New Drugs Offer Hope For Hepatitis C Sufferers
NEAL CONAN, host: Last month, the Food and Drug Administration announced the approval of two new drugs for the treatment of hepatitis C virus type 1, the first major advance in treatment in years. The good news: the new drugs can leave patients apparently free of the virus. The bad news: according to the Centers for Disease Control and Prevention, as many as three out of four Americans with hep C don't know they're infected and don't seek treatment. Of the over three million Americans infected with hepatitis C, two-thirds are baby boomers, and the CDC may recommend screening for everyone aged 45 to 64.
If you have questions about these new drugs for hepatitis C or if you have experience with the disease, give us a call, 800-989-8255. Email, firstname.lastname@example.org. You can also join the conversation on our website. That's at npr.org. Click on TALK OF THE NATION. With us now is Dr. John Ward, director of the Division of Viral Hepatitis at the Centers for Disease Control and Prevention. He's on the phone with us from his office in Atlanta. Nice to have you with us.
Dr. JOHN WARD: Thank you, Neal. Good afternoon.
CONAN: And congratulations, I guess.
WARD: Yes. This is just a great advance for hepatitis C treatment and increased opportunities for hope and for clearing the virus among the 3.2 million persons living with this infection in the United States.
CONAN: What's different about these drugs?
WARD: Well, they actually work directly on the virus. For many years, we've had therapies that help - either help the immune system ramp up the immune response to combat the virus. That was interferon, pegylated interferon or ribavirin, which is just a general anti-viral that has very general effects in a variety of viral infections, and those are still important for therapy. But what's been brought to bear now with the FDA licensure of these two new drugs is - or agents that really act directly on the virus, greatly increasing the chance of clearing the virus, almost increasing it from an average of about 40 percent clearance with current therapies or previously standard therapy to over 75 percent with the addition of one of these new drugs, while in many cases, shortening therapy from 48 to 24 weeks. So really a huge game change in therapy.
CONAN: And from the way you're saying it, these are taken in combination with the older drugs?
WARD: That's right. They're in addition to these other therapies.
CONAN: And those other therapies, well, they can be awfully expensive. What about these new drugs?
WARD: The older drugs had - were expensive, agreed, as - and these will increase that cost. And so with that, it has to be taken into consideration, but they do, you know, they do add considerable benefits. So there is a tradeoff in both increasing costs but also increasing the benefits to patients.
You know, you still have issues of side effects to be dealt with. There - of the - not every person living with hepatitis C needs to be treated for hepatitis C, and it really has to be based on the progression of their disease and the timing of that therapy.
But what is clear is that every person living with hepatitis C would benefit from knowing it, so they don't unknowingly transmit to others, number one. And then, secondly, to be in care, so that they understand what they can do to protect their liver, such as avoiding alcohol, which is like adding alcohol - gasoline to a flame, and then deciding whether their liver disease is continuing to progress and then therapies would really help eliminate the virus and their disease progression.
CONAN: How could it be that so many people with this disease don't know they have it?
WARD: It's a very silent infection, and hepatitis C is often referred to as the silent epidemic. In fact, even at the time of infection, it tends to be a fairly mild disease that doesn't even prompt people to go seek medical attention. You may just get flu-like symptoms, and then, it becomes very silent. But in that silent period, it's causing the liver to be inflamed. The liver progressively becomes scarred in many instances and put you at risk of liver cirrhosis, which is like end-stage scarring of the liver, where the liver becomes completely dysfunctional, or putting you at risk for liver cancer known as hepatocellular carcinoma.
And indeed, when - I mean, if you look at the cancer death rates, one of the few causes of cancer deaths on the increase is liver cancer and much of that increase is because of hepatitis C.
CONAN: Let's get a caller in on the conversation, 800-989-8255. Peter is on the line in - is this San Francisco? Peter, are you there? I guess Peter has left us. And let's go instead to - this is Mike and Mike is on the line from Fort Myers.
MIKE: Yeah. Hi. Yes, I was medevacked from Vietnam when I was a young man and I was yellow, and they admitted me to Walter Reed Army Hospital and the admission diagnosis said hepatitis. And then, after all these tests and everything, they came back, hepatitis was unproven and tests were inconclusive. So all these years, I've been very sick, especially I cannot even have - I can't even have a teaspoon of alcohol. It gets me seriously ill.
Anyway, about five years ago, my doctor called me and told me he had good news, kind of, for me, that they found out what's wrong with me. He said, you got hepatitis C. Well, I said, well, what can we do? He said, nothing. And I'm - and basically, I've been untreated. And there are a lot of medicines that I can't even take because they got a little bit of alcohol in them. It gets me seriously sick. So I'm really hopefully about hearing about this new drug. It sounds like now there might be a treatment for it.
CONAN: Doctor Ward, I know you can't diagnosis any individual problems on the radio, but might these help Mike?
WARD: Well, that's right. I think it's really important for Mike to go back and talk again about his disease with his physician. But he raises several key points that have been brought out by the Institute of Medicine in a recent review of viral hepatitis, whereby they really recognize the lack of knowledge among many health care providers about the benefits of hepatitis screening, care and now, increasingly, treatment, and how, you know, oftentimes that patients are not presented with an opportunity to benefit from being tested for hepatitis C, and then, if they're positive, to be appropriately managed and even referred for care.
