Rapid Progress and Effective Cures Usher New Era for Hepatitis C

Adrian Di Bisceglie, M.D., chair of internal medicine and co-director of the Liver Center at Saint Louis University, urges baby boomers to learn about the risk factors for hepatitis C and talk with their physicians about screening for the virus.

Newswise — In 1989, researchers first identified the hepatitis C virus, a health threat that had been worrying doctors as they noticed patients with unexplained liver damage occurring after receiving blood transfusions. The discovery of the potentially debilitating and deadly virus sparked several decades of productive research. Researchers made unusually rapid progress, in medical research terms, and developed therapies that had success in eliminating the virus, at least in some patients. Then, in 2011, two new drugs were brought to market that changed the landscape in a dramatic way, offering a cure for many more who suffer from a chronic form of the illness.

Currently, we estimate that 4 million people in the U.S. are infected with the virus, and at least 10,000 people in this country will die from its complications each year. Symptoms of hepatitis C can be quite variable and often only develop at the most advanced stages of liver disease, years after the virus was contracted. For this reason, it is believed that roughly 60 percent of those who have the virus are unaware of it. Patients who have a chronic infection can develop inflammation of the liver, leading to fibrosis and cirrhosis, as well as other complications that may result in liver cancer and death.

While hepatitis C is sometimes compared to HIV, and, indeed both are blood-borne, the viruses behave differently. For example, hepatitis C is not frequently spread through sexual contact. It is more likely to be transmitted from a needle stick, blood transfusion or organ transplant received before 1992, recreational drug use, or from mother to infant.

(In fact, reducing hepatitis C transmission by blood donation has been a success story of its own. In the mid-1960’s, approximately one in 10 transfusions was associated with hepatitis, initially referred to as non-A, non-B hepatitis, but now known as hepatitis C. Now, thanks to an all-volunteer blood donor system, as well as questionnaires that weed out donations from those with high risk behavior, and the routine testing of donated blood for various biomarkers of hepatitis, the risk is virtually nonexistent at one in five million.)

Today, we see hepatitis C patients from all walks of life. We see captains of industry who may have contracted the virus in their youth and healthcare workers who received accidental needle sticks on the job or even young people who acquired it from their mothers at birth. Because they may only begin to show symptoms decades later, it’s often impossible to pinpoint the exact way the virus was contracted.

However, there is an inexpensive and accurate blood test for hepatitis C. Liver disease specialists advocate that those at risk ask their doctor to be tested. In particular, the CDC now recommends that all baby boomers -- those born between 1945 and 1965 -- be screened. Doctors also urge those with risk factors such as a blood transfusion prior to 1992, a history of injection drug use and abnormal liver enzymes counts be tested.

With parallel clinical trials successfully concluding in recent years, two effective new drugs, Merck’s boceprevir and Vertex’s telaprevir, were FDA approved in 2011 to treat the virus. Added to the existing treatment regimen of peginterferon and ribavirin, these new medicines can cure nearly 80 percent of those with the disease.

Though the new treatments still require the use of peginterferon, which frequently causes taxing side effects, we’ve turned a corner. The new drugs lower the average treatment time from 1 year to 6 months. More antiviral drugs against hepatitis C are in the pipeline, and their use may eventually eliminate the need for interferon altogether.

But, right now, we can tell patients with hepatitis C that treatment time is expected to be much less than a year, is far more likely to cure them, and is likely to add years to their lives. The opportunity to halt progressive liver damage is a chance to save those with the virus from debilitating fatigue, cancer and death.

Physicians now can recommend testing to patients with the knowledge that we have effective medicines to treat the virus if we find it. These new medicines are revolutionizing the care of those with hepatitis C. It’s critical that those at risk be screened so the illness can be treated.

Adrian Di Bisceglie, M.D. is chair of the department of internal medicine and co-director of the Liver Center at Saint Louis University. He also served as Liver Diseases Section Chief at the National Institutes of Health where he supervised research in viral hepatitis and was among the first to use interferon when the illness simply was known as non-A, non-B hepatitis. Throughout the search for a cure for hepatitis C, Di Bisceglie led numerous research studies and recently co-authored a New England Journal of Medicine paper on the successful telaprevir clinical trial.

Established in 1836, Saint Louis University School of Medicine has the distinction of awarding the first medical degree west of the Mississippi River. The school educates physicians and biomedical scientists, conducts medical research, and provides health care on a local, national and international level. Research at the school seeks new cures and treatments in five key areas: cancer, liver disease, heart/lung disease, aging and brain disease, and infectious disease.