in Treating Hepatitis C Virus
Special to the Journal By
Steven A. Rogers, MD
The Food and Drug
Administration recently approved an extremely promising new treatment for
hepatitis C virus. This new medication, sofosbuvir, marketed under the name
Sovaldi, is considered a major breakthrough for two reasons: it is much more
easily tolerated by patients than previous treatment protocols, and it has
proven to be 80-90 percent effective in curing hepatitis C, representing a
significant increase over previous approaches to treatment. Sofosbuvir, which
works by blocking the ability of the hepatitis C virus to replicate, is a pill
that is taken once a day. It received final approval in December 2013 and is
available now locally.
What is hepatitis
Hepatitis C is a
virus that affects the liver. An estimated 3 million people in the United
States and over 100 million people worldwide have it. This is a virus that often
does not disappear on its own; in most people, if you have acquired hepatitis C,
it will infect your liver for the span of your life and may progress to liver
cancer or cirrhosis of the liver if not successfully treated. Hepatitis C is the
most common cause of liver failure.
typically difficult to treat and hepatitis C is no exception. While it is true
that treatment for hepatitis C has evolved and improved over the past 25 years,
it has historically been difficult for people to tolerate the treatment. An
additional serious drawback has been that many people undergoing treatment for
hepatitis C were not cured.
sofosbuvir compare to previous treatment methods?
For the past 25
years, hepatitis C has been treated with interferon. This is a drug that stimulates
the body’s immune system and can cause many uncomfortable side effects.
Patients treated with interferon had to inject themselves once a week for months
(and in some cases up a year) and many suffered with flu-like symptoms for the
duration of treatment. After all was said and done, the cure rate was only 30
percent. About 15 years ago, we began prescribing an oral medication called
ribavirin, to be taken along with interferon. This combination of medications
increased the cure rate for hepatitis C to around 50 percent. In 2011 two new
medications that directly attack the virus, teleprevir and boceprevir, were
added to the mix and the cure rate climbed to 65 percent. However, a major
drawback that remained was the need to take these new medications along with
interferon. Treatment was long (up to a year) and for many, very difficult to
What are the
factors that influence the cure rate for hepatitis C?
A cure for
hepatitis C has been greatly influenced by the particular strain or genotypes
of the virus. The most prevalent type of hepatitis C is genotype 1. In the
United States, 70 percent of the people infected with hepatitis C have genotype
1, which is the hardest to cure. Genotypes 2 and 3 are much easier to cure.
What are the new
treatment recommendations issued by the FDA?
majority of people infected by hepatitis C have genotype 1, the new
recommendations will be for 12 weeks of interferon, ribavirin, and sofosbuvir.
This treatment regimen, when studied in clinical trials, has resulted in a 90
percent cure rate. Although this combination still includes interferon,
individuals would only need to be treated for three months (instead of up to
one year, as previously required). For those infected with either genotype 2 or
3, treatment would require the medications ribavirin and sofosbuvir only. This
represents the first interferon-free treatment and leads to a 90 percent cure
rate. Side effects associated with the new medications are quite minimal.
Additionally individuals with hepatitis C who were previously treated but not cured
have nearly as good cure rates with these new agents. One major concern among
physicians is the cost of these medications, with estimates as high as $28,000
Who should get
tested for hepatitis C?
The virus is
blood borne. If you had a blood transfusion before 1992, when testing for
hepatitis C in blood donors became standard practice, you should be tested. You
should also be tested if you have shared a hypodermic needle or razor blade, or
engaged in any activity that exposed your blood to that of someone else. The
U.S Preventive Services Task Force is recommending that everyone born between
1945 and 1965 (members of the Baby Boomer generation) be tested for hepatitis
This virus often goes
undetected for many years after the initial exposure. By the time symptoms
appear, you may have sustained liver damage. A blood test is quick and easy. With
this new treatment breakthrough, hepatitis C virus can be cured before it
causes potentially fatal illness.
Dr. Rogers is board
certified in gastroenterology and internal medicine. He serves on the medical
staff of Cayuga Medical Center and is in practice with Gastroenterology
Associates of Ithaca, where he can be reached at (607) 272-5011.