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Hepatitis C: What's New

Hepatitis C virus (HCV) can cause both acute and chronic hepatitis. The acute process is self-limited, rarely causes hepatic failure, and usually leads to chronic infection. Chronic HCV infection often follows a progressive course over many years and can ultimately result in cirrhosis, hepatocellular carcinoma, and the need for liver transplantation. Chronic hepatitis C is one type of hepatitis virus. It is spread when a person is exposed to the blood of another person who has the virus. Seventy-five to 85 percent of people who are exposed to the chronic hepatitis C virus develop chronic hepatitis C. Chronic hepatitis C is a lifelong infection that may damage the liver. Three to 4 million people in the United States have chronic hepatitis C. Eighty percent of them don't know they have it. That's because they don't necessarily look or feel sick. It is important to be tested for chronic hepatitis C if you think you may be at risk.



Risk factors:


People with tattoos or body piercing done with non-sterile equipment


People who received an organ transplant or blood transfusion before July 1992


People with clotting problems who took blood products prior to 1987


People receiving hemodialysis or who have a history of hemodialysis for kidney failure


People with HIV infection.


Since July 1992, all blood and organ donations in the U.S. are screened for the hepatitis C virus. According to the CDC, the number of hepatitis C infections declined by 90 percent from 1994 to 2006, partially as a result of this. Since 2006, the number of new infections each year has remained relatively stable.



Symptoms:


Many people who get hepatitis C do not experience symptoms for a number of years. Consequently, many do not find out they have the virus until they take a blood test for other reasons. In people with chronic hepatitis C, symptoms may include:


Fatigue


Upset stomach and diminished appetite


Joint and muscle pain


Also, patients may experience symptoms related to liver cirrhosis, such as:


Jaundice, which is a yellowing of the skin and eyes


Urine of a dark yellow color


An increased tendency to bleed or bruise


The presence of hepatitis C infection can be determined by a blood test checking for the presence of antibodies to the virus. The CDC has recommended that everyone born from 1945 through 1965 get a blood test for hepatitis C.



Treatment:


The goal of antiviral therapy in patients with chronic HCV is to eradicate HCV RNA, which is predicted by attainment of a sustained virologic response (SVR). An SVR is associated with a 97 to 100 percent chance The decision to treat a patient with chronic hepatitis C virus (HCV) infection is based upon several factors, including the natural history and stage of the disease, the efficacy of therapy, and potential side effects. In general, patients being considered for treatment should have histologic and virologic evidence of chronic HCV infection. When identifying patients who are candidates for treatment, factors that are associated with a favorable response (e.g., HCV genotype 2) should be weighed against factors associated with a lower likelihood of response of being HCV RNA negative during long-term follow-up and can therefore be considered cure of the HCV infection . Attaining an SVR has been associated with decreases in all-cause mortality, liver-related death, need for liver transplantation, hepatocellular carcinoma rates, and liver-related complications, even among those patients with advanced liver fibrosis.



New Medications/Treatment


Hepatitis C treatment is on the cutting edge of medicine. Treatment of hepatitis C evolved from monotherapy with Interferon to Infergen and ribavirin combination to Interferon, ribavirin and protease inhibitors. Recently FDA unanimously approved Sofosbuvir for the hepatitis C genotypes 1,2, 3 and genotype 4.


Sofosbuvir and simeprevir for genotype chronic 1 Sofosbuvir, a hepatitis C virus (HCV) polymerase inhibitor, and simeprevir, an HCV protease inhibitor, are currently becoming available in the United States and elsewhere for treatment of chronic genotype 1 HCV infection. Regimens that include these agents offer high sustained virological response (SVR) rates, more favorable adverse effect profiles than earlier regimens, ease of administration, and relatively short treatment durations . However, regimens for genotype 1 infection generally continue to include interferon. Interferon-free regimens are expected in the near future, and it is reasonable for many patients to defer treatment while awaiting newer therapies. Most patients with chronic genotype 1 HCV infection who are candidates for and desire therapy at this time should be treated with peginterferon, weight-based ribavirin, and a direct-acting antiviral (DAA). If available, we recommend the DAAs sofosbuvir or simeprevir rather than telaprevir or boceprevir



Sofosbuvir for genotype 2 and 3 chronic hepatitis C infection


Sofosbuvir, a hepatitis C virus (HCV) polymerase inhibitor, is becoming available in the United States and elsewhere for the treatment of genotype 2 and genotype 3 chronic HCV infection. Despite relatively high sustained virologic response (SVR) rates with only 24 weeks of peginterferon and ribavirin among most patients with genotype 2 or 3 infection, the many contraindications and side effects associated with interferon have precluded therapy for many patients. Thus, the introduction of sofosbuvir, which offers the possibility of an effective, well-tolerated, all-oral, interferon-free regimen for most genotype 2 and 3 infected patients , represents a major milestone in the management of chronic HCV infection. Where available, for most patients with chronic genotype 2 and 3 HCV infection, we recommend the combination of sofosbuvir and ribavirin, rather than peginterferon and ribavirin.


For patients who are treated with interferon, the common side effect of depression can be prevented with antidepressants. Randomized trials have previously yielded conflicting results about the benefits of prophylactic antidepressants, but meta-analyses have found that prophylaxis is beneficial. A new analysis of eight trials including nearly 600 patients compared antidepressants (selective serotonin reuptake inhibitors) with placebo for preventing depression in patients who were about to start interferon for hepatitis C or malignant melanoma . Major depression was less likely to occur during interferon treatment in patients who received antidepressants (odds ratio 0.4).


Srinivas Seela, MD, completed his fellowship in Gastroenterology at Yale University School of Medicine. He is board certified in both Internal Medicine and Gastroenterology.



 
 
 
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