So I think it's really important for our - and we are making this big effort, here at CDC, to begin - to increase our efforts to educate clinicians about hepatitis C, and so that they know about the benefits of screening and increasingly, the benefits of treatment.
He also raises another very important point, that even if you may not need treatment, you know, managing these other issues that can accelerate your progression toward severe liver disease like the intake of alcohol is very important for patients to be aware of, and so that he had another benefit of being in care and knowing your status.
MIKE: OK. Well, can they do anything, though, that - right now, there's - I'm getting absolutely no treatment at all from the VA.
WARD: Well, I think that's, you know, I think that's something that - I don't know enough about your particular condition to make a specific comment about that except to say it's important to go back to your physician to learn more about your disease and then to find out some of the reasons for that. But, you know, CDC does work with the VA. You know, the VA has a very well-developed hepatitis C program.
About five percent of Vietnam veterans are living with hepatitis C, so this is a huge problem for our veterans here in the United States, and the VA has tried to respond to that. So I can only encourage you to go back to your physician and ask him about these new treatments and to see if they are right for you based on their assessment.
MIKE: I'd say anything about what - you know, I'm talking about my case personally, but about what is the general course of treatments that they've been using anywhere, because I was on the impression there was no treatment whatsoever.
WARD: We don't - we like - with this current therapy of - well, the standard therapy of pegylated interferon and ribavirin for a genotype 1, which is the most common strain of hepatitis C in the United States, overall, you can get about 40 percent clearance of - when you look at the persons treated with these drugs. Other types of strains, you even get better responses - upwards to 75 and 80 percent.
As I mentioned, with these new drugs coming out, and as Neal mentioned at the introduction of this segment, these new drugs are only for genotype 1. But for that, most patients will be able to benefit from it if they have medical indications to receive it and then that will increase the chances of clearing the virus, which is essentially represents a cure of this infection from about 40 percent to over 75 percent, while for many patients shortening their duration of treatment.
CONAN: Mike, thanks very much. Good luck.
MIKE: Thank you.
CONAN: Let's - here's an email from Wes in Kingsport, Tennessee: My wife's adopted sister is 14 and currently has hepatitis C with stage four cirrhosis. She was infected with the disease at birth by her biological mother. She's on the list for a liver transplant and is currently taking interferon and ribavirin treatments at the University of Virginia. Are these medications available for younger people? And if not, currently, are there or will there be studies in the near future involving children and adolescents?
WARD: Well, that's a good point. There hasn't been as many studies of these drugs yet in children. I think they - most of the studies that I'm aware of have been among adults. And I think we have a lot more to learn about how these drugs will benefit, you know, special populations such as young persons and adults, I mean, adolescents, excuse me. So I think we have a little bit more to learn about these treatments. But I think, again, this is a rapidly evolving field, so I think it's very important for the parents of this infected child to discuss treatment options with their physician.
CONAN: Let's go next to Steve, and Steve is on the line from Las Vegas.
STEVE: Hi. Thanks for being on the air here, presenting these things. My question is in the understanding of suppression and cure, you're talking about going to 40 percent suppress, to 70 suppress, and that tells me, well, there is still 30 percent virus there. Define that as opposed to, like, bacteria, where you take penicillin and you actually eradicate the bacteria.
WARD: Well, we're not saying 40 percent. I'm talking of up to 70 percent. I'm not talking about suppression and - as we often do for an infection such as HIV, where we use multiple drugs for multiple years to suppress the virus so that persons can - not have adverse effects from that infection, but can actually, you know, can live for many years with that suppression on going. In contrast with these therapies, we're going from a clearance rate, which means the virus is actually eliminated from the system in 40 percent with the current treatments to 70 percent of persons treated with medical indications for therapy...
WARD: ...with the addition of this new treatment. So you're actually talking, essentially, about a cure rate of changing from 40 percent to over 75 percent.
STEVE: And the other question I had is since this is treating something so small a virus, is this type of science of new medications is going to be applicable to things like general herpes, which is supposedly an incurable virus?
WARD: Well, I think for these drugs, what is actually exciting is that we have agents for the first time specific for this virus. So - and then there's - and the pipeline for developing new therapies for hepatitis C is actually very promising, and there's a variety of different agents. So it really begins to raise the specter of moving away from interferon therapy, which does cause side effects, does require injections, to a day where it may have oral therapy that will be as equally effective as what we're seeing now with the addition of the new therapies and perhaps even more so, and embraces the issues of, I mean, it raises the opportunities of really bringing treatment more together with prevention, capturing people early in the course of their infection before they transmit to others, and eliminating that infection and thereby eliminating additional transmission.
STEVE: Last question....
CONAN: I'm sorry, Steve, we have to move on. Thanks very much for the call. Dr. Ward, thank you very much for your time.
WARD: Thank you for your interest, Neal.
CONAN: John Ward, director of the Division of Viral Hepatitis of the Centers for Diseases Control and Prevention. He joined us on the phone from his office in Atlanta. You're listening to TALK OF THE NATION from NPR News.
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