New Treatments Available For Hepatitis C
New, effective, direct-acting antiviral (DAA) treatments are now available to treat Hepatitis C (HCV). HCV is a silent disease affecting people who may have contracted the virus through contaminated blood and/or who were born between 1945-1965, the baby boomer generation. PCPs are the first line of defense and should consider HCV testing when treating the high-risk population.
“I’ve been interested in the disease for years because it’s part of my generation,” says Joseph Eisenach, MD, a gastroenterologist with Consultants in Gastroenterology, P.C. “There was a period of time when it was spreading rapidly and we didn’t have a test for it. It’s been only in the last 12-18 months that effective drug treatments have become available.” An estimated 4-6 million people in the U.S. have HCV, but most don’t know it because they may have had brief flu-like symptoms, but they can be asymptomatic for 20 years or more.
Effective New Treatments
The first non-interferon treatment was introduced in the fall of 2014, and more are on the way to the market. The four most recent DAA treatment options are SFO + Simeprevir, Harvoni, Viekira PAK and Daklinza.
“These new drugs are a game changer. They are well tolerated, last for a short duration and are effective in over 95% of the cases,” Dr. Eisenach said. “That’s in major contrast to the early days of treatment, which were onerous and had a success rate of only 20%.”
Testing Is Needed
Most people at risk haven’t been tested, and less than a quarter of those who have HCV are being treated. “When patients come into the PCP’s office and are overweight and have an elevated liver test, it’s common to assume it’s the result of fatty liver disease,” Dr. Eisenach explained.
“But everyone in that age population should be tested for HCV and the HCV antibody,” he recommends. That’s especially true, he says, for patients who led high-risk lifestyles that included IV drug use, needle sharing, getting tattoos and sexual promiscuity. Boomers exposed to Hepatitis C-contaminated blood in healthcare settings also should be tested.
In 1998, the CDC recommended HCV testing for people at risk for Hepatitis C infection. However, in 2012, the CDC amended testing recommendations to include a one-time HCV test for all people born during 1945–1965 regardless of other risk factors.
An easy viral load test is now available to screen for HCV. If it’s positive, the diagnosis should be confirmed with the HCV RNA test. “HCV-infected patients need to be treated and should be referred if possible,” Dr. Eisenach said.
“With today’s treatment options there is no reason not to receive treatment; however, treatment cost continues to be an issue,” Dr. Eisenach cautions. Most private insurance does cover the cost.
Progression If Untreated
Patients respond differently to HCV depending on their immune systems. “Since the course is variable and unpredictable, the infection often remains subclinical and the patient is asymptomatic,” Dr. Eisenach said. Cirrhosis doesn’t usually present until 17 - 25 years after infection.
Suspicion and testing are important to catching cases early, when treatment is more effective. “If you halt the progression of HCV- induced fibrosis, there will be some liver improvement and the damage is partially reversible,” he explained.
“In the last decade, we have discovered with treatment, there can be regression of liver fibrosis and even improvement in cirrhosis, “Dr. Eisenach says. “They key is to identify and treat Hep C before cirrhosis develops, and the patient is at risk for cancer. If a diagnosis comes too late, treatment will be ineffective, and the liver will fail.”
Risk Is Lessening
Fortunately, younger generations face less risk of contracting HCV because:
- The virus was identified in 1989 and a screening test developed.
- At HCV’s peak, 5-10% of the blood supply was contaminated. Currently, contamination is virtually zero.
- Awareness and education around HIV and AIDs resulted in a decline of IV drug use and shared needles.
Joseph Eisenach, MD
Dr. Eisenach received his medical degree from and completed his residency in internal medicine at the University of Nebraska Medical Center. He also completed a fellowship in gastroenterology-hepatology at the University of Iowa Hospitals and Clinics.