Sunday, June 7, 2015

Weekend Reading: Talking About HCV Treatment - "Can Hepatitis C Be Cured" or "Am I in remission?"


Hello everyone, it's a beautiful day in the neighborhood. Today my family is heading off to the park for a picnic, which means a game of BASEBALL!

Nana and the short people most likely will end up in the outfield again, our talent for catching butterflies instead of an occasional fly ball has never been fully appreciated. 

In any event, if you landed here today for a bit of HCV information take a stroll over to Medscape and check out a video presentation launched last month offering advice to health care providers about counseling newly identified HCV patients.

A Few Topics
Treatment Can Stop The Progression Of Liver Disease
Hepatitis C Can Be Cured
Cirrhosis Means Risk For Liver Cancer, even after SVR
Fatigue In Most Persons With HCV
Hepatic Fibrosis- Cirrhosis or No Cirrhosis, That Is The Question
Adverse Effects On New HCV Antiviral Therapies 


Dr Muir: Those newly identified patients are coming into our clinics now that new therapies are available. Mark, could you comment on these new therapies and what they can offer our patients?

Mark S. Sulkowski, MD: It’s linked into the new screening initiative. One of the reasons to identify these people is that they have been infected for many decades and are developing progressive liver disease.[5] Now we have highly effective, curative therapies.

I tell patients that the end of 2014 was the end of interferon alfa as a first-line therapy for hepatitis C. We are no longer using first-line regimens that include interferon, which has been a major barrier to getting patients into care; they do not want interferon because of its attendant adverse effects and that it did not work for many people. We now have 3 all-oral regimens approved by the US Food and Drug Administration (FDA) for the treatment of chronic hepatitis C infection genotype 1. They do not require interferon and they offer a ≥95% chance of virologic cure.[1]

The second important point is we do believe this is a cure. Several years ago I may not have used that term "cure" in my office. I called it a sustained virologic response (SVR). However, this confused patients. They would ask, "Am I in remission?" or "What does this really mean?" I want patients to leave my office knowing I’m not going to give them interferon and that my goal is to cure their hepatitis C.

Dr Muir: I agree with using the word "cure," but my experience is that this is often shocking to patients and some providers. Has that been your experience?

Dr Sulkowski: Yes. The typical response is "You cannot cure hepatitis C." Then I talk about why HCV is different from other diseases, such as human immunodeficiency virus (HIV) infection, which is what people often compare HCV to. I think it’s important that people understand that the cure is a virologic cure. We will still have to deal with any liver disease, because that does not go away when the virus is gone....

Watch the video here, read the CME transcript and view slides here


3 comments:

  1. Yes as Sukowski has mentioned , for " most" patients these new regimes offer a cure. However the data shows that approx. Between 5 and 10 % of patients will fail these treatments and for the most part will be left with long lasting ( if not forever) mutations. There seems to be very little discussion on what these folks do moving forward. With the amount of ppl currently treating this will end up being many thousands that have or will fail. ?

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  2. It is interesting that Sulkowski says that this is a cure. Certainly the chances of SVR have significantly increased, however the research shows that approx. 5 to 10 % of patients will fail these regimes and most of them left with resistant virus. Are patients being apprised of this fact before starting treatment? There seems to be very little discussion on this matter. Given the numbers of patients treating this could cause thousands to have no salvage therapy. There needs to be much more discussion with patients on this.

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  3. Here's the deal. If one does not treat they may progress to compensated cirrhosis and then decompensated cirrhosis. You won't know what's going on inside you. You will notice your urine has a noticeable stench in the morning. Your stools are still brown, but are always loose. One day you wake up and notice a yellow hue to your skin or whites of your eyes. What would you do? I treated with interferon and ribavirin. Relapse. I retreated with Sovaldi. Relapse. I took the Harvoni and gambled on the greater than 95% SVR. As of today, four months to go for SVR check. It's not a sure thing, but my stools have stiffened, my urine not so smelly and my enzymes are normalizing. I have hope. The alternative to not medicating is scary ugly.

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