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HEPATITIS DOCTOR HOME since October 1998

Welcome to patients with chronic viral hepatitis B or C and to their loved ones. The FDA approved

Incivek (telaprevir) on May 23rd. It allows us to cure 2/3 of patients. Most will only need 24 weeks

of treatment instead of 48 or longer since Incivek (telaprevir) rapidly reduces HCV-RNA. If you are

cured, your viral level falls to undetectable during treatment and stays undetectable the rest of

your life, after you stop the medications. If your HCV-RNA level becomes detectable in your blood,

you were not cured. If your HCV-RNA is undetectable 6 months after your last injection of

interferon, you have a 99% chance of permanent cure. Liver damage stops and liver healing starts.

This improves survival and often restores health. You can read the PDF file of my poster from AASLD,

that demonstrates improved survival when HCV is cured. PDF file of AASLD poster 2011

I add information to this web site as often as I can, and I want to make it a resource for patients whom

are often incorrectly told that they cannot be helped. The opinions expressed here are entirely my

own, and are based on my experience in treating more than 3,000 patients with hepatitis C.

I am especially excited about the new oral medicines for patients with hepatitis C. I am a board

certified in internal medicine and gastroenterology. In addition, I completed 2 years of residency

in pathology at Duke University Medical Center. I have been a physician for 34 years. I spend about

95% of my time treating patients with chronic viral hepatitis C. I enjoy helping as many patients as

possible cure this infection.

I am very excited about the HCV protease inhibitor from Vertex Pharmaceuticals called VX-950. The

generic name is . The brand name is Incivek. It is taken by mouth every 8 hours and drops

the viral level by about 99.9% in less than a week. When combined with Pegasys plus ribavirin, it greatly

improves the cure rate in genotype one patients. Telaprevir plus Pegasys and ribavirin eliminated HCV

in 75% of patients in the ADVANCE study with only 24 weeks of therapy. This treatment was

successful in 62% of African-American patients and 62% of patients with stage 3 or stage 4 fibrosis

(cirrhosis). Only 7% of patients had to stop the treatment because of side effects. Another HCV

protease inhibitor, , from Merck is also promising. We expect 2011 to be a happy year for

patients with HCV now that the FDA has approved these medicines. Incivek Prescribing Information Link

If you have previously failed or could not tolerate standard antiviral therapy, you should consider

individualized therapy. Some patients need to start with lower doses of interferon.

If there is no response, Infergen 15 mcg daily plus ribavirin eliminates HCV in about 10% of patients

Ribavirin does not add much to the fall in the viral level. It is the interferon that is the muscle drug.

Ribavirin does not transform a nonresponder into a responder. What ribavirin does is greatly reduce

the chance of viral breakthrough (HCV-RNA falls with treatment, but then rises even

though treatment is continuing) or relapse in patients who respond to interferon. A relapser is a

patient who became undetectable for HCV-RNA on her previous treatment, but the virus came back

when the treatment ended. Cirrhotic patients who take telaprevir or boceprevir plus pegylated

interferon plus ribavirin have more success with shorter duration of treatment. Many succeed with

The CDC now recommends that Americans be tested for HIV routinely. They should have also

recommended that all American middle aged persons be tested for HCV and HBV. Their data indicate

that 7.1% of men and 2.3% of women between 45 and 49 are infected with HCV. Identify infected

persons and offer treatment is the logical strategy. We can lower the death rate from HCV if we are

aggressive in identifying infected patients. Cure the curable patients and lower the death toll.

Five million Americans are infected and we can cure TWO MILLION TODAY with currently available

I am an advocate for patients infected with HCV. The medical insurance companies place too many

obstacles to block patients from going on or staying on the medications. I have seen many curable

patients fail because of this. Medicaid cancels Rx Even though treatment is now less expensive and

more effective, the insurance companies are shifting more of the cost of treatment to patients.

Stage 3 and stage 4 HCV liver disease is life threatening and should be covered like cancer treatment,

coronary artery bypass surgery and kidney dialysis. HCV cirrhosis is just as deadly as these other

life-threatening diseases. Insurance companies should not discriminate against treatment of HCV, just

I can give information, but cannot practice medicine over the internet. Patients with HCV should

consult a knowledgeable medical provider who treats large numbers of HCV infected patients

You can find more HCV information in the links below and the links on the left side of this page.