The thrill of curing hepatitis C and the pain of watching the disease soar with opioid abuse

(THE CONVERSATION) – (The Conversation is an independent, non-profit source of news, analysis and

When I started my medical career in Hong Kong in the early 1980s, I chose to focus on hepatitis B, partly because it was very common and because the hepatitis C virus had not yet been discovered.I have witnessed the devastation caused by this virus – cirrhosis, the Hepatic insufficiency and liver cancer – and the lack of treatments that we could offer patients.At the time, scientists knew that there was another type of hepatitis, but no one could not identify it.We therefore called it non-A, non-B hepatitis.I would have never imagined that During my career I would witness the discovery of what was going to be known as Hepatitis C and the development of a cure for almost all hepatitis patients. Chronic C in 2014.

The development of treatments of other researchers that I have seen over the last 30 years testifies to the extraordinary progress that the field has made in the fight against hepatitis C. in a relatively short time. Initially, in the late 1980s, before a diagnostic test was available, some physicians began treating well-characterized cases of non-A, non-B hepatitis (C) with hepatitis C. interferon, a natural protein that the body produces to fight the virus. ribavirin, an antiviral drug. These medications were not developed specifically for hepatitis C, had to be administered as injections for 6 to 12 months, had many side effects and allowed to cure only half patients who have received treatment. It took more than two decades for the first direct-acting antiviral drugs to be approved by the FDA.

I remember the excitement when my colleagues and I tested one of the new drug combinations in patients. from 1 million to less than 20 in two weeks. We published the results of our pilot study in the New England Journal of Medicine in 2012. Although the study only concerned 21 patients, it was considered a turning point because it was the first study to prove that a combination of oral pills without interferon could cure hepatitis C

The effective treatment of hepatitis C became even more relevant today considering the fact that recent increase in new cases of hepatitis C due to increased use of opioids.

An expensive drug and new generic

The first pill combined with two drugs that inhibit different stages of hepatitis C replication was approved by the FDA in 2014. This pill is taken once a day for 8-12 weeks, has little or no side effects and improved the cure rate to 90-95 percent. He was hailed as a magic cure, but came with a price of US $ 94,500 for a 12-week treatment. This has led many insurers in the United States and the national health departments to limit access to treatment.

Since then, several other co-treatable pills with equally well-tolerated cure rates are available and the cost has significantly decreased. In addition, inexpensive generic drugs and special prices are available in many resource-poor countries.

Although the current price of drugs for hepatitis C is still very high, it must be remembered that 95% of patients have a cure. It does not look like drugs for many diseases that need to be taken for a long time, sometimes for the rest of the patients' lives. Indeed, a treatment against the hepatitis C virus has allowed some patients on the waiting list for a liver transplant to reverse their liver failure, which makes transplantation useless. This is good news not only for these patients, but also for others on the waiting list.

The remarkable success of treatment against hepatitis C has revived hepatitis B. Current treatments can suppress the replication of the hepatitis B virus to eliminate it. Most patients must follow a long-term treatment to prevent hepatitis attacks when the virus recurs after stopping treatment.

Deaths due to hepatitis B and C increase worldwide

a better understanding of the biology of the hepatitis B virus and improved animal models, drugs that target different stages of the cycle hepatitis B virus are under development. Although the cure for hepatitis B will be more difficult as it can integrate into the patient's DNA, allowing him to escape the patient's immune response, I am optimistic that we will witness the availability of a new combination of drugs that will bring us closer to the goal of a cure for the hepatitis B virus.

But the news is not all positive . While death rates from HIV, TB and malaria have declined in recent years, mortality from hepatitis B and C has increased. Globally, it is estimated that 257 million people have chronic infection with the hepatitis B virus and 71 million have a chronic hepatitis C virus. Together, hepatitis B and C caused 1.34 million deaths in 2015. This led the World Health Organization to develop national plans to eliminate these two viruses by 2030. [19659007] Hepatitis B virus and hepatitis C virus contact with blood or body secretions such as sperm from infected persons by sharing needles or sexual exposure. But they can also spread through contaminated needles used for medical treatment, which continues to occur in many parts of the world. In addition, hepatitis B virus can be transmitted from infected mothers to newborns unless vaccination is given immediately after birth.

For the hepatitis C virus, about two thirds suffer from chronic infection. For the hepatitis B virus, the risk of chronic hepatic infection decreases as the patient encounters the virus: 90% is infected during infancy; 20-30 percent if infected during childhood; and 2-5 percent if infected in adult life. Some people infected with the hepatitis B virus or the hepatitis C virus can heal on their own, but many of them turn into chronic infection (which lasts more than six months and often years or all of life). People with chronic infection are at risk of cirrhosis (severe liver injury), liver failure and liver cancer.

An epidemic of homeless opioids causes an increase in hepatitis B and C infections

In the United States New infections with hepatitis B virus and hepatitis B infection. Hepatitis C have been declining for many years, but this trend has reversed in recent years due to the epidemic of opioids, as more and more people are injecting drugs, sharing needles or other sexual attractions. This is especially true for hepatitis C, where the number of new cases in the last 10 years has more than doubled, highlighting the need for a preventative vaccine, which is a vital tool if we want to eliminate the disease. Hepatitis C. The increase in the number of new hepatitis B cases are smaller and especially seen in adults in their thirties because most young people have benefited from a vaccination against the hepatitis C. Hepatitis B virus.

When we talk about viral hepatitis, hepatitis B and C infection, while hepatitis A does not cause that. an acute infection and does not lead to cirrhosis or liver cancer. However, as of the end of 2016, many US states have witnessed outbreaks of hepatitis A. The Centers for Disease Control and Prevention (CDC) received more than 2,500 cases of 39 Hepatitis A between January 2017 and April 2018, with risk factors in two-thirds of these cases being drug use or homelessness or both. In the state of Michigan, where I live, 859 cases of hepatitis A including 27 deaths have been reported between July 2016 and June 2018. We can prevent hepatitis A through vaccination and can be prevented from becoming infected. improvement of hygiene conditions.

As we celebrate World Hepatitis Day 28, a day chosen in honor of Dr. Baruch Blumberg, who received the Nobel Prize for discovering the hepatitis B virus I am amazed by the progress made over the last three decades and I am delighted not to be an observer but also a contributor to progress. Our work is not finished. Much remains to be done to completely eliminate new cases of viral hepatitis and deaths due to chronic hepatitis B and C.

This article was originally published on The Conversation . Read the original article here: http://theconversation.com/the-thrill-of-cure-hepatitis-c-and-the-pain-of-watching-the-disease-surge-with-opioid-abuse -99,568.