Hepatitis C - ‘Dreaded Virus Is Curable’
Fri, 12/16/2016 - 3:00pm
Jonnalagadda, Sudhakar, MD
Hepatitis C virus (HCV), RNA virus, is a potentially devastating virus that attacks the liver and there are six genotypes recognized worldwide. In the USA, genotype one and two are the most common. Left untreated, the inflammation of the liver can cause scarring of the liver, reduces the ability of the liver to filter toxins and perform other crucial functions and, over time, lead to cirrhosis of the liver, liver failure and liver carcinoma. Hepatitis C is the most common reason for a liver transplant.
Acute HCV refers to the first several months of the disease, after infection through a blood product. Early symptoms can range from very mild to a serious condition requiring hospitalization. For reasons that are not known, about 15-45 % of people are able to rid the body of the virus without treatment within the first six months. Most patients are unaware of the infection. The remaining percentage develops a chronic life-long HCV infection. Over time, chronic HCV can cause liver disease and ultimately liver failure. Symptoms can take decades to appear and are often dings of advanced liver disease. Though not yet diagnosed, these patients can spread the HCV inadvertently through the blood.
2014 marked the 25th anniversary of the discovery of the HCV by scientists at the CDC. With the identification of the virus in 1989, Public Health had a valuable tool to provide screening of the blood supply, the main source of the spread of the HCV at that time. However, HCV was often called the silent killer as the symptoms developed slowly over many years and decades. Most diagnoses were not made until the disease was advanced. Before the blood screenings began in 1992, blood transfusions were the main method of transmission of the Hepatitis C virus. A small number of infections were transmitted by: sexual transmission, patients who sniffed cocaine, tattoos or body piercing with non-sterile equipment or infants born to infected mothers. Between 1990 and 2009, with the isolation of HCV, screening procedures of blood products and organs for donation led to a dramatic decrease in HCV infections.
The recent, dramatic rise in HCV infections is attributed directly to the use of unsterile hypodermic needles by opioid addicts who inject heroine and other drugs; often sharing needles with other addicts and consequently infecting each other with blood-borne diseases such as HCV and HIV. According to the CDC, deaths from HCV began to rise sharply in 2013. In that year there were more deaths from HCV than with 60 other infectious diseases combined—including HIV, TB and pneumococcal diseases. In 2014, the CDC counted 19,659 — a record number of deaths caused by HCV. Additionally, the spread of HCV can foretell an increase in HIV, both of which are spread by using dirty needles with intravenous drug usage.
Over the next 5 years, the CDC has a goal to reduce HCV deaths in the US by 5%. However, the growing number of young people engulfed in the opioid epidemic adds another pressure to the success of this hopeful cure rate. Estimates are as many as 30,000 people will acquire HCV each year. In the US the infection rate estimates are currently 3.2 million cases, with 130-150 million infections world-wide. Acute cases have more than doubled since 2010, and, it is estimated that because there are few symptoms, only one in 10 cases is diagnosed.
The demographics of an HCV patient in the US describes the infected population as mostly young, white, drug injectors in rural and suburban areas. Public Health offices scrambling to contain the disease by promoting clean needle exchanges for addicts and blood tests for high risk populations. The goal is to identify infected persons, treat them with the antiviral drugs and prevent them from infecting others. The CDC recommendation is for all persons born between 1945 and 1965 to be tested for HCV. However, most have not been tested and those who have, if found to be positive, do not seek proper care.
The testing recommendations from the CDC are:
1. Anyone born from 1945-1965, who may have contracted the virus before our blood supply was safely screened, 2. Anyone who received a donated organ or blood before 1992, 3. Anyone who ever injected drugs, 4. Anyone with certain medical conditions including chronic liver disease, HIV or AIDS, 5. Anyone with an abnormal liver test or liver disease, 6. Anyone ever exposed to blood from an HCV patient, 7. Anyone on hemodialysis, and 8. Anyone born to a mother with HCV. 9. Household contacts who share razor blades or toothbrushes.
Recently, new antiviral drugs have been developed. These direct antiviral agents are much more effective, safer and better tolerated than older therapies and the new drugs can cure most patients with few side effects. The costs remain high ranging from $54,000 to $94,000 for a 12 week treatment. New drugs became widely available in 2014 and the cure rate has begun to multiply. Several new breakthrough drugs have recently become available with approval from the FDA. There are even newer drugs in the testing phase which will make treatment somewhat less costly and therefore more readily approved by private and government insurers. Clinical trials for these drugs found that a 12 or 16 week treatment reduced virus to undetectable levels (which is considered a cure) in more than 94% of patients. However, insurers are reluctant to cover this expensive treatment in drug-addicted patients, there is a high percentage of these patients resuming the injectable drugs and thus causing a reinfection by HCV.
There is currently no vaccination for Hepatitis C virus. With 2-3% of the world population infected it is a worldwide problem for us all. Much needs to be done to ensure access to treatment globally. The most affected regions are Africa, and Central and East Asia. Depending on the country, the HCV infection can be concentrated in certain populations (in the US among people who inject drugs) and/or in general populations with poor sanitation and a shortage of medical support and screening capabilities. There are multiple strains of the HCV and their distribution varies by region. Symptoms, though not always present can include: fever, malaise, loss of appetite, nausea, vomiting, joint pain, dark urine and jaundice. The best defensive is comprehensive testing and monitoring of people and the blood supply to reduce risk of exposure.
The World Health Organization recognizes July 28 as World Hepatitis Day to increase awareness and understanding of viral hepatitis.
CDC-Center for Disease Control
FDA-Food and Drug Administration