"Q: Will we be able to wipe out hepatitis C entirely?
A:
In contrast to HIV, we do have the capability of doing that -
essentially curing everyone who got infected. While we have made
tremendous progress against HIV, we still don't have a cure, we still
don't have a vaccine. The situation for HCV is dramatically different. A
cure is achievable. Someday soon, the cure using an interferon-free
cocktail is going to be routine...."
----------
Until now, I thought it was likely that this disease would kill not only my imprisoned friend Davon,
sick as a dog on interferon right now, but also my big brother, who
hasn't been able to get treatment - both I feared would die very
painfully, at an early age.
This news gives me
hope, though. We have the capability to wipe out this disease and cure
those who are ill right now - the question remains: do we have the
collective will? That much, I still don't know.
Nearly
6,000 AZ state prisoners have tested positive for the Hepatitis C
virus, but only a fraction are deemed eligible for a miserable course of
interferon treatment because it costs so much and takes such a toll on
body and mind. Many drop out from the side effects, having to face
debilitating and fatal liver disease instead. Most public health
estimates put the jail/prison population at being over 50% HCV+. Imagine
how hard it is already to see loved one do time and maybe even make
amends for their crimes in prison, and come home only to find that they
were sentenced to die from an infectious disease, as well.
For
those who don't care about prisoners, though, think about this: since
95% of then return to the free world eventually, that means there's
already an epidemic in communities with high rates of poverty,
unemployment, homelessness, felonization, incarceration, uninsured
persons, IV drug addiction, HIV/AIDS, and other compromised populations.
It also disproportionately affects people of color, the LGBTQ
communities, and Baby Boomers. That's a huge public health problem that no one in Arizona likes talking about - why are they so silent now, I wonder? Surely they've heard this by now.
It sounds like it's time for the AZ DOC and Wexford to re-write their
Hep C treatment protocols, in any case, in order to assure that the
standard of care they provide to prisoners with the virus (HCV) is
consistent with the community's new standard. Otherwise, they can both
expect to be named in a new class action lawsuit
soon, I'm sure. I'd think the public at large could even sue the state
for having an infected population unleashed on us - uneducated,
untreated, unsupported, uninsured, and unwell.
remembering those we have already lost...
we must accelerate the fight for the living.
Fight the spread of HEP C today:
Phoenix Art Museum: Art of Resistance
Prisoners' Justice Day Guerilla Installation
August 10, 2012
--------from the San Francisco Chronicle----------
Erin Allday / San Francisco Chronicle
Tuesday, September 11, 2012
Earlier this year, an editorial in the
New England Journal of Medicine
declared that the world was in a "watershed moment" in the history of
treatment for hepatitis C, a virus that is believed to infect roughly
180 million people globally. Dr.
Warner Greene, director of the
Gladstone Institute of Virology and Immunology
in San Francisco, agrees wholeheartedly - and believes that with recent
advances in treatments and a cure, the world could be on the cusp of
nearly wiping out the virus.
Q: What does the hepatitis C virus do to the body?
A:
This is an RNA virus that infects hepatocytes, cells in the liver.
That's why you ultimately get hepatitis, or inflammation in the liver,
and that can progress on to cirrhosis. About 20 percent of people
spontaneously clear the hepatitis C virus, and of the rest, about 20 to
25 percent will progress to cirrhosis, and eventually end-stage liver
disease. Hepatitis C is the leading reason behind liver transplants in
the United States.
Q: For many years, hepatitis C has been treated with interferon. What is interferon?
A:
Interferon is a type of protein called cytokine. It normally triggers
an antiviral response in the body. It inhibits key steps in the
(hepatitis C) virus life cycle that allow it to replicate. But it's
doing it at a cost. Cytokine is pretty toxic. It makes patients
very sick.
Q: Last year the Food and Drug Administration approved new drugs to treat hepatitis C. How do they work?
A:
It's just like with HIV - you're attacking multiple, key proteins
needed for the hepatitis C virus lifecycle. Now you have these small
molecules that are attacking the virus itself, as opposed to trying to
induce an antiviral response, like with interferon.
These drugs
are proving to be just dynamite. We're very close to being able to cure
everybody of hepatitis C. The natural history of hepatitis C virus
infection has been fundamentally changed.
Q: Why has hepatitis C been so hard to treat historically?
A:
One thing that limited progress was the lack of an infectious molecular
clone to use in the laboratory to test drugs. It was only in the last
few years that an infectious molecular clone came out of Japan. Before
that, none of them fully replicated (in the lab). When the molecular
clones came along progress just took off at light speed.
Then the
blueprint for working on HIV became very informative - protease
inhibitors, polymerase inhibitors, they were all targeted very quickly,
by multiple pharmaceuticals. Many of the pharmaceuticals just moved
their HIV discovery teams into HCV. Progress has been made so rapidly
here because the trail had been blazed by all of the HIV drugs.
Q: Will we be able to wipe out hepatitis C entirely?
