Hepatitis C Treatment

Hepatitis C – The Bloodborne Virus

Identified in only 1989, hepatitis C is known to affect 150 million people around the world – alarmingly this number may be even higher as many people show no symptoms of the disease.

Different medication has been used to successfully treat HCV for several years now, but recently a new wonder drug has been approved by the FDA making the treatment of this virus much easier and faster.

Viekira Pak (Viekirax & Exviera, with or without Ribavirin) has demonstrated a 95-100% cure rate in Hepatitis of the 1-st and 4-th Genotypes, including in cases of advanced liver disease, cirrhosis.

What is Hepatitis C?

Hepatitis is the inflammation of the liver, caused by infectious organisms like viruses, bacteria, and parasites. Viral hepatitis has 5 forms A, B, C, D, and E each varying in symptoms and treatment. Other forms of hepatitis virus can be caused by the Epstein-Barr virus and the cytomegalovirus. Non-infectious causes of hepatitis are alcohol-related, particular drugs, as well as certain autoimmune and metabolic diseases.

Hepatitis C (hep C, HCV) is bloodborne – entering the bloodstream and ensuing damage to the liver, in later stages it affects multiple organs. In the acute phase of infection, around 20% of people will combat the virus and become immune. The remaining 80% will still have the virus present in their system after 6 months – the chronic stage.

HCV is one of the leading causes of liver disease. Chronic HCV is also responsible for the deaths of 350,000 to 500,000 people each year!

Hepatitis C Symptoms

Most people can be asymptomatic (no obvious symptoms presented) for years – remaining undiagnosed until the start of liver damage, where they begin to present the signature symptoms. The acute phase of infection can take around 7-8 weeks for any noticeable symptoms to the surface, most people are asymptomatic. Acute symptoms of hepatitis include:

• Nausea
• Vomiting
• Generally, feel unwell

To complicate matters even further, there are 6 variations (genotypes 1-6) of HCV, 46% of people are infected with genotype 1 – which is the hardest to treat. Symptoms of chronic hepatitis:

• Severe tiredness
• Poor concentration
• Muscle and joint pains
• Lack of appetite
• Depression

3.2 million people in the US have chronic HCV, however, most people are unaware that they even have the disease as many are asymptomatic!

Confirmation of HCV is only through a series of tests, namely blood. Symptoms are slow and progressive (around 20 years), numerous and can ultimately lead to extensive damage. Spider naevi (visible spider-looking blood vessels) across the chest and upper body are one of the strong indications of chronic hepatitis. Late diagnosis is incredibly complicated to treat as there is already noticeable organ damage. Cirrhosis leads to an enlarged spleen, fluid in the abdomen (ascites) and a decline in brain function. Usually, a liver transplant is the only option in case of such extensive damage.

Over a period of one to two decades one-third of those with chronic HCV will have further complications other than cirrhosis of the liver:

1-4% are at risk of developing hepatocellular carcinoma.
2-5% develop liver failure annually
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Hepatitis C Transmission

Any contact with blood infected with HCV can put a person at great risk, including:

• Drug-users sharing needles
• Blood transfusion before 1990 (routine screening for hepatitis only began in the early ’90s)
• Slight possibility of sexual transmission (~5%), especially people who are HIV positive
• Blood-to-blood contact by sharing razors or toothbrushes
• Mother-to-child transmission – from the infected mother
• Healthcare settings – needlestick injuries (~3% risk)
• Unsterile equipment for tattooing and piercings
• People in Under-developed countries that seek medical care – medical equipment and proper sterilization of equipment is scarce

It is important therefore to not share needles with other drug users, practice safe sex and should you want a tattoo or piercing – ensure the establishment uses strict sterilization methods, as well as use only single needles and inks.

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Screening for Hepatitis C

It may take some time for a person to be diagnosed with HCV, especially due to them being asymptomatic or having non-specific symptoms. Most people are usually only diagnosed when HCV is detected as a result of routine blood tests, or those that voluntarily undergo screening because they are of high risk, or donating blood, or have suspected hepatitis. Usually, at the time of diagnosis, the person already has chronic HCV – at which point the damage may be irreversible as is their recuperation. It is therefore imperative, to be screened for HCV, especially if you were exposed in a high-risk environment. Get tested if:

• You use drugs
• Your partner is infected with HIV or HCV (or both) if you have HCV
• You were exposed to blood products or any medical procedure (especially in a developing area)
• You had a blood transfusion before 1990
• You had unusual liver function test results
• HIV testing should also be done for high-risk individuals
• You were/are residing in a high-risk area of HCV (Central and East Asia and North Africa) or sought medical treatment in a developing area (for example, limited resources to sterilize equipment and screen blood for transfusions poses a great risk)

If you present any of the above-mentioned symptoms (jaundice, fatigue, etc.)
By undertaking HCV screening, one is not only able to make the necessary lifestyle changes, but to seek suitable and effective treatment (if positive for HCV), as well as prevent transmission to others. Early detection is also essential in assisting in full restorative health, before irreparable organ damage.

