This is the most exciting time in 30 years for hepatitis C.
The chance of cure of HCV from antiviral therapy for hepatitis C is now 90%. By the end of 2014 we will be able to avoid the risks and side effects of interferon injections. The treatment length for most patients is now 12 weeks and will fall to 8 weeks in the second half of 2014.
If you are cured, your viral level falls to undetectable during treatment and stays undetectable for the rest of your life. If your HCV-RNA is undetectable 3 months after completion of treatment, you have greater than 95% chance of permanent cure. If your HCV-RNA is undetectable 6 months after completion of treatment, you have greater than 99% chance of permanent cure. Liver damage stops and liver healing starts. This improves survival and often restores health.
Your treatment is determined by the genotype of the HCV virus in your blood. About 80% of American patients have genotype one. About 10% have genotype 2 and about 10% have genotype 3. Only a few American patients have genotypes 4,5 or 6.
Sovaldi (sofosbuvir) is an oral HCV polymerase inhibitor that is combined with ribavirin for patients with genotype 2 and genotype 3. Genotype 2 patients are treated 12 weeks with a success rate of 97%. Genotype 3 patients are treated 24 weeks with a success rate of 85%.
Standard treatment for patients with genotype one is now three drugs for 12 weeks. Twelve weekly interferon injections of either Pegasys or PegIntron are combined with Sovaldi and ribavirin. Sovaldi is taken once daily and ribavirin is taken twice daily. The dose of ribavirin is determined by your weight and kidney function.
Some patients are not eligible for interferon. The most common reason is that their platelet count is very low because of severe cirrhosis. If you cannot take Pegasys or PegIntron, Sovaldi and ribavirin can be given for 24 weeks without interferon with very good results. The success rate drops from 90% to 76% but the risks and side effects of interferon are avoided.
Sovaldi does not have the numerous drug interaction problems found with Incivek (telaprevir) and Victrelis (boceprevir), which are protease inhibitors.
The combination of Sovaldi and Olysio for 12 weeks is effective in curing large numbers of patients with HCV even with cirrhosis. The COSMOS study proved that only 12 weeks of two oral drugs cures HCV even in cirrhotic patients. This is a huge improvement and is very exciting.
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 from 1977 to 1979. I have been a physician for 37 years. I spend about 98% of my time treating patients with chronic viral hepatitis C. I enjoy helping as many patients as possible cure this infection. We will treat 500-1000 patients with HCV this year.
My office: 1009A Dupont Square North, Louisville KY 40207 phone: 502-894-9950
The CDC and the US Preventative Services Task Force now recommend that ALL Americans born between 1945 and 1965 be tested one time for HCV. One-third of persons with HCV die from complications of cirrhosis. We can lower the death rate from HCV if we are aggressive in identifying infected patients. Five million Americans are infected. Make sure that your loved ones have been tested once for HCV.
I am an advocate for patients infected with HCV. The medical insurance companies and the Veterans Administration block patients from starting or completing treatment. I have seen many curable patients fail because of this. Stage 3 and stage 4 HCV liver disease is life threatening and should be covered like cancer, heart disease and kidney dialysis. HCV cirrhosis is just as deadly as these other life-threatening diseases. Patients with HCV should not face discrimination and denial of antiviral therapy.
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.
Bennet Cecil, MD