While news of a pandemic captured headlines in 2020, the US continues to battle silent epidemics in population health – opioid use and hepatitis C, to name a few. Given its ‘silent epidemic’ classification by the CDC, hepatitis C has emerged as a major public health issue in the United States. More than 3.2 million Americans are infected according to the CDC, yet as many as 75% are not aware that they carry the virus. The number of acute hepatitis C cases reported in the population more than tripled between 2010 and 2016, and more deaths are attributed to hepatitis C than from all 60 other reported infectious diseases combined.
Hepatitis means inflammation of the liver. When the liver is inflamed or damaged, its function can be affected. Heavy alcohol use, toxins, some medications, and certain medical conditions can all cause hepatitis. However, hepatitis is often caused by a virus. In the United States, the most common hepatitis viruses are hepatitis A, B, and C. The liver infections caused by these three viruses can show similar symptoms, but they affect the liver and are spread in different ways. Hepatitis A is usually a short-term infection, while hepatitis B and C are more likely to remain in the body and cause chronic infection. There are vaccines to prevent hepatitis A and hepatitis B, but there is no vaccine for hepatitis C.
Hepatitis C is spread through contact with blood from an infected person. Today, most people become infected with the hepatitis C virus by sharing needles or other equipment used to prepare and inject drugs. Chronic hepatitis C can result in serious, even life-threatening health problems like liver failure, cirrhosis, and liver cancer. People with chronic hepatitis C often have no symptoms and don’t feel sick, but when symptoms appear, they often are a sign of advanced liver disease.
There are at least six distinct hepatitis C genotypes, or strains, which are genetically different groups of the virus. Knowing the genotype helps inform treatment recommendations and the duration of treatment for those seeking it. Approximately 75% of Americans with hepatitis C have genotype 1, 20-25% have genotypes 2 or 3, and a small number of patients are infected with genotypes 4, 5, or 6. Before a few years ago, existing hepatitis C treatments were either accompanied by adverse side effects, or only effective for certain genotypes of the disease. In 2016, new medication brought widespread treatment opportunity via the ability to treat all six major genotypes of the disease.
Sofosbuvir/velpatasvir, a fixed-dose combination medication, was approved as the most applicable regimen for the treatment of hepatitis C in adults. More than 90% effective for hepatitis C genotypes one through six, the medication inhibits proteins that play a key role in hepatitis C RNA replication. With the therapy, most people take just one pill, once a day for 12 weeks.
Results from Phase III clinical trials of the medication demonstrated that 95 to 99% of patients who received the novel treatment had no virus detected in the blood 12 weeks after finishing the course – suggesting the patients’ infections had been cured. The approval of the combination therapy saw follow-on innovation in the subsequent approval of two other medications to treat all six genotypes of hepatitis C: glecaprevir/pibrentasvir and sofosbuvir/velpatasvir/voxilapresvir. The drug’s approval, prescription, and pace-setting ability have allowed an effective treatment option for a wider scope of patients with the disease. A Top 10 Medical Innovation for 2021, universal hepatitis C treatment is helping community clinicians combat this silent epidemic.