HCV diagnosis

• Looking for antibodies: antibodies to the hepatitis C virus can be found in the system as soon as two-three months after exposure, but the test is usually performed 6 month after the supposed infection since some people are able to defeat the virus without treatment in that period. Tests for hepatitis B antibodies are also performed. This virus cannot be cured and it will always be in your system, but knowing that it is there allows you to take the necessary precautions and prevent liver cancer.
• Viral load: whether the antibodies test’s result was positive or negative, quantitative PCR or bDNA test is performed to determine whether the virus is in a person’s bloodstream and how big is the viral load.
• Determining the Genotype: there are 6 Genotypes of HCV. The Genotype and its subtype determine the treatment plan, its length and the chances of a positive outcome.
• Liver function tests: there are several blood tests for liver function – AST, ALT, GGT. These are performed during initial diagnosis in order to determine how badly the liver has been damaged by the virus, and all along the treatment course.
  Liver biopsy: this is a rather complicated procedure during which a sample of the liver’s tissue is analyzed to determine whether there is fibrosis and/or cirrhosis. Today there is a non-invasive procedure that allows getting the same results, called fibroscan. The fibroscan, also called elastography, uses ultrasound for a quick, safe and painless evaluation of the liver.
• One of the common complications of HCV is the varicosis of the esophageal blood vessels. When diagnosing and before starting the treatment of hepatitis C in Israel, a gastroscopy is performed in order to assess the blood vessels. If necessary, gastroscopy allows treating the various vessels by ablation.
• Before beginning treatment, an ECG and a chest X-ray are performed.
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Hepatitis C Treatment

As stated earlier, the Genotype and the extent of liver damage are some of the most important factors affecting the success of the treatment. Conventional methods of treatment include antiviral drugs – interferon and ribavirin, which are known for their severe side-effects. Direct-acting antivirals (DAAs) have been designed to target the virus itself, with fewer side-effects than antiviral drugs and shorter course treatment time-proven effective in 90% of the cases. Harvoni, also a relatively new drug on the market that combines 2 drugs (sofosbuvir and ledipasvir) clearing the infection in the majority of cases, but is expensive, as is the drug Sovaldi.

Proper management and monitoring of chronic HCV are essential, like screening for liver cancer using ultrasonography, every 6 months. Lifestyle changes should also be implemented – avoiding alcohol, maintaining a healthy diet and exercise. Liver transplant is considered only in extremely severe cases of liver damage, this option is limited by the number of donors.

Hepatitis C Cure

A person is considered cured when they have a sustained virologic response (SVR) or the virus is no longer detected in their blood, 12-24 weeks after completion of treatment. Over two decades later since the discovery of the virus, there is finally a novel treatment protocol combined of Viekirax and Exviera tablets:

• Stable SVR of 95-100% in patients with 1-st and 4-th Genotypes of HCV
• Treats those with compensated cirrhosis (heavily scarred liver that is still able to perform the vital bodily functions)
• 100% success rate for genotype 1b HCV/HIV coinfection and 91% genotype 1a

Viekirax and Exviera (Viekira Pak), marketed by AbbVie, comprises of 3 direct-acting antivirals – ombitasvir, paritaprevir, and ritonavir tablets, with dasabuvir tablets. The combinative effect of the drug inhibits the development of HCV. In addition, patients are supplemented with or without ribavirin (RBV). Like any other drug, there are possible side-effects with or without RBV. The drug is prescribed for 12 weeks or 24 weeks for those with genotype 1a with cirrhosis. Given its excellent success rates and being newly available on the market, it comes at a price.

