By Bonnie Miller Rubin, Chicago Tribune reporter
January 30, 2013
A diagnosis of hepatitis C — a stubborn virus that is a common cause of chronic liver disease — can be devastating. In 2007, it passed HIV/AIDS in annual deaths, with more than 17,000 annually, according to the Centers for Disease Control and Prevention.
But new therapies are offering more promise, better outcomes and fewer side effects for the estimated 4 million Americans who are infected. Two out of three of those living with hepatitis C are baby boomers, according to the CDC, which recently recommended screening for everyone born between 1945 and 1965.
For more on this rapidly changing landscape, we turned to Dr. Donald M. Jensen, director of the Center for Liver Diseases at University of Chicago Medicine and a noted hepatitis C researcher, with more than 100 peer-reviewed articles .
Q: Tell me about the new drugs and what they mean for patients.
A: In May 2011, two new drugs were approved — telaprevir and boceprevir — and were added to the backbone of interferon, which has been around since the early 1990s, and ribavirin (since 1998), and have always been the standard of care. The old therapy had a lot of side effects — such as aches, severe fatigue and depression. Even then, the cure rate was only about 40 percent.
Q: Did the new drugs eliminate the nasty side effects?
A: No. Sometimes, it aggravated them ... with anemia and a skin rash. It wasn't pleasant, but the success rate jumped to 70 percent, which was nothing to scoff at. But now there are even better drugs in the pipeline, such as Sofosbuvir, Daclatasvir, Simeprevir, Faldaprevir, ABT450, Danoprevir, Apeline, which should be available in the 2014-15 time frame. The treatment is shorter — 12 to 24 weeks vs. 24 to 48 weeks — and has fewer side effects and even better success rates (90 to100 percent cure rates). Many patients with mild cases are deciding to wait.
Q: If the future looks better, why did the CDC issue a recommendation last fall that baby boomers should be tested for hepatitis C?
A: Because only 25 to 50 percent of this group knows they have the infection. Many got it by experimenting with drugs. A lot of primary care doctors are uncomfortable asking, "Did you inject drugs or have more than 50 lifetime sexual partners?"
Q: Are there other ways to get infected?
A: If you got a blood transfusion prior to 1992, when all donor blood had to be tested ... because the only way hepatitis C is transmitted is through the bloodstream. Others who should be screened include: (those with) hemophilia, hemodialysis, persistently elevated liver enzymes; HIV-infected individuals; children born to HCV (hepatitis C virus)-infected mothers; and (those who have had) tattooing. But a huge number of people don't know how they acquired it ... and it can be decades before symptoms develop, such as abdominal pain, dark urine or jaundice.
Also, another benefit to testing and identifying those with hepatitis C is to counsel against significant alcohol use, as this may accelerate progression to cirrhosis.
Q: What's involved with testing?
A: It's a simple blood test ... and by testing everyone, it removes stigma. The CDC says we'll uncover about 800,000 undiagnosed cases for treatment. Everyone thinks cirrhosis is about alcoholism, but hepatitis C is a common cause of cirrhosis, along with liver cancer — the only major cancer to be increasing in the U.S. It's also the most common reason for a liver transplant.
Q: So, with all these new therapies, why are most Americans not aware of the breakthroughs?
A: I think because it didn't come in one fell swoop, like penicillin. These have been incremental victories ... so they didn't generate the same excitement.
Q: So this is good time to be a hepatitis C researcher?
A: Definitely. Before, we'd say a patient had a "sustained response." Now, we're comfortable with the "cure" word.
Here at the U. of C., we have initiated HCV CURE for patients who have been successfully cured of their hepatitis C in order for them to "pay it forward." We met a couple weeks ago with almost 40 patients and their family members to celebrate their cure status. They are being asked to help support patients now undergoing HCV treatment as well as advocating publicly for increased awareness and testing. To my knowledge, this is the first such organization ... in the U.S. I think that such a group of highly motivated — and thankful — individuals could play an important role by providing their individual stories and success.
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