New hepatitis C diagnosis and treatment
By Rosemary Sparacio

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Hepatitis C, a liver disease that results from infection with the hepatitis C virus, can range in severity from a mild illness lasting a few weeks to a serious, lifelong illness. The infection is often asymptomatic, but chronic infection can lead to liver diseases, which can become apparent after many years. Several new options are emerging that could change the way hepatitis C is treated.


Which new treatment offers the most promise for hepatitis C?
  • 1. Birth cohort screening
  • 2. Telaprevir and boceprevir
  • 3. Sofosbuvir

Hepatitis C is spread primarily by blood-to-blood contact. An estimated 130200 million people worldwide are infected with hepatitis C, and 350,000 people die each year from the disease — 15,000 in the U.S. alone. And the only way to diagnose hepatitis C is to be tested, and early treatment affords many options.

Researchers at the University of Cincinnati have discovered that screening can become more cost-effective when targeting certain populations. According to the CDC, in recently released guidelines, they advocated "birth cohort" screening, not only for hepatitis C, but applicable for other diseases as well. This type of screening is a strategy to target patients born in years within a designated cohort.

In the case of hepatitis C, they are the baby boomer years — 1945 to 1965. It is estimated that one-time testing of everyone in this age group, will prevent more than 120,000 deaths. While this testing could miss some individuals who may be at higher risk — for whatever disease is being targeted — it could make this kind of screening more cost-effective. On the other hand, patients with no risk factors, other than their membership in the "birth cohort," may be at a low enough risk to make their screening less cost-effective.

While there is no vaccine for hepatitis C, it is treatable with antiviral drugs and can result in clearing the virus from the bloodstream in many individuals. Two new drugs, telaprevir and boceprevir, when added to standard treatment, can also increase the effectiveness and shorten the treatment time for many.

On the cutting edge is another drug studied in Phase 3 clinical studies (FUSION and POSITRON), called sofosbuvir, which offers more effective treatment for those who have no other treatment options, either because they could not tolerate or were unwilling to use, or did not respond to the standard treatment. These are patients with two subtypes of the infection — genotype 2 and 3, which account for about 25 percent of hepatitis C infections in the U.S.

Researchers reported in the New England Journal of Medicine that after three months of therapy with sofosbuvir and ribavirin, the patient response rate was 93 percent for those with genotype 2, and 61 percent with genotype 3. There are seven major genotypes of hepatitis C, but most cases are 1, 2 or 3. Genotype 1 is the most common subtype in the U.S. Genotypes 2 and 3 are more common in Europe, and genotype 3 is very prevalent in southern Asia.

According to the lead investigator, Dr. Ira Jacobsen, this new treatment has the potential to achieve the same or higher cure rates as interferon, but can accomplish this in half the time — and with fewer side effects.

Rosemary Sparacio is a freelance medical and technical writer, and she substitute teaches in her current home in South Carolina. Rosemary has always been involved in healthcare and education, starting out in the lab as a med tech and in R&D. Her career lead her to teaching microbiology at a community college, while working in the pharmaceutical industry for Pfizer.