The cost of a 12-weeks treatment course with Viekira Pak starts at 65,000$
It is also imperative to note that it is prohibited to prescribe Viekirax and Exviera to those with:

• Decompensated cirrhosis (extensive liver damage) that is also life-threatening
• Hypersensitivity to ritonavir
• Prescribed drugs that can interact with Viekirax and/or Exviera (oral contraceptives, is one example)

At Herzliya Medical Center (HMC), you can expect the best treatment by our dedicated team of specialists. We offer diagnostics, screening, and treatment for Hepatitis C. We are proud to announce that we have the novel drug Viekira available at our private hospital. The drug has an excellent cure rate of up to 97% for genotype 1 HCV – at an exclusive rate.

Hepatitis C: Q&A with Dr. Efrat Broide

We had the opportunity to interview Doctor Efrat Broide, a leading senior gastroenterologist at Herzliya Medical Center’s Gastroenterology Department, who treats adults and children in Israel, as well as treating those with hepatitis C. We found out more about the disease and treatment with Viekira in a recent Q&A.

What is Israel’s statistics for the number of patients and percentage of healing?

There is no precise information regarding the number of patients with viral hepatitis C in Israel, but the Health Ministry data indicate that from 1992 to 2013, there were 25,000 new cases of acute viral hepatitis, of which, around 4% were associated hepatitis C. While using innovative medicines, we are able to cure 95% of hepatitis C cases.

Are global statistics for hepatitis patients improving?

Yes. In view of screening efficiency, the rate of new cases of infection with hepatitis C is in decline. It is also worth noting that developing innovative treatments for the disease has resulted in an impressive cure rate which has significantly lowered the rate of chronic (prolonged) disease.

What are the latest developments in the treatment of hepatitis?

Today due to drug enhancements, drug therapies do not rely so heavily on interferon. The latest, innovative drugs are designed to target and attack specific mechanisms of the hepatitis C virus that cause the disease. They also have a higher success rate of treatment, are non-invasive (taken orally) and have a shorter treatment course than conventional drugs.

Who is a good candidate for the treatment of Viekira and is the drug suitable for everyone?

Indications are many and vary. A patient should consult their specialist regarding treatment. In general, Viekira is prescribed to patients with a medium to severe genotype 1 hepatitis C and in cases when blood tests show impaired liver function (compensated cirrhosis). Also where there is an indication of the rapid and active division of virus cells. It is important to note, however, that the drug is not suitable for those with severe cirrhosis (decompensated cirrhosis), or those who are sensitive to ritonavir. Viekira also cannot be taken in combination with various other drugs that can interact, this includes St. John’s wort, rifampin, and oral contraception – it is important to speak with your specialist.

What is Viekira’s mechanism of action? What makes this drug so effective in allowing to shorten the treatment period?

This drug acts on different biological mechanisms of the hepatitis C virus – thus affecting its survival in the body. Disruption of these mechanisms will lead to destruction, and the liver – known for its high self-healing ability can continue to function normally. Fewer side effects (than conventional treatment), shorter duration of treatment and taking Viekira orally are just some of the reasons that contribute considerably to the drug’s efficacy.

In which cases can treatment with Viekira be combined with other drugs, such as ribavirin?

Patients with genotype 1a, cirrhosis or those who have had a liver transplant are administered with ribavirin.

Why is it important to perform gastroscopy and to determine there are no esophageal varices?

Varices are a cluster of blood vessels found in the lower part of the esophagus and are often a source of severe hemorrhaging in patients with chronic liver failure, indicating advanced disease. A gastroscopy test allows quick and easy access to the location of the varices, the specialist is able to treat the varices during the procedure and prevent future hemorrhaging.

What is the follow-up treatment for a hepatitis patient taking Viekira?

Monitoring a patient who began a Viekira course includes blood tests (containing the viral load), various liver function tests and more. Six months following treatment if the test results are within the normal range, you can assume with high probability that the treatment was successful.

What are the benefits of receiving a diagnosis and treatment at Herzliya Medical Center for hepatitis?

Herzliya Medical Center is one of the leading centers of advanced medical treatments in Israel that combines accurate diagnosis, fast and convenient with the implementation of a treatment program and follow-up – tailored by leading experts in the field. The availability of treatment for hepatitis C is among the highest in Israel. With the strict monitoring of the patient, we can ensure a greater chance of successful treatment. Modern equipment and a team of medical specialists from a variety of fields, play an integral part in the treatment program and are just some of the many benefits of the hospital.

To hear more about screening or the advanced novel drug, Viekira that we offer at HMC, contact us today!