Contagious Disease HBV/HCV Uncategorized

Is Hepatitis C a more significant killer than HIV?

According to a study in the Annals of Internal Medicine, in the U.S. the answer is yes.

National serum surveys indicate that approximately 3.2 million persons in the United States are living with chronic hepatitis C (10), 66% of whom were born between 1945 and 1964 and are now entering a period of risk for diseases and premature death.”

In 2007, more people died from Hepatitis C than either HIV or Hepatitis B.   The study finds that age-adjusted morality rises by 0.18 deaths per 100,000 per year when a person has HCV.   Odds ratios for HCV-related death are higher for the following groups:

  • Individuals aged 45-64 relative to individuals 0-44 or 65+
  • Non-whites
  • Males
  • Less educated
  • Single, never married or divorced
  • Never Married or divorced
  • HIV-infected
  • Chronic liver disease
  • alcohol-related conditions
  • Co-infection with hepatitis B

Although HCV’s disease burden is large, there is some hope.  Whereas the cure rate for HCV before 1990 was only 10%, the standard therapy for chronic HCV infection (pegylated interferon and ribavirin) is effective in 40% to 60% of patients with HCV genotype.

Triple therapies may be a useful alternative to the standard therapy.

New viral protease inhibitors, boceprevir (Victrelis, Merck & Co., Whitehouse Station, New Jersey) and telaprevir (Incivek, Vertex Pharmaceuticals, Cambridge, Massachusetts), used in conjunction with standard therapy, significantly increase treatment success in persons infected with genotype 1 and shorten treatment duration. These new treatment regimens are more expensive (boceprevir, $1100 per week [for 24-34 weeks]; telaprevir, $4100 per week [for 12 weeks]) and can cause more severe adverse effects than standard therapy.

One paper finds that “For patients with advanced fibrosis, universal triple therapy increases the proportion achieving SVR [sustained virologic response] to 51% compared with 32% SVR for standard therapy.”  [Note: SVR is defined as the absence of HCV RNA from serum 24 weeks after discontinuation of treatment.]

The new new therapies, while potent, do have their drawbacks.  The adverse effects from triple therapy are more likely to be more frequent and more severe than the adverse effects from standard therapy.  These side effects include anemia, depression, rash, and flu-like symptoms.

Thus, although progress is being made to improve the treatment of HCV, much work is left to be done.

1 Comment

  1. Good article pointing out some of the risk assessment details — such as the odds ratios for HCV-related death for certain groups. The cost for triple therapies including doctor and lab can easily be $75,000 per patient. And the side effects from treatment are so bad that approximately 25% of people stop treatment.

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