Recent headlines show that more people died of Hepatitis C than HIV last year. Since Hepatitis C is now known to be more sexually transmitted than before, MSMs (men who have sex with men) should be routinely checked for Hepatitis C. Some will live 20 years or more with Hepatitis C and not know they have it until it is too late. Some will live shorter. You can feel fine up to that point, so testing is very important if you are at risk: former needle user or MSM or anyone who had sex with someone in these groups. If you can’t be sure (and who can?) then get checked.
I will discuss the oldest, the older, the newer, and the newest treatments for hepatitis C. Also I will discuss the chance of success with treatment when a person also has HIV.
If you start treatment for Hepatitis C, you should stop it if it isn’t working. We check a viral load at 1 month and 3 months, and if they haven’t dropped enough, you’ll be told that the medication is not working. If it is working, most will need to take medications for about a year. You are committing to 1 month, then a total of 3 months, then a total of 12 months—in stages. You can always stop if it isn’t working or the treatment is too hard on you. But you have a chance of being cured for life and that is hard to pass up. I will be discussing the treatment of the very common genotype, genotype 1.
Interferon & Ribavirin
The Interferon was injected daily and caused flu-like symptoms in some. Ribavirin was taken twice a day and in some it causes anemia.
Peg-Interferon & Ribavirin
After adding a long chain of molecules to the interferon, pegylation, they found that the injection of interferon could last a week. So now the patient can time when they might feel weak, feverish, or achey to the weekend if employed the other days, or to Monday so they could feel good on the weekend. Ribavirin is also given as before. The side effects usually are quite apparent in the first month so we can deal with them. Some become depressed or irritable on the interferon, and need treatment for that. Many are able to stay employed with careful handling of the possible side effects, good communication with the clinic, and timing of the dose.
Peg-Interferon & Ribavirin & new pills (two are available and not taken the entire year)
For years we have known that there are many with Hepatitis C in the world and that there is a great need for medication. After many years of development, 2 new medications are approved for Hepatitis C. As with HIV and Tuberculosis we have a similar stage of medication development and strategy; we add the new treatments onto the old until there is a great leap of success so that we can start eliminating the more toxic medications. This virus, like HIV and Tuberculosis, develops resistance if the treatment is weak.
These two new medications have increased the success rates to greater levels, from around 44%.
Boceprevir is a pill taken with food three times a day, and not at the time of the ribavirin. So you have to really pay attention every day to the time. It should be taken for 24-44 weeks. This pill is in addition to the peg-interferon for up to a year. The common side effects may be anemia and changes in taste. Boceprevir has studies showing success in 63-66% of those who took it.
Telaprevir is taken the same way as Boceprevir and is taken for 12 weeks while on the peg-interferon for up to a year. Common side effects may include: rash, anemia, itching, nausea, diarrhea. Most of these can be controlled enough to continue treatment. Telaprevir has studies showing success in 69-75% of those who took it.
HIV CO-INFECTED WITH HEPATITIS C
More data is needed to confirm how strong these new medications are with those who have HIV and Hepatitis C. Roughly 15-30% are cured with the peg-interferon and ribavirin. This is not very encouraging. Recently reported studies showed that in these patients the cure rate was 61 % for boceprevir and 74% for telaprevir. Boceprevir may lower the protease inhibitor levels in those taking these HIV medications. More studies are planned.
EVEN NEWER MEDICATIONS
Here is a list of new activity on discoveries in treating Hepatitis C (per medfrontiers.com):
Johnson & Johnson’s drug TMC435, Bristol-Myers Squibb’s daclatasvir (BMS-790052). In November 2011 Gilead Sciences bought Pharmasset for $11 billion in cash. The company plans to apply for US approval of its experimental drug, PSI-7977, in the second half of 2013. Companies including Inhibitex Inc. and Achillion Pharmaceuticals Inc. are also racing to develop medicines for the virus.
Roche Holding AG, based in Basel, Switzerland, agreed in October 2011 to buy Anadys Pharmaceuticals Inc., another maker of experimental medicines for hepatitis C.
The only way to get a chance to take the latest medications which have lately shown a leap in strength is to seek out a clinical trial.
WHAT IF YOU HAVE ALREADY FAILED HEPATITIS C TREATMENT
Your liver specialist can advise you. There are limited spaces in trials that specifically include those who have failed the oldest, older and even the newer treatments.
OK, WHERE DO I GO TO GET THE LATEST TREATMENTS?
I looked at clinicaltrials.gov and found these sites. Look for a city near you and call the contact them. If there isn’t a trial ready for you there may be one in the future; keep checking back. Be aware that they only want patients who are serious, who are not using drugs or alcohol, and can make the appointments. If you can’t complete the trial, it hurts you and the process of finding a better cure for Hepatitis C. No one will blame you if you don’t have success or the side effects are too strong for you. Here is the list:
• Southern California Liver Centers
– Riverside, Studies–619-522-0399 EXT 501.
• Other offices-San Clemente, Coronado, Chula Vista, Mission Viejo, Palm Springs
· Dr. Somerro, Palm Desert 760-346-3430
· Desert Medical Group, Palm Springs 760-320-9505
· USC, Los Angeles
· Aids Healthcare Foundation Los Angeles (310) 657-9353
· Aids Research Alliance, Los Angeles
· Cedars-Sinai, http://goo.gl/S2Wk3 1-866-634-4372
· Kaiser, Los Angeles (members only?) 323-783-7404 ·
· UCLA, Los Angeles
· Harbor UCLA, Torrance
· Dr. Pockros, La Jolla, CA 92037 858-554-8879
· UCSD, San Diego
Wear condoms 100% and get HIV tested routinely.
Keep those questions coming.
Daniel Pearce, D.O., FACOI, AAHIVS
Associate Clinical Professor of Internal Medicine, Loma Linda University
HIV Specialist, Riverside County Public Health Department