Hepatitis C Treatment Update
What is hepatitis C?
Hepatitis C (HCV) is a liver disease resulting from infection with the Hepatitis C virus. It can range in severity from a mild illness lasting a few weeks to a serious, lifelong illness. Hepatitis C is usually spread when blood from a person infected with the Hepatitis C virus enters the body of another person. Today, most people become infected with the Hepatitis C virus by sharing needles or other equipment used to inject drugs. Prior to 1992, before widespread screening of the blood supply began in the United States, hepatitis C was also spread through blood and blood product transfusions and organ transplants.
Hepatitis C is a leading cause of liver disease requiring liver transplantation. Of patients with acute hepatitis C, 75-85% will develop chronic HCV. Up to 70% of those with chronic HCV will develop chronic liver disease. The rate of progression of liver disease is highly variable. Approximately 20% of persons with HCV develop cirrhosis after 20 years. For patients diagnosed with HCV, the HCV genotype must be identified. A genotype is a subgroup of the hepatitis C virus with a unique arrangement of genetic material. This arrangement determines specific characteristics of the genotype, and therefore which treatment plan is selected.
What labs are typically used to monitor infection?
Blood is drawn for genotype testing and this helps determine the type and duration of therapy, as well as treatment response rates. Genotype 1 is the most common in the United States, followed by genotypes 2 and 3. The viral load (amount of hepatitis C virus in the blood) is another lab that is monitored. A very high viral load does not indicate “worse” liver disease; similarly a lower viral load does not indicate “less” disease. Viral load response, however, is closely monitored during HCV treatment.
What are the current therapies available?
The standard therapy for patients with HCV infection has been the combined use of peginterferon and ribavirin. These drugs are administered for either 48 weeks (HCV genotypes 1, 4, 5, 6) or for 24 weeks (HCV genotypes 2 and 3), causing sustained virologic response rates of 40%-50% in those with genotype 1 and 80% or more in those with genotypes 2 and 3 infections.
Researchers are continually looking for improved treatment options. Boceprevir (Victrelis) and Telaprevir (Incivek) were approved by the FDA in May 2011 for treatment of HCV, genotype 1. These protease inhibitors (direct-acting antiviral agents) are used with peginterferon and ribavirin. This “triple therapy” has a higher treatment response rate (as high as 75%) as compared to the combination of peginterferon and ribavirin. Length of therapy depends on many factors and is determined by the hepatologist (liver doctor) treating the HCV; it is very important that individuals with hepatitis C are closely followed by a hepatologist. Therapy response is determined by regular measurement of the patient’s HCV viral load.
There are also new agents being explored for genotype 2 and 3 patients, but these therapies will not be available for several years. However, high success rates (~80%) are already available to individuals with genotype 2 and 3 using the peginterferon and ribavirin combination.
There are side effects to therapy and these vary widely with each individual. These can include flu-like symptoms, fatigue, anemia, lower intestinal discomfort, rash, headache, and a variety of other symptoms. A patient’s health care team helps manage these side effects to make therapy more tolerable. Within the next few years, interferon-free regimens may become available.
Special considerations for those with HCV
Hepatitis C is transmitted via blood, and sexual transmission is rare. Members of the household of a person with HCV should all be tested. Common items that could potentially transmit blood should not be shared, including razors, toothbrushes, and nail clippers. HCV-positive persons should avoid alcohol because it can accelerate liver disease, including cirrhosis and end stage liver disease. HCV-positive individuals should always check with their healthcare provider before taking any over-the-counter (OTC) medications, including Tylenol. Some OTC medications can be potentially harmful to the liver.
Further Information:For further information, visit the CDC website at http://www.cdc.gov/hepatitis/C/ or for general questions and assistance finding a hepatologist, call Carla Robinson, RN, IHTC Risk Reduction Clinician at (877) 256-8837.
- American Journal of Health-System Pharmacy, January 1,2012, Volume 69, Number 1, Telaprevir: An Oral protease inhibitor for hepatitis C virus infection.
- AASLD Practice Guideline; An update on Treatment of Genotype 1 Chronic Hepatitis C Infection: 2011 Practice Guideline by the American Association for the Study of Liver Diseases; Marc G. Ghany, David R. Nelson, Doris B. Strader, David L. Thomas, and Leonard B. Seeff
- Treatment of Viral Hepatitis, Appendix III, Paul Kwo, 2011