Hepatitis C

Hepatitis C
By Randi Chittum

According to “Could New He”, an estimated 3.2 to 5.2 million Americans are afflicted
with Hepatitis C. Because this disease is asymptomatic until advanced stages, it usually goes
undetected for years, often decades, and it is estimated that at least half of the people with
Hepatitis C do not know they have it. More people now die of Hepatitis C than HIV/AIDS,
according to the U.S. Centers for Disease Control and Prevention (CDC).
“Hepatitis” means inflammation of the liver. Certain drugs and diseases, toxins, alcohol
abuse, and viral and bacterial infections can all cause Hepatitis. Hepatitis C is a contagious liver
disease. It ranges in severity from a mild, short lasting illness to a serious lifelong illness that
attacks the liver.
Hepatitis C is usually spread when the blood of an infected person comes in contact with
a wound or blood of a non-infected person. The most common ways to become infected are;
sharing needles and other equipment to inject drugs, the use of non-sterile tattoo instruments,
needle stick injuries in healthcare settings and being born to an infected mother. Less common
risks are having sexual contact or sharing personal care items such as a toothbrush or razor
(items that can come in contact with blood) with an infected person.
Hepatitis C can be either “acute” or “chronic”. Acute Hepatitis C virus infection is a short
term illness that occurs within the first 6 months of exposure to the Hepatitis C virus. Acute
Hepatitis C usually always leads to chronic infection, a long term illness that happens when
Hepatitis C remains in the body. This disease can last a lifetime and lead to serious liver
problems or even death. Hepatitis C is the leading cause of cirrhosis and liver cancer and the
most common reason for liver transplant in the United States. Approximately 15,000 people die
every year from Hepatitis C related liver disease.
Early diagnosis of the HCV infection is rare due to the fact that acute HCV infection is
asymptomatic, with 80% of infected people exhibiting no symptons. Those who are acutely
symptomatic may exhibit fever, fatigue, decreased appetite, nausea, vomiting, abdominal pain,
dark urine, grey colored feces, joint pain and jaundice.
HCV infection is diagnosed in 2 steps:
1. Screening for anti-HCV antibodies, with a serological test identifies people who have
been infected with the virus.
2. If the test is positive for anti-HCV antibodies, a nucleic acid test for HCV RNA is needed
to confirm chronic HCV infection because about 15-45% of people infected HCV
spontaneously clear the infection by a strong immune response without the need for
treatment. Although no longer infected, they will still test positive for anti-HCV
antibodies.
After being diagnosed with chronic Hepatitis C infection, an assessment of the degree of
liver damamge should be done. This is done by a liver biopsy or through a variety of non-
invasive tests. A laboratory test to identify the genotype of the Hepatitis C strain should
also be performed. There are 6 genotypes of the HCV and they respond differently to
treatment. It is possible for a person to be infected with more than one genotype. The
degree of liver damage and the virus genotype are used to guide treatment decisions and
management of the disease.
Hepatitis C does not always require treatment because the immune response will
clear the infection in some people. When treatment is necessary, the goal of Hepatitis C
treatment is cure. The cure rate depends of the strain of the virus and the type of
treatment given. Careful screening should be done prior to starting treatment to determine
the most appropriate approach for the patient.
The current standard treatment for Hepatitis C is a combination of anti-viral
therapy with interferon and ribavirin which are effective against all the genotypes of
Hepatitis viruses. Unfortunately, interferon is poorly tolerated in some patients and is not
widely available globally. The management of the treatment is complex, and many
patients never finish their treatment. Despite these limitations, interferon and ribavirin
treatment can be life-saving.
There are two new medications to treat the deadly epidemic of Hepatitis C. both
have shorter periods of treatment and fewer side effects. The new drugs, Simeprevir and
Sofosbuvir could stamp out the disease. In clinical trials, the new drugs, which have
already reached the market, have reached cure rates as high as 95%. They are taken by
pill, usually every day for 12 weeks, and they have mild side effects.
The downside of the new advances in treatment is the potential cost. Treatment
with interferon or other drugs cost around $15,000-$20,000. Many patients have declined
those treatments, waiting for Simeprevir and Sofosbuvir to hit the market.
“I don’t recall any other situation in which we’ve had very effective, very
expensive drugs come out for an important condition with such a large patient population
potentially eligible for treatment,” said Steven Pearson, President of the Institute for
Clinical and Economic Review. The potential cost of treating even a small portion of
those with the disease is nothing short of astronomical. The cost of these new
medications is between $84,000-$168,000.