Dire Public Health Threat

Former U.S. Surgeon General C. Everett Koop’s put the hepatitis C threat this way in 1998:

“We stand at the precipice of a grave threat to our public health...It affects people from all walks of life, in every state, in every country. And unless we do something about it soon, it will kill more people than AIDS”

Could it be that bad? In a word, yes. More than 3 million people are infected with the hepatitis C virus (HCV) in the U.S. alone — that’s four times the number of HIV patients — and 170 million are infected with the virus worldwide.

Over time, chronic HCV infection can lead to serious liver damage, liver cancer, and early death. Most people are unaware of their infection. It can silently destroy the liver for 20 years or more without being diagnosed. The rate of HCV transmission hit its peak in the United States in the late 1980s.

Progression to Liver Disease

New findings from long-term studies in untreated or treatment-failure patients spotlight the insidious, destructive power of the virus in patients over time. Among 214 patients with genotype 1 HCV (the most common in the US, Europe and Japan) followed for 17 years who never cleared the virus, more than half developed liver failure, 32% developed liver cancer, and 35% died. Similarly, for a large cohort of HCV patients infected with HCV in their 20s, the probability of a patient having to undergo liver transplant and/or dying by 60 years of age was found to be 40%.

A Healthcare Tsunami

HCV is poised to come crashing down on healthcare systems around the world — and the potential costs are staggering. Consider the impact in the U.S. alone: the liver transplant wait list has tripled in size since 1991, with advancing HCV disease a major reason. An estimated forty percent of liver transplants conducted in the U.S. are due to hepatitis C. While the incidence of almost all major cancers in the U.S. has declined over the past 15 years, one major tumor type — liver cancer — has increased in both men and women over the past 5 years, likely due to more patients with advancing hepatitis C disease.

Suggested Reading: Hepatitis C

Specific Targeted Antiviral Therapy for Hepatitis C
Mark S. Sulkowski, MD
Current Gastroenterology Reports, Vol 9, No 1, March 2007, pp 5-13

Future Therapies for Hepatitis C: Where Do We Go From Here?
Samuel Sigal and Ira Jacobson
Nature Clinical Practice Gastroenterology & Hepatology, Vol 4, No 2, February 2007, pp 60-61

Estimating the Future Health Burden of Chronic Hepatitis C and Human Immunodeficiency Virus Infections in the United States
S. Deuffic-Burban, T. Poynard, M.S. Sulkowski and J.B. Wong
Journal of Viral Hepatitis, Vol 14, No 2, April 2007, pp 107-115

Projecting Future Complications of Chronic Hepatitis C in the United States
Gary L. Davis, James E. Albright, Suzanne F. Cook, and Daniel M. Rosenberg
Liver Transplantation, Vol. 9, No 4, April 2003, pp 331-338

Fighting Back

A Curable Disease

HCV is a chronic disease. But unlike viruses such as HIV, hepatitis B and herpes, it is possible to completely rid the body of the HCV virus because it never integrates itself in the DNA of the cell. The goal of HCV treatment is to the clear the virus from the bloodstream: patients in whom HCV cannot be detected 6 months after completing treatment are said to have a sustained viral response—“SVR”—and many clinicians believe that such patients are effectively cured of their viral infection. What the scientific and medical communities — and HCV patients — now seek is to cure more people in shorter timeframes, with more tolerable therapies. Thanks to great strides in HCV research, that goal may now be within reach.

Promising Drugs in the Pipeline

Since the HCV virus was definitively identified in 1989, major advances in understanding its biology and mechanism of replication has led to multiple drug candidates. It is not known precisely how the current standard treatment, a combination of pegylated interferon and ribavirin, works, but it’s thought to be by stimulating the immune system without directly targeting the virus. In the past few years however, a number of novel, specifically target antiviral therapies for hepatitis C (STAT-Cs) have entered clinical trials, including HCV protease inhibitors from Schering-Plough (boceprevir; SCH 503034) and Vertex (telaprevir; VX-950), and HCV polymerase inhibitors from Roche Laboratories (R1626). The hope of investigational compounds such as these is to potentially increase the number of genotype 1 patients who can be successfully cleared of virus.

Whether devising new strategies to optimize the effectiveness of existing drug combinations, or evaluating investigational STAT-C agents in clinical trials, clinical researchers are pioneering new thinking in HCV that challenges longstanding treatment paradigms and provides new hope for hepatitis C patients.