Hepatitis C, or HCV (often called simply hep C), kills 350,000 people every year. Most deaths are caused by cirrhosis (irreversible and catastrophic scarring of the liver) and liver cancer. HCV affects an estimated 130 to 170 million people around the world. There is no vaccine yet that will protect against the acquisition of hep C, but new drugs have been developed that provide a cure for most cases.
In the past, the standard treatment for chronic hepatitis C was an antiviral therapy that combined a pegylated interferon and ribavirin, sometimes call PEG/riba therapy. Patients were also cautioned to abstain from alcohol, which is thought to cause HCV to multiply in the liver. This treatment reduced the viral load, but the disease was considered incurable. Also, interferon cannot be used by all patients, and its side effects can be life-threatening.
Then the U.S. Food and Drug Administration (FDA) approved a trio of new drugs. These drugs can cure hep C in most infected patients, according to the particular genotype of HCV present. These revolutionary drugs are Olysio, Sovaldi, and Harvoni. Of these, simeprevir (Olysio) and sofosbuvir (Sovaldi) are the most effective.
Simeprevir is one of a class of drugs called protease inhibitors. These block a specific protein needed by HCV in order to replicate. Simeprevir is approved to treat HCV genotype 1. It is taken once a day for 12 weeks along with pegylated interferon and ribavirin, followed by 12 to 36 weeks more of the PEG/riba therapy. It has proved to cure hep C 80 percent of the time, according to a 2014 article in the British Medical Journal.
Sofosbuvir is one of a class of drugs called polymerase inhibitors, which block another protein that HCV produces. Sofosbuvir is approved to treat genotypes 1, 2, 3, and 4. According to the British Medical Journal, it has a cure rate of more than 90 percent. Most importantly, it provides a cure without the need for interferon injections in some patients.
The protocol for sofosbuvir is as follows:
With pegylated interferon and ribavirin for 12 weeks to treat genotypes 1 and 4
With ribavirin for 12 weeks to treat genotype 2
With ribavirin for 24 weeks to treat genotype 3
With ribavirin for 24 weeks to treat genotype 1, if a patient cannot take interferon
Haryoni was approved by the FDA in 2014. It is a combination drug that includes sofosbuvir and ledipasvir. Haryoni has been studied in three clinical trials with more than 1,500 participants. At least 90 percent of the subjects taking Harvoni achieved an SVR. Some had been treated for as little as eight weeks.
At the end of 2014, the FDA approved another treatment that was free of interferon, the Viekira Pak. This combination of ombitasvir, paritaprevir, and ritonavir tablets, combined with dasabuvir tablets, treats hepatitis C genotype 1. It is taken for 12 to 24 weeks, and it has proved more than 95 percent effective, according to a report in the New England Journal of Medicine. The Viekira Pak cannot be used by patients in an advanced state of liver disease.
A patient is considered cured of the disease if they demonstrate a sustained virologic response (SVR), meaning their HCV viral load cannot be detected six months after treatment. In rare cases, some of the virus survives and may replicate even after a patient reaches SVR. Also, recovering from hepatitis C does not make a patient immune. It is possible to re-contract the disease with a second exposure.
Finally, although patients can now be cured of HCV, if a person’s liver is in danger of failing, he or she may require a transplant to fully recover.