A:
In contrast to HIV, we do have the capability of doing that -
essentially curing everyone who got infected. While we have made
tremendous progress against HIV, we still don't have a cure, we still
don't have a vaccine. The situation for HCV is dramatically different. A
cure is achievable. Someday soon, the cure using an interferon-free
cocktail is going to be routine.
Then it becomes more of an
implementation issue - how you distribute these drugs, what you charge
for them. There are 180 million people infected worldwide, five to six
times the size of the HIV epidemic, and many are living in resource-poor
settings. We're going to have to figure out how to deal with the
developing world.
Erin Allday / San Francisco Chronicle
Updated 4:09 p.m., Wednesday, September 12, 2012
Scientific breakthroughs, one piled on top of another at
breakneck speed over the past few years, have put medical researchers on
the cusp of curing almost everyone who suffers from hepatitis C, if not
wiping out the disease entirely.With 180 million people in the
world thought to be infected with the virus - 12,000 of them in San
Francisco alone - that's potentially a huge public health coup, doctors
and scientists say.
In a little more than a decade, a virus that was once almost untreatable could be made nearly extinct.
"It is just a remarkable moment in the history of hepatitis C," said Dr.
Warner Greene, director of the virology and immunology division at the
Gladstone Institute
in San Francisco. "I think hepatitis C and its sequela - liver cancer,
cirrhosis, liver transplants - can largely be gone in the future. We
just won't have to worry about it."
In the past year, new
treatments have come out that already have doubled the number of people
who can be cured of hepatitis C. Now the race is on among drug
developers to market the first medical cocktails that would cure almost
everyone on the planet, and do it safer and faster than the best
treatments currently available.
New treatments - both those
already available and those expected to be approved in the next five or
so years - were a large part of the reason the
U.S. Centers for Disease Control and Prevention recommended this summer that all Baby Boomers get screened for hepatitis C.
That
generation is thought to have the largest number of undiagnosed cases
of the disease, with so many of them potentially exposed to the virus in
the wild, drug-friendly hippie years of the '60s and '70s. Until
recently it wasn't practical to screen millions of people for possible
cases of hepatitis C because few good treatments were available.
Hepatitis C's spread
Hepatitis
C is a virus transmitted through the blood, similar to HIV. It's often
spread through shared needles used by intravenous drug abusers. Decades
ago, and even still in some developing parts of the world, people were
exposed to hepatitis C through unsterilized equipment used for tattoos
or surgical procedures. Also, the U.S. blood supply wasn't screened for
hepatitis C until the early 1990s, so people sometimes became infected
from a blood transfusion or organ transplant.
In roughly 20
percent of hepatitis C cases, the body's immune system fights off the
virus without any medical intervention and probably without the
individual ever being aware of having it. The remaining cases develop
into chronic hepatitis C.
In some of those cases, the virus may
lie dormant for decades, or even a lifetime, but in about 1 in 5 chronic
cases, the virus will attack the liver, scarring it and causing
cirrhosis, and potentially leading to liver cancer and liver failure.
The infection causes about 10,000 deaths a year in the United States,
and it's the leading reason for liver transplants. Hepatitis C is
especially prevalent in people who also have HIV infections; in fact,
HIV-positive patients are more likely to die of hepatitis-caused liver
disease than of AIDS or HIV.
Antiviral drugs
It's
only in the past seven years or so that doctors and scientists
discovered the first antiviral drugs that can stop the virus, giving the
body's natural immune system a chance to fight it off. The cure rate
with those drugs is 75 to 80 percent, but they require that patients
also take interferon, a toxic medication that can cause disabling side
effects for a year.
In the next five years, researchers expect to
develop even more potent antiviral medications - drugs that will cure
more than 90 percent of patients, and do it in half the time and without
the interferon.
"There's no question that with these new treatments, cure is going to be the rule and not the exception," said Dr.
Brad Hare, medical director of the HIV/AIDS ward at
San Francisco General Hospital,
who studies HIV and hepatitis C co-infections. "It's more important
than ever to identify people with hepatitis C, because we have something
even better to offer them."
That said, Hare added, it's unlikely
that the virus will ever be eradicated. There will always remain a
pocket of people who don't respond to drug therapy or aren't able to
take it for some reason. Those who have been cured can be reinfected.
And
getting new medications to the tens of millions of people affected by
hepatitis C won't be easy, especially because the drugs will almost
definitely be expensive.
Strains on the system
Just
screening the millions of Baby Boomers in the United States, and
getting those who test positive for hepatitis C into treatment, could be
an overwhelming strain on the health care system, public health experts
say. Drugs in development could ease some of that burden if they're
easier to take and more effective than the current treatments.
Hepatitis
C was discovered in the late 1980s, although scientists had known for
years that a virus existed that was causing inflammation in the liver
and that wasn't the hepatitis A or B viruses.
The U.S.
