Hepatitis C: a virus with serious implications for hemophilia patients

Unlike HIV and HBV, hepatitis C (HCV) is not a disease for life. Cure rates have risen from 10% to now over 95% since the virus was discovered in 1991.

Dilip Moonka, Detroit, Michigan, USA, took the stage first Wednesday morning during “Hepatitis C Update: Complications and Side Effects.” Looking forward, he said drugs for HCV will be taken orally, have a cure rate of over 95%, will require less than 12 weeks of therapy and will be well tolerated.

Moonka said that in individuals exposed to the virus:

  • 20% will clear the virus
  • 75% to 85% will develop chronic infection
  • 5% to 20% will develop cirrhosis, and
  • Typically it takes 20 years to develop cirrhosis
  • 5% to 20% of patients with cirrhosis will develop liver cancer

“You have to continue to screen for liver cancer if HCV has been cured if you have cirrhosis,” said Moonka. “Persons infected with HCV should refrain from excessive alcohol use and should be vaccinated against HAV and HBV if not immune.”

Moonka said there are two tests that are used to confirm HCV. The first is an HCV antibody test to screen for the virus. The HCV RNA (PCR) in the confirmatory test.

In order to successfully treat the virus, the patient’s genotype needs to be known. “The drug Harvoni is effective with genotype 1,” he said, warning that this drug should be used with caution if the patient is taking amiodarone and should be avoided if creatinine clearance is less than 30 ml/minute. “The drug AbbVie [offers] is also very well tolerated, even though more pills are taken. Zepatier can be given to those with renal failure and we will still see cure rates close to 100%.” Drugs are also available for other genotypes that elicit a cure rate of more than 95%.

Magdy El-Ekiaby, Egypt, told the audience that Egypt is one of the countries in the world with the highest rate of infections. The HCV burden is great, with the 15 to 59 year age group estimated to be 7% infected. “This is an endemic infection with social, economic and political implications,” he said. “On-going transmission is still occurring with up to 200,000 new patients each year.”

He said the economic burden is $670 million USD and intangible costs to society and families cannot be assessed. “Curing one patient saves $10,000 and preventing an infection saves $20,000.”

Until 2006 Egypt did not have a comprehensive national program for control of HCV. At that time the objectives became to track prevalence, implement infection control, expand access to treatment and ensure high quality scientific research. In the 2011 to 2014 action plan, new drugs were launched and 400,000 patients were treated. “Government scaled up treatment centers nationwide and they should reach 100 by the end of 2016,” said El-Ekiaby. “Treatment guidelines are updated regularly and there is fast track registration of all approved new drugs with special pricing.” The government pays for 83% of costs, health insurance pays 9% and 8% is out of pocket.

Real-life results shows that therapies have close to a 95% cure rate. “To achieve elimination, we need to increase annually the number of treated patients. Without significantly changing treatment strategies, HCV will remain a highly prevalent problem for the next 20 to 30 years,” he said.

Gerard O’Reilly, Ireland, told the audience that he was born in 1959 with severe hemophilia A. He received his first treatment at age 12, which gave him a better quality of life, but he had to travel long distances for on-demand treatment.

“In the 1970s, treatments became life changing and I could finish my education and work,” said O’Reilly. “The 1980s saw contaminated product and in 1986 I received a diagnosis of HIV. Still trying to cope with this, in the 1990s they told me about a second virus, called non-A/non-B.” Diagnosed with HCV he was offered his first treatment of interferon and spent ten months on injections which caused mood swings, nausea and were mentally draining.

“In 1997 new AVR drugs came on the market and within three months of taking them my HIV was undetectable, but my liver showed signs of fibrosis so my biggest challenge became hepatitis C.” With his liver moving toward cirrhosis, it was ten more years before a new drug came onto the stage.

Doctors discovered a tumour on his liver in 2013. Chemotherapy was injected into the vein that fed the tumour. “I went to get a liver transplant, but failed the assessment as they discovered I needed a triple bypass. In the meantime the tumour started to grow and spread.” He had a liver transplant in 2014 with no rejection issues. “I now have 58% clotting factor, so good-bye hemophilia!” But the HCV virus still had be tackled. HCV treatment is cost prohibitive in Ireland.

O’Reilly started his treatment in 2015 and was cleared of virus. However, the virus returned aggressively in May of 2016. He expects to start retreatment in September. “Life has changed a lot for me without hemophilia. I have a regime of walking every day. Hepatitis C is a very nasty virus, but with the support of friends I have learned a lot.