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The thrill of curing hepatitis C and the pain of observing the disease with opioid abuse



(THE CONVERSATION) – (The Conversation is an independent and nonprofit source for news, analysis and comments by academic experts.)

When I was in the early 1980s in Hong Kong my medical Career started, I decided on Hepatitis B, in part because it was very common and because the Hepatitis C virus had not been discovered yet.I was witness to the devastation that caused this virus – cirrhosis, liver failure and liver cancer – and the lack of treatments that we could offer to patients, at the time scientists knew there was another type of hepatitis, but no one could identify them, so we called them non-A, non-B hepatitis, I never imagined In the course of my career in 2014, I witness the discovery of what is known as Hepatitis C, and the development of a cure for almost all patients with chronic hepatitis C would be.

Developing Treatments Other researchers and I have seen in the last 30 years the amazing advances that have made the field tackle hepatitis C in a relatively short period of time. Initially, in the late 1980s, before a diagnostic test became available, some physicians began to treat well-characterized cases of non-A, non-B hepatitis (Hep C) with interferon, a natural protein used by the body Combating viruses produces ribavirin, an antiviral drug. These drugs were not specifically developed for hepatitis C, had to be given as injections for 6-12 months, had many side effects, and cured only half of the patients treated. It took more than two decades before the first direct-acting antiviral drugs were approved by the FDA.

I remember the excitement as me and my colleagues tested one of the new drug combinations in patients and decreased the virus count from more than 1 million to less than 20 within two weeks. We published the results of our pilot study in the New England Journal of Medicine in 2012. Although the study included only 21 patients, this was considered a turning point as it was the first study that could detect a combination of oral pills without interferon hepatitis C. [19659007] Effective treatment for hepatitis C has become even more important today, given the recent increase in new cases of hepatitis C due to the increased use of opioids.

An expensive drug and new generics

The first two-drug combination pill that inhibits various levels of hepatitis C replication was approved by the FDA in 2014. This pill is taken once a day for 8-12 weeks, has little to no side effects and improves the cure rate to 90-95 percent. It was hailed as a magical remedy, but it came with a price of US $ 94,500 for a 12-week treatment. As a result, many insurers in the United States and national health departments in other countries restricted access to treatment.

Since then, several other combination pills with similar cure rates that are equally well-tolerated have become available and the cost has dropped markedly. In addition, cheap generics and special price agreements are available in many countries with limited resources.

While the current price for hepatitis C virus medications is still very high, one must remember that this is the case in 95 percent of patients undergoing a cure. It's different than medications for many diseases that have to be taken for a long time, sometimes for the rest of the patient's life. In fact, a cure for the hepatitis C virus has enabled some patients on the liver transplant waiting list to reverse their liver failure, making transplantation unnecessary. This is good news not only for these patients, but also for others on the waiting list.

The remarkable success of hepatitis C treatment has revived efforts to cure hepatitis B. Current treatments can suppress hepatitis B replication but do not eliminate it. Most patients must receive long-term treatment to prevent hepatitis flashes when the virus recurs after treatment is stopped.

Deaths from Hepatitis B and C Infections Worldwide

Learning from the Hepatitis C Experience and Having a Better Understanding of the Biology of the Hepatitis B Virus and Improved Animal Models, Drugs Available at Different Levels of the Hepatitis B Virus Target hepatitis B virus life cycle are being developed. While the cure for hepatitis B is more challenging because it can integrate into the patient's DNA to escape the patient's immune response, I am optimistic that we will see a new combination of drugs that bring us closer to the goal a Hepatitis B Virus Cure

But the news is not all positive. While mortality rates of HIV, TB and malaria have fallen in recent years, mortality from hepatitis B and C has increased. Worldwide, an estimated 257 million people have a chronic hepatitis B virus infection and 71 million have a chronic hepatitis C virus. Together, hepatitis B and C caused 1.34 million deaths in 2015. This prompted the World Health Organization to call on countries around the world to develop national plans to eliminate these two viruses by 2030.

Hepatitis B virus and hepatitis C virus usually spread contact with blood or body secretions such as semen from infected individuals by sharing needles or sexual exposure. But they can also be spread over contaminated needles that are used for medical treatments and continue to exist in many parts of the world. In addition, the hepatitis B virus can be transmitted from infected mothers to newborns unless vaccinated immediately after birth.

About two thirds of chronic hepatitis C virus suffer from chronic infection. In hepatitis B virus, the later a patient encounters the virus, the likelihood of chronic liver infection decreases: 90 percent if infected in infancy; 20-30 percent if they became infected during childhood; and 2-5 percent when infected in adult life. Some people who are infected with the hepatitis B virus or the hepatitis C virus can recover on their own, but many develop chronic infection (more than six months and often years or a lifetime). Patients with chronic infection are at risk of cirrhosis (severe liver damage), liver failure and liver cancer

Opioid epidemic, homelessness leads to an increase in hepatitis B and C infections

In the United States, the Number of new hepatitis B virus and hepatitis C virus infections has declined for many years, but this trend has been reversed in recent years due to the opioid epidemic, as more people injecting drugs, sharing needles or other paraphernalia and practicing high-risk sexual behavior. This is especially true for hepatitis C, where the incidence of new cases has more than doubled in the last 10 years, highlighting the need for a preventive vaccine, which is an important tool in eliminating hepatitis C. New cases of hepatitis B are smaller and are mainly seen in adults in the 30s, as most younger people have benefited from a hepatitis B vaccine.

When we talk about viral hepatitis, the focus is on hepatitis B and C because they can become chronic infection, while hepatitis A only causes acute infection and will not lead to cirrhosis or liver cancer. However, since the end of 2016, many states in the US have experienced a hepatitis A outbreak. Between January 2017 and April 2018, the Centers for Disease Control and Prevention (CDC) received more than 2,500 reports of hepatitis A associated with human-to-human transmission of risk factors in two-thirds of these drug use or homelessness cases or both. In the state of Michigan, where I live, 859 cases of hepatitis A were reported between July 2016 and June 2018, including 27 deaths. We can prevent hepatitis A through vaccinations and improved hygienic conditions.

We celebrate World Hepatitis Day on July 28, a day in honor of the late Dr. Baruch Blumberg, who won a Nobel Prize for the discovery of the hepatitis B virus, admires how much progress we have made over the last three decades and is pleased to be not just an observer, but also a contributor to progress. Our work is not finished. Much more needs to be done to completely eliminate new cases of viral hepatitis and death from chronic hepatitis B and C.

This article was originally published on The Conversation. Read the original article here: http://theconversation.com/the-thrill-of-curing-hepatitis-c-and-the-pain-of-watching-the-disease-surge-with-opioid-abuse-99568.


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