If you were diagnosed with the hepatitis C virus (HCV) 20 years ago, your path forward was anything but certain. But over the past decade, a new generation of medications called direct-acting antivirals (DAAs) has revolutionized HCV treatment. These drugs have proven capable of curing the infection in more than 90% of patients. Now, new research suggests these drugs are effective even among hard-to-treat groups, such as people with advanced organ damage, and in young children.
These days, virtually everyone with hepatitis C can be effectively treated with one of the drugs available on the market. No longer solely the domain of specialists, there is a bigger push for primary care doctors and non-specialists to start prescribing meds to treat HCV to make it easier for patients to get help and expedite their ability to begin treatment. “There are an estimated 800,000 people in the U.S. that could be diagnosed but have not seen a specialist.” says Paul J Pockros, M.D., director of clinical research at Scripps Clinic in San Diego. “We’ve identified about only half the infections in the United States.”
Meanwhile, despite public service announcements and a growing awareness of the virus, there has been a steady uptick in cases in the last decade, likely due to the nation’s opioid epidemic. It highlights a still-urgent need to find a vaccine to prevent new infections in the first place. Scientists are exploring this, and other aspects of hepatitis C treatments, in research labs across the country and world. Take a look at the latest medical innovations in the fight against HCV.
Hep C Meds Expand Their Reach
First, the good news: Studies show that hepatitis C treatments are capable of curing the vast majority of people who take them. Initial studies, however, did not include certain groups deemed to be a higher risk of complications, such as people with advanced liver disease (known as cirrhosis), or those in danger of serious side effects, like children. That’s changing, thanks to new science suggesting that some of the existing medications are safe and effective in hard-to-treat patients.
Within the past year, several drugs have been approved to treat HCV in high-risk groups, says Dr. Pockros. In September 2019, the FDA approved the drug Mavyret for patients with or without cirrhosis (but not decompensated liver disease), for an abbreviated 8-week course of treatment. Two months later, the FDA approved the drug Epclusa to treat patients with end-stage renal failure. And in March 2020, Epclusa was also approved for use in children with hepatitis C who age 6 or older, or weigh more than 37 pounds.
What is means for you: If you are in a higher-risk population, or your HCV has advanced to the stage of liver damage, treatments that previously may not have been available to you are now an option—and the odds of them still working effectively is high.
The Quest for a Hepatitis C Vaccine
While huge strides have been made on the treatment front, finding a vaccine to prevent HCV in the first place has proven more elusive. It’s an important piece to the puzzle of wiping HCV out for good, because unlike some viruses that grant you immunity once you’ve been exposed, hepatitis C doesn’t work that way.
“Current cures do not prevent reinfection,” says Andrea Cox, M.D., Ph.D., a professor of medicine at the Johns Hopkins University School of Medicine in Baltimore and speaker at the 2020 Conference on Retroviruses and Opportunistic Infections (CROI). In other words, you can get healthy, then get hep C again, which explains why the rates of infection in the U.S. are higher than the rates of cure.
As for where we stand on a vaccine, right now, there are three vaccines that have advanced beyond the laboratory and are being studied in humans. The furthest along, a collaboration between the pharmaceutical industry and the United States National Institutes of Health, is slated to show results “in just a few months,” says Cox.
If it works—or if any of the three shows promise—it would be a huge step forward for those treating hep C. Because although a vaccine exists against other hepatitis strains, like hepatitis A and B, the C strain is more complex. “One of the challenges with hepatitis C is its global diversity,” Cox said, noting there are eight genotypes of the virus, meaning you either need multiple permutations of a vaccine to be effective, or the single vaccine needs to inoculate against eight different versions of the virus.
Focused on the Future
Although the hepatitis C vaccine pipeline is thin, Cox hasn’t given up hope that one day an effective vaccine can be given to all patients to protect them from this deadly virus. “An HCV vaccine would be a total game-changer for our public health response,” says Lauren Canary, director of the National Viral Hepatitis Roundtable, an advocacy organization in Washington, DC. “But as we have learned from our experience with the hepatitis B vaccine, which only has 25% uptake among adults in the U.S., we would still need to invest in public health programs to raise awareness and get the vaccine to those most at risk.”
In the meantime, if you or someone you love has been diagnosed with HCV, know that a robust treatment lineup can help you get healthy in a matter of weeks to months. Even if your condition has advanced to the stage of liver damage, you can regain much of your health simply by following the medication protocol outlined by your doctor. And the easiest way to avoid reinfection is to steer clear of the activities that likely caused the condition in the first place. That means no unprotected sex, and no recreational drug use with shared needles. HCV is one disease where you are truly in control of your destiny.