A Big warning issued for hep C antivirals

Direct-acting antivirals can now cure every kind of hep C, quickly. The debilitating ordeal associated with the former treatment, interferon, is long gone. But for some patients, DAA treatment has a big-with a capital B—drawback.

The Federal Drug Administration has just ruled that a warning for people with hepatitis B must be included in packages of many direct-acting antivirals. The ruling came after the agency found 24 inactive cases of hepatitis B had become virulent among patients being treated for the C disease.

Unlike hep C, no cure exists for chronic hepatitis B. However, a vaccine can protect against it, and treatment can suppress replication of the virus.  But uncontrolled hepatitis B can cause liver failure.

The FDA warning on the hep C antivirals states that people infected with HBV risk reactivation of hepatitis B.

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Ultrasound recommend twice a year for some people who have cleared hep C

Two leading researchers have warned that many people who achieved sustained virologic response after anti-viral treatment should continue to be screened for liver cancer.

Roberta D’Ambrosio of the Migliavacca Center for Liver Disease in Italy and the Department of Pathology at Beaujon Hospital in France, and Massimo Colombo of the Migliavacca center, recommended the testing in this month’s Liver International journal. They advised hepatologists to continue the screening, particularly among patients who had decompensated chirrosis (the most advanced stage of liver disease) before their treatment.

SVR does not automatically reverse the ravages of hep. The researchers said some patients’ livers may have reached a point of no-return before they cleared hep C. Even when a patient’s liver seems to have regressed, not all measures of regression may be accurate, they suggested.

European guidelines recommend that anyone who achieves SVR after having decompensated cirrhosis get a liver ultrasound twice a year thereafter. Those who may have had less cirrhosis but abuse alcohol or suffer from diabetes or other risks should do so too, the guidelines state.

If your gastroenterologist isn’t doing this and you believe you’re at risk, maybe you should ask about getting an ultrasound.

 

 

Hep history and food for thought

ancient greek buildingThe Greek physician Aretaeus of Cappadocia was one of the first people to write about hepatitis. In the 2nd century AD he wrote that hep weakened “the liver’s power of nutrition.” It’s wise to take heed of that ancient advice. Every bit of nutrition that goes into your body gets filtered by the liver, but if you’ve contracted hepatitis C, it may not be filtered well. Some substances are easy on the liver and some are not.

At the top of the not list are alcohol and all drugs with liver warnings. The good news is that the list of excellent nutrition for the liver is long–and tasty. Here are a few of my favorite liver-good foods. There are many more:

  • Avocados help the body produce glutathione, which the liver uses for detoxification.
  • Walnuts contain the amino acid arginine, which detoxifies ammonia. These nuts also contain glutathione and omega-3-fatty acids.
  • Eggs contain choline, which protects the liver from toxins and heavy metals. Although too many eggs can cause heart disease, the usual problem is not the eggs. It’s the bacon or sausages they are paired with.

 

Elimination, Europe’s hepatitis C goal, requires testing

This year’s World Health Organization policy summit on hepatitis C announced the first Hepatitis C European Elimination Manifesto. The manifesto, launched in February, makes elimination of hep C in Europe a public health priority.

Just a few years ago elimination of the disease, anywhere, seemed impossible. But the development of quick-working direct-acting antivirals has changed the landscape for researchers and for people with hepatitis C. Now virtually everyone can be cured.

The World Hepatitis Alliance’s strategic plan for 2016-17 cites that close to seven out of ten people with hep C didn’t even know what HCV was before they were diagnosed. Presumably, once diagnosed almost everyone learns quickly.

But first, they have to be tested.

 

Cost of treating all Canadians who have hepatitis C

The cost of treating all 250,000 Canadians who are infected with hepatitis would be $20 – 32 billion, according to Dr. Brian Goldman.

Goldman’s radio show, White Coat, Black Arts has often critiqued the high cost of drugs in Canada. On CBC radio’s On the Coast afternoon show last week, he cited the bottom-rung cost for today’s antiviral cures as $55,000 for an eight-week regimen. Often the treatment time is longer and the cost is higher.

Nonetheless, Canadians are getting a bargain–a relative one, that is. Canada’s falling dollar has ramped up the cost of food, clothing and other necessities, yet the cost antivirals for hepatitis C has remained high but stable.