As of Friday, July 18, 2014
DEAR DOCTOR K: My son has a hepatitis C infection, based on a blood test. The doctor says he’s OK now, but could someday become seriously ill. I hear there are new treatments for hepatitis C. Is there reason for optimism?
DEAR READER: Hepatitis C is caused by a viral infection that inflames and damages the liver. (“Hepatitis” means inflammation of the liver.) The hepatitis C virus (HCV) is usually transmitted through contact with infected blood. HCV can cause short-term (acute) or long-term (chronic) hepatitis C. Most people with acute hepatitis C eventually develop chronic hepatitis C.
Hepatitis C may not cause symptoms for 20, even 30, years. Unless they are tested for the virus, many people do not even know that they are infected.
But even without causing symptoms, the virus often is slowly damaging the liver. Eventually, some people develop symptoms such as weight loss, fatigue or aching joints. Hepatitis C virus infections also can lead to cirrhosis (scar tissue in the liver) and liver cancer. (On my website, AskDoctorK.com, I’ve put an illustration showing how HCV damages the liver.)
Not everyone infected with hepatitis C needs treatment. For those who do, the treatment can cause unpleasant symptoms. Until recently, treatment involved up to a year of weekly injections with peginterferon. This is a man-made form of an antiviral substance produced by the immune system called interferon. Side effects include depression, anxiety, anemia and fatigue.
Peginterferon is taken in combination with ribavirin (Virazole), an antiviral drug. The effectiveness of this drug combination varies based on the subtype of the virus you have. (Once you are diagnosed with hepatitis C, blood tests determine your subtype. In the United States, the most common subtype is genotype 1.)
In 2011, the FDA approved two new antiviral drugs that could be taken by mouth. Either of these drugs taken with peginterferon and ribavirin eliminates HCV in up to 90 percent of patients with genotype 1.
In more good news, two studies published earlier this year report that a combination of several oral antiviral drugs clears the virus from the liver in more than 95 percent of people — in just 12 weeks.
Quite a number of viruses infect the liver and can cause serious disease. When I was in medical school, we hadn’t yet discovered most of the viruses that cause hepatitis, and the ones we had discovered accounted for only a small fraction of all cases.
The discovery of the two viruses that cause the most serious liver disease, hepatitis B virus and hepatitis C virus, has been the result of brilliant and painstaking research by many people. This discovery has led to blood tests to diagnose the viruses. Research also has led to a vaccine for hepatitis B, and to the powerful new treatments for hepatitis C virus that you asked about. This research has been funded by a combination of tax dollars and investment by the pharmaceutical industry.
So to answer your question, I believe there is reason for optimism. Your son should discuss these newer treatment options with his doctor to see if they might be able to help him.
(Dr. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.)