Food and Drug Administration
approved the first treatment for hepatitis C - the chemotherapy drug
interferon - in 1991, and added a second drug, ribavirin, in 1998. Those
two medications were considered a breakthrough therapy for a virus that
had previously been untreatable, but the treatment itself was rough and
not all that effective.
The ribavirin comes in pill form, but the
interferon has to be given intravenously three times a week for 48
weeks. Both drugs, especially the interferon, often come with awful side
effects - major depression and, sometimes, suicidal thoughts, plus
fatigue, nausea and flu-like symptoms.
And the worst of it is that
the treatments lead to a cure only roughly half the time - less than
half for patients with the most common strain of hepatitis C.
"A lot of us didn't have bad symptoms before we went on treatment," said
Daniel Berrner,
a San Francisco resident who was diagnosed with both HIV and hepatitis C
in 2005, and underwent successful treatment for the latter in 2009.
"People maybe feel some fatigue, but that's it. So to convince them to
feel awful for a year when they're not feeling that bad to begin with is
a really hard thing to do."
Because treatment was, for many
people, tougher to endure than the virus itself, many doctors over the
years have "triaged" patients by performing liver biopsies or blood
tests to determine if hepatitis C was causing severe enough damage to
treat even at the risk of failure. If patients weren't experiencing
acute symptoms and their livers seemed relatively healthy, they'd often
postpone treatment.
More seek treatment
Whether
to get treatment for hepatitis C is still a personal decision and best
made after a thoughtful conversation with a primary care doctor or a
liver expert, doctors said. But increasingly patients are being
encouraged to get treatment, even if their infection isn't
particularly virulent.
"I still try to triage based on the risk of end-stage liver disease. But now more patients are willing to be treated," said Dr.
Natalie Bzowej, a liver disease specialist at
California Pacific Medical Center.
Bzowej
helped lead national research into one of the first antiviral
treatments that targeted hepatitis C, a protease inhibitor called
telaprevir made by Vertex Pharmaceuticals, which was approved by the FDA
in June 2011. A similar drug, boceprevir from Merck, also won FDA
approval last year.
Remarkable success
In
clinical trials, about 80 percent of patients with the most common
strain of hepatitis C who took one of those drugs, plus the usual
interferon and ribavirin combination, were cured. That was a remarkable
improvement over the previous 40 to 50 percent cure rate.
Also
encouraging: Most of the patients who were cured were able to stop
taking the medications after just 24 weeks, cutting the treatment time
in half.
The reason for the difference is that the new drugs
single out the hepatitis C virus specifically, whereas the interferon
and the ribavirin essentially just give a boost to the body's natural
immune system. For many people, the immune system is not strong or fast
enough on its own to fight off the virus.
Protease inhibitors are
best known as a class of drugs used to treat HIV infection. They work by
attacking specific enzymes, or proteases, in a virus that are a key
part of the replication process. By inhibiting those enzymes, the virus
is unable to reproduce and eventually dies off.
Now, scientists
are looking for the next line of drugs to attack other points of the
hepatitis life cycle. The pharmaceutical industry is racing toward
clinical trials - companies battling to be the first to get new drugs,
especially those that would make interferon obsolete, to the market.
Multidrug attack
Doctors
and scientists alike expect the first of the new wave of drugs to be
available in four or five years. Part of the reason not everyone can be
cured of hepatitis C is that, like many viruses, it mutates so quickly
and becomes immune to drugs. So ideally, doctors will have at their
disposal several drugs - maybe dozens - that will attack the virus on
several fronts at once.
If those drugs are strong and fast enough,
they could cure patients without the need for interferon. Protease
inhibitors and other antiviral drugs aren't without side effects, but
the symptoms are much less severe than those from interferon, and the
newest classes of drugs may work in as little as 12 weeks, or about half
the time it takes telaprevir, the protease inhibitor, to do the job.
"I
feel like we are glimpsing the beginning of the end for hepatitis C,"
said Dr. Cami Graham, vice president of global medical affairs at
Vertex. "We really are beginning to see what that path to eradication is
going to look like."
Long incubation period
Both
drug developers and doctors alike said they are advising patients not
to raise their hopes too high. Almost all of the clinical trials are in
their earliest stages, and for the Baby Boomers especially, patients
with decades-old infections may not have even a few years to wait for
new treatments.
"What we have now is better than anything we've
had in a long time," said Dr. Joanna Ready, chief of gastroenterology at
Kaiser Santa Clara. "What will be even better is interferon-free
therapies, and the early studies have been very, very, very promising.
But the disease has such a long incubation period and damages the liver
over decades, so we really need to be following people over time.
Still, Ready said, she's hopeful.
"If
we don't wipe out hepatitis C entirely, we can probably make it go away
like polio, where you haven't gotten rid of it but you've really beaten
it down," she said. "The science behind these treatments is improving
every day. And the more we know, the better we are at treating it."
Erin Allday is a San Francisco Chronicle staff writer. E-mail: eallday@sfchronicle.com
---------------------
FIGHT THE SPREAD OF HEP C TODAY.
