New antiviral therapies for Hep C are eliminating complications and producing better than 90 percent cure rates, says Lorna Dove, MD, MPH, a hepatologist at Columbia’s Center for Liver Disease and Transplantation. In the past clinicians used to “watch and wait” carefully monitoring the patients to see if they would fall into the 25% who develop fibrosis, and the smaller percentage who progress to liver cancer. “In the past, drugs for this virus were hard to take and we weren’t sure how well they would work in different populations. As a result, many individuals felt they were living with time bomb and in the meantime, worried that they might transmit Hep C to their loved ones.
With the new class of antiviral drugs, the algorithm has changed. “Our approach is now to treat everyone, and to be proactive. The new medication is easier to tolerate and we can pinpoint, with great accuracy, which drugs an individual will respond to,” says Dr. Dove who has cared for over 500 Hep C patients.
The new Hep C drugs are genomic. “Seventy-five percent of Hep C patients in the United States are genotype 1 and we have an array of proven drugs that work very well for them,” says Dr. Dove. “The newest medication, Epclusa, is pangenotypic, approved for all Hep C patients, but is especially effective for those genotype 3—the hardest to treat.”
There are intricacies about drug resistance that needs to be factored in, as well, and that’s why many gastroenterologists refer their patients to Columbia. Once Hep C has been eradicated we have a new imaging technique called Fibroscan to monitor patients and find out if there is any scarring of the liver that can increase the risk of cancer. This is a noninvasive way of assessing damage from the virus.
Treatment of Hep C is now aided by a database that matches the patient’s genotype and diagnosis with the latest medications. The latest Hep C guidelines are available here »