Jun 17, 2014 — With new treatments, revolutionized by recent innovations, Hepatitis C is no longer the mysterious, untreatable virus it once was. Dr. Tom Miller weighs the costs of the new treatments, the cure rates and the remarkable progress achieved in confronting the virus with liver specialist Dr. Juan Gallegos.

Interview

Dr. Tom Miller: Hepatitis C, is the cure here? I'm going to talk about that next on Scope Radio. I'm Dr. Tom Miller.

Man: Medical news and research from University of Utah physicians and specialists you can use for a happier, healthier, life. You're listening to The Scope.

Dr. Tom Miller: I'm here today with Dr. Juan Gallegos. He's a member of The Division of Gastroenterology. He has a specialty interest in hepatology in the treatment of liver disease. He's also a member of the Department of Medicine. Good morning, Dr. Gallegos.

Dr. Juan Gallegos: Good morning, Dr. Miller. Thank you for the invitation.

Dr. Tom Miller: Hepatitis C, is it treatable?

Dr. Juan Gallegos: It is treatable, and that's something I think our audience needs to know. Up until a few years ago, many people thought that it was not treatable, but we've actually had fairly decent treatment for the last 20 years. But over the last two or three years, very exciting things have come to the field.

Dr. Tom Miller: That's a remarkable progression in the last 10 years, in terms of how this illness is treatment, how this virus is eliminated from the body. Let's talk a little bit about the first therapies, because I think some people are under the assumption that a certain percentage of Hepatitis C might be cured with the past regimens. But those were kind of tough to take, weren't they?

Dr. Juan Gallegos: They were, and it was basically a combination of interferon, which is an injectable medication that people injected once a week, and they combined that with an oral pill that you would take twice a day called ribavirin. And the combination of that treatment would have to be taken for about a year. It was a while.

Dr. Tom Miller: It was.

Dr. Juan Gallegos: And it had a lot of different side effects, so it made it difficult for people to tolerate the treatment throughout the whole year of therapy.

Dr. Tom Miller: Do you recall what percentage of people was even able to complete that therapy?

Dr. Juan Gallegos: About 90% of people were actually able to get through it, but that took a lot of encouragement from the people taking care of them.

Dr. Tom Miller: Right, exactly. And then of the percentage that got through the treatment, how many of those were actually cured of the hepatitis C virus?

Dr. Juan Gallegos: Overall, the cure rates were around 50% in most people. Certainly there were certain factors that were associated with a decreased likelihood of responding, such as if you had very advanced liver disease like cirrhosis, or if you had one of the more difficult to treat types of hepatitis C, what we call genotype 1.

Dr. Tom Miller: And genotype 1 was the more common one in the United States, correct?

Dr. Juan Gallegos: It is currently the most common one, correct.

Dr. Tom Miller: So there's a lot of exciting stuff going on now. Let's talk about what therapies are out there in the last six months, because I think this is a field that's been revolutionized by recent innovations.

Dr. Juan Gallegos: It certainly has. Over the last six months, we've had the development of new medications that actually destroy the virus itself, which was not the case with the interferon and ribavirin. So that has allowed us to improve our cure rate, and with the current regimens, about 85-90% of patients get cured with these treatments.
It has also allowed us to decrease the duration of the treatments, so most people can actually get treated for about 12 weeks now. And it has allowed us, under certain circumstances, to get rid of the interferon, so that people can now be treated even without interferon.

Dr. Tom Miller: And the interferons would give people the fever, the chills, just the bad side effects that prevented them from completing the treatment originally. Is that right?

Dr. Juan Gallegos: Correct. It was the major player in causing all these side effects. Certainly, ribavirin also has a few side effects, but nothing compared to the interferon.

Dr. Tom Miller: So you're saying now we have a single pill that can be taken for 12 weeks, which eliminates it, you see in 85% percent of the cases?

Dr. Juan Gallegos: Well, that is not yet available, but we anticipate that it will be in the next six to 12 months. But current available regimen is basically a combination of ribavirin and interferon, with another pill called sofosbuvir that was available in December of 2013. And that combination, you take it for 12 weeks for those with genotype 1, and they can get greater than 90% cure rate.
In those patients that are infected with an easier to treat virus, what we call genotype 2, actually we can get rid of the virus with 12 weeks of the combination of the sofosbuvir and ribavirin, which are both oral pills, and no need for interferon, with similar cure rates of about 90%.

Dr. Tom Miller: So if you're a person who has hepatitis C, given your specialty, what would you tell the listener to do, in terms of whom they should see about being treated? Is this something that a family practitioner does, or an internist, or should they be referred to a hepatologist who has experience with these medicines? Talk to me about that.

Dr. Juan Gallegos: So it's a very good point. There are not enough liver specialists in the United States to treat all the patients with hepatitis C. And as these treatments are becoming easier to give and easier to take, I think the treatment over time will be something that intern medicine physicians or the family medicine doctors can do.
At this stage though, I don't think we're there yet. So I would recommend that patients who currently have hepatitis C discuss treatment options with their family doctor or their internal medicine doctor, and for now we wouldn't recommend they be referred to somebody with more expertise.

Dr. Tom Miller: Now, cost has been an issue, and I know there have been some articles in newspapers about the cost of this treatment. Maybe you could talk a little bit about that. And also, is it insured? Are people who have insurance able to get the treatment?

Dr. Juan Gallegos: The cost has been certainly in the news out there, and especially this medication called sofosbuvir has been made famous, because we call it the "$1000 pill treatment." And yes, if you were to take the whole treatment for 12 weeks, which is 84 days, and the treatment is $84,000 just for the sofosbuvir.

Dr. Tom Miller: It's cheaper than a liver transplant.

Dr. Juan Gallegos: It is cheaper than the liver transplant, and cheaper than having patients come to the hospital multiple times over their lifetime, once they develop complications of the liver disease.

Dr. Tom Miller: But it's still potentially out of the range of people who don't have insurance.

Dr. Juan Gallegos: That's correct. Unfortunately, that is the truth. So people do have to have some insurance to help them with treatment. I'm hopeful that the cost of these treatments will change in the future as more treatments become available.
But I think that, overall, for the individual, it is worthwhile to receive treatment, because it would cure this person of hepatitis C and the likelihood of them developing chronic complications of the virus, like cirrhosis, or liver cancer, which is a big complication, or having to leave their work, or having to lose their job. All those things are favorable for the person.

Dr. Tom Miller: And how about for the patient who had been treated for hepatitis C, maybe a few years back, and they didn't tolerate the interferon and thus stopped treatment, could they be treated with this new regimen and be cured?

Dr. Juan Gallegos: That's a very good question. Yes, they can. We have a lot of patients in our clinics that have not responded to prior therapies, so now we're trying to get them through these newer treatments, and although the success rate is maybe not as high as it would be for somebody who's never been treated, still, the success rate is greater than 80% in most cases.

Dr. Tom Miller: So there you have it. If you have hepatitis C, you should talk to your physician about whether you can be treated or not. In most cases, you can be treated, and you have a very high likelihood of clearing the virus, at this stage, from your system, of getting rid of it, and then finally, thinking about referral to a specialist at this point in treatment for hepatitis C. Is that right?

Dr. Juan Gallegos: Yes, I completely agree with your commentary there.

Man: We're your daily dose of science, conversation, medicine. This is The Scope, the University of Utah Health Sciences Radio.


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