Mark Mailliard, MD, chief of Gastroenterology and Hepatology at Nebraska Medicine and director of the Hepatitis C Clinic, discusses exciting new treatments for Hepatitis C.
Is there an actual cure for hepatitis C? How effective is this drug cocktail?
Instead of “cure,” I like to use the word “eradicate.” With the drugs we have now, we can eradicate the hepatitis C virus without risk of recurrence or reactivation. You would have to be infected again to acquire the virus.
With hepatitis C, your body does not build immunity – unlike with other viruses. So our goal is to kill the virus in your system. That might be considered a cure, but because you can acquire the infection again, it’s a little different than mumps, for example. Once you’ve had mumps, you are immune – in essence, “cured.”
But, the good news is – with these new medications, we estimate that up to 95 percent of hepatitis C patients can get rid of the virus. Not everyone, because of certain factors. But just about everyone. That’s amazing news!
What drugs are part of this new treatment?
The new drugs are Sovaldi, Harvoni, Olysio, Viekira, Daklinza, Technivie. Sovaldi (sofosbuvir) is the big wonder drug – and it is quite an advancement. This drug has a unique mechanism that prevents the hepatitis C virus from replicating. That’s medical-speak for “stops the virus in its tracks.” If the virus can’t produce new strands of virus, it’s dead in the water. Production halted. The virus goes away. This drug is incredibly effective and amazingly safe. People have little to no side effects. It’s a walk in the park compared to previous hepatitis C drugs. My patients love it!
How it works is interesting, as this drug blocks a “gate” we haven’t used before, similar to a gate to your backyard. These gates are composed of molecules called nucleotides. This drug blocks a “gate” called the NS5B nucleotide – which prevents the virus from multiplying in the body.
This time, the drug developers nailed it. The patients who have taken this new drug — Sovaldi – can’t believe the difference. They are absolutely delighted! Further good news, this drug works for most people.
For patients with the genotype 1 strain of hepatitis C, we prescribe Harvoni (ledipasvir/sofosbuvir) which is a combination drug that includes Solvadi, and is the preferred option with practically no side effects.
Another option – the Viekira Pak – is four medicines combined which patients take twice daily. Some patients will add a Ribavirin pill with this Pak, which adds up to 9 to 10 total pills per day.
That may sound like a lot of pills, but it’s still far fewer than in the past. And with virtually no side effects — this really is a critical improvement.
How long have these drugs been available?
Solvadi became available in December 2013; Harvoni in November 2014; Daklinza in July 2015 (yes, very recently); the Viekira Pak since January 2015. As you can see, these are indeed very new medications. We’re intent on getting them to our patients ASAP.
Do I have to make several trips to Nebraska Medicine for treatment?
Actually, there are only two or three times when you need to come to the clinic.
If you’re just getting tested for hepatitis C infection, you will come for an initial blood test. Some patients have had this initial testing elsewhere and come to us for confirmation and treatment.
If there is evidence of infection, you’ll come in for a second test to confirm the diagnosis – and to determine the virus count in your blood. That tells us how aggressive your infection is. You will also get an ultrasound of your liver at that appointment.
After those initial two visits for testing, you’ll come back to talk about treatment. You’ll get your prescription at that third visit.
Once you’ve got your prescription, you’re on your own! There’s no need to return for check-ups, or anything like that. We’ll stay in touch with you via phone calls, to make sure everything is going smoothly. And, of course, you can always call us with questions. Our goal is to help you get rid of this virus, and to make your treatment as smooth as possible. Whatever we can do to help with that, we are happy to do.
Who should get tested for hepatitis C virus? Why is it necessary to get treated?
People born between 1945 and 1965 are encouraged to get tested since many don’t recognize they are at risk for the disease. A simple blood test can diagnose the disease.
Not only will treatment reduce the chance for liver failure and liver cancer, the diagnosis reminds patients of the danger of alcohol use and obesity, which increase the risk of getting cirrhosis and cancer.