Top 10 for 2021: #5: Universal Hepatitis C Treatment

Top 10 for 2021: #5: Universal Hepatitis C Treatment

Classified as a silent epidemic by the CDC, more than 3.2 million Americans are infected with Hepatitis C, and as many as 75% are unaware they carry the virus. Spreading through contact with blood from an infected person, Hepatitis C is a virus that causes liver inflammation that can result in liver failure or cancer. Currently, there are no vaccines to prevent Hepatitis C infection.

There are at least six distinct Hepatitis C genotypes or strains, which are genetically different groups of the virus. Until now, treatments were either accompanied by adverse side effects or only effective for certain genotypes of the virus. New combination medications have the ability to treat all six major types of Hepatitis C.
Results from phase three clinical trials of a recently approved combination medication showed that 95% to 99% of patients who received the treatment had no virus detected in the blood 12 weeks after finishing the course. The new multi-strain Hepatitis C therapy has allowed an effective treatment option for a wider scope of patients, helping clinicians combat this silent epidemic.

Akhil Saklecha, MD:
Hi, this is Dr. Akhil Saklecha from Cleveland Clinic Ventures. Today we're going to be talking about #5 on our Top 10 Medical Innovations list, ‘Universal Hepatitis C Treatment.’ With me today is Dr. Bobby Zervos, Associate Chair, Center for Abdominal Transplantation at Cleveland Clinic Florida. Dr. Zervos, we just saw in the summary video that Hepatitis C affects almost 3.2 million people in America. Obviously, that's a big number. It's something that we need to know quite a bit more about, and therapy for this is critical. What can you tell me about this new therapy?

Bobby Zervos, DO:
These direct-acting antivirals have been available now since 2014, and they truly have revolutionized liver disease, specifically for the treatment of Hepatitis C. Prior to that, our patients suffered immensely, as the previous regimen of medications often had more side effects than actually having the virus itself. And since 2014, not only have the side effects from these medications been virtually non-existent, but we're also seeing success and cure rates of greater than 98%, 99%, which over five years ago was completely unthought-of.

Akhil Saklecha, MD:
So how is this different from other treatments that we're using now for Hepatitis C? Is this substantially better?

Bobby Zervos, DO:
Yeah, so there's four different versions of these direct-acting antivirals. Each one attacks a different area along the genome of the virus. So in combination therapy, they're actually successful in not only suppressing the virus, but what is complete eradication of the virus. Where previous treatment, the success rate, at best, in individuals who did not have cirrhosis and had a specific strain of the virus, was maybe 65% to 75%. Now we're seeing success across the board with all the genotypes, whether there's scar tissue present, no scar tissue present, with again virtually no side effects with any of these combination medications.

 Akhil Saklecha, MD:
Now, you brought up the word genotyping. So it sounds like understanding the strain of Hepatitis C plays a role here. I know that in prior treatments, the strain was impactful to understand. Is that still the case here? With the multiple strain treatment, is that something we need to look at at all?

Bobby Zervos, DO:
So now that we have second and third generations of these direct-acting antivirals, the genotype or the strain is completely irrelevant in terms of susceptibility to treatment and eradication rate.

Akhil Saklecha, MD:
Does it matter whether the patient is treatment-naive or has cirrhosis?

Bobby Zervos, DO:
So in the past, that was significant to the likelihood of outcomes. Now with these new medications, again, cirrhosis, treatment-naive, or experienced really make no difference in terms of treatment success.

Akhil Saklecha, MD:
So it sounds like really we've taken a lot of the factors that were more barriers in treatment and eliminated them with this new type of treatment option. How is it impacting patient lives?

Bobby Zervos, DO:
Well, it really, like I said, has been revolutionary. I'm a transplant physician, and many of the patients that we see for transplant come with Hepatitis C-related cirrhosis and complications, including liver cancer. Now with the eradication of the virus, it really has opened the doors in terms of what we can do not only pre-transplant but more importantly, post-transplant. So with the unfortunate burden of street drugs, there's been a lot of unfortunate donors that have had irreversible damage from anoxic brain injury. So from the head down, these individuals, unfortunately, are leaving behind perfectly healthy organs that, because of the Hepatitis C previously, we were not able to use for transplant. Now with these medications, the success rate post-transplant is equal to that in pre-transplant or in individuals who don't need transplants. So, we're actually able to use organs from donors that are infected with Hepatitis C into individuals who have never had Hepatitis C, infect them with the virus, and then successfully treat them post-transplant and eradicate the virus.

By doing this, it has allowed us to significantly increase the number of organs available for transplant and potentially decrease the number of individuals waiting on the list. And not just for the liver. We've been able to do this successfully in heart transplant recipients and kidney transplant recipients, as well.

Akhil Saklecha, MD:
Wow. It sounds like it's making quite a difference. So I want to thank you, Dr. Zervos, for taking the time today to discuss the innovation that is ‘Universal Hepatitis C treatment’ – #5 on our Top 10 Medical Innovations list for 2021.

Bobby Zervos, DO:
My pleasure. Thank you.
 

To read more about #5, click here. To watch the full one-on-one interview with Drs. Saklecha and Zervos, click here.

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