Every Hepatitis C genotype on the planet can now be cured with short-term oral medications with very few side effects, research published in Annals of Internal Medicine concluded.
But while the news certainly is one of the biggest stories in modern medicine in many decades, it’s bittersweet because many people do not have access to these expensive drugs.
“Oral direct-acting antiviral (DAA) regimens that are highly efficacious, well-tolerated, and relatively short in duration are now available for all HCV genotypes and for patient populations historically considered difficult to cure,” the authors concluded. “The ease of dosing, safety profile, and effectiveness of these agents provide an opportunity to expand the number of patients who can be treated for HCV infection and the pool of treating providers.”
But, the researchers add, “Rapid developments in oral DAA therapies can be beneficial only if they are linked to efforts to improve rates of HCV detection, linkage to care, and access to DAA therapy.”
As many as five million Americans are living with Hepatitis C, according to the researchers from Johns Hopkins University School of Medicine. Many of the infected are baby boomers who should be tested at least once for Hepatitis C.
Hepatitis C is a disease of the liver which can be fatal if left unchecked. The virus is transmitted via blood, and many baby boomers contracted the disease while hospitalized in their younger years. Hepatitis C can linger in the body for decades before doing noticeable damage such as cirrhosis or cancer of the liver.
Prior to the HIV epidemic, hospital sanitation procedures were far more lax than they are today, so the disease was frequently spread in that environment. But Hepatitis C also is making a comeback among a new generation of injection drug users. Often, Hepatitis C and HIV pass on the same needle, leaving a person co-infected with both diseases. Men who have sex with men are also at risk of contracting both HIV and Hepatitis C through unprotected sex.
But the new regimens are effective in curing Hepatitis C, even in people co-infected with HIV. Nearly a dozen drugs have come to market to cure Hepatitis C during the past four years, but they cost between $55,000 and $150,000 for a 12-week regimen. Often, more than one drug needs to be taken to rid the body of Hepatitis C, also known as a sustained virologic response, or SVR. Before the advent of these drugs, treatment for Hepatitis C included interferon, which many people say is worse than the symptoms of Hepatitis C itself.
Between two and five percent of people with Hepatitis C still cannot be cured, per the authors of the paper. “Although this rate is low, it equates to tens of thousands of persons who might remain infected despite therapy, potentially harboring antiviral resistance-associated variants. Fortunately, more rigorous antiviral regimens are being developed that hold material promise.”
In an accompanying editorial, Dr. Jay H. Hoofnagle and Dr. Averell H. Sherker of the National Institute of Diabetes and Digestive and Kidney Diseases at the National Institutes of Health, Bethesda, Md., called Hepatitis C “down but not out.”
“The excess mortality in SVR cohorts is largely due to the hepatocellular carcinoma, the most dire and dreaded consequence of chronic liver disease of any cause…For those reasons, patients with HVC infection and cirrhosis (or even advanced fibrosis) deserve continued follow-up with imaging and blood tests focusing on early detection of this carcinoma after successful therapy,” they added.
While these follow-ups should be continued, the appropriate and exact method of monitoring remains unclear, an issue that remains a “high priority for future research in this now easily treated disease.”