they are combined are:
- Interferon does not attack a cancer or virus directly, but boosts the immune system’s response to these diseases.
- There are different types (alpha, beta, lambda & gamma) used to treat different diseases.
- Many patients cannot tolerate interferon due to side effects and co-morbidities.
- Ribavirin affects the reproductive capabilities of the virus through its RNA and DNA.
- It is a synthetic chemical not found in nature.
- Ribavirin does not have as many side effects as interferon but is a teratogen, which means it can cause birth defects in a fetus or embryo.
Interferon & Ribavirin
- Interferon and ribavirin have been used to treat Hepatitis C for almost 20 years.
- Interferon and ribavirin must be taken for at least 6 months and usually up to a year.
- This drug combination cures less than half of the patients with HCV genotype 1 and 70% of the patients with genotypes 2 & 3.
Boceprevir & Telprevir
- Developed in May of 2011, boceprevir and telprevir were the first drugs to act directly on the HCV virus (DAA)
- Boceprevir and teleprevir increased the cure rate for HCV genotype 1 to 70% (This is the same cure rate for HCV genotypes 2 & 3 using interferon and ribavirin).
- A treatment regime with boceprevir or telprevir, with interferon and ribavirin lasts 24-48 weeks.
Sofusbuvir, Interferon & Ribavirin
- Sofosbuvir was approved as first-in-class nucleotide drug in December 2013.
- When combined with interferon and ribavirin, sofosbuvir can be used to treat HCV genotype 1 for 12 weeks with a cure rate of 90%.
- When combined with interferon and ribavirin, sofosbuvir for 12 weeks can also treat some genotype 3 patients. (This is off-label).
Sofosbuvir & Ribavirin
- Sofosbuvir & ribavirin for 12-24 weeks cured HCV and allowed the elimination of interferon for the treatment for about 90% of HCV genotype 2 and for many HCV genotype 3 patients.
Sofosbuvir with Simeprevir or NS5A inhibitors
- The combination of these drugs classes together has not been approved for use by the FDA, but will be important since interferon and, likely, ribavirin will no longer be needed.