Leading expert in liver diseases, Dr. Simon Robson, MD, explains how new oral Hepatitis C therapies have transformed patient prognosis. These direct-acting antiviral medications achieve cure rates of 95% in just 8 to 12 weeks. Dr. Robson contrasts this with Hepatitis B and HIV, which require lifelong, suppressive therapy. He discusses the high upfront cost of Hepatitis C cure versus the cumulative cost of managing other chronic viral infections. Treatment prioritization currently focuses on patients with advanced liver disease or extrahepatic complications.
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Modern Hepatitis C Treatment: Achieving Cure with Direct-Acting Antivirals
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- Hepatitis C Treatment Revolution
- Hepatitis C vs Hepatitis B Therapy
- Cost Comparison of Viral Infections
- Current Treatment Prioritization
- Future of Hepatitis C Eradication
- Full Transcript
Hepatitis C Treatment Revolution
New oral Hepatitis C medications represent a monumental shift in viral hepatitis therapy. Dr. Simon Robson, MD, highlights that these direct-acting antivirals can cure over 95% of patients. Treatment duration is remarkably short, typically lasting only 8 to 12 weeks. This is a stark contrast to the complex and lengthy interferon-based regimens of the past.
Key medications in this revolution include sofosbuvir (Sovaldi), ledipasvir/sofosbuvir (Harvoni), and the ombitasvir/paritaprevir/ritonavir combination (Viekira Pak). Dr. Simon Robson, MD, explains that because Hepatitis C is an RNA virus, once it is eradicated from the body, it is gone for good. A patient only faces reinfection if exposed to the virus again, making a true cure possible.
Hepatitis C vs Hepatitis B Therapy
The treatment paradigms for Hepatitis C and Hepatitis B are fundamentally different. Dr. Simon Robson, MD, clarifies that Hepatitis B therapy is suppressive, not curative. Similar to HIV treatment, medications for Hepatitis B must be taken indefinitely to keep the virus under control.
Dr. Simon Robson, MD, notes that the Hepatitis B virus behaves like a defective retrovirus. It establishes reservoirs within the body. If treatment is stopped, the viral load can rebound, causing the disease to reactivate in a large proportion of patients. This necessity for lifelong management stands in direct opposition to the finite, curative course offered by modern Hepatitis C drugs.
Cost Comparison of Viral Infections
The financial aspect of these treatments is a critical factor in healthcare decision-making. Dr. Simon Robson, MD, provides a clear cost analysis. A full course of new Hepatitis C medication carries a significant upfront price, typically between $80,000 and $100,000.
Dr. Robson contrasts this with the annual cost of HIV treatment, which ranges from $10,000 to $15,000 per year. This means the one-time cost to cure Hepatitis C is equivalent to approximately 5 to 10 years of HIV suppressive therapy. While the initial investment is high, it eliminates all future treatment costs for the cured individual, offering long-term economic benefit.
Current Treatment Prioritization
Due to budget constraints, access to these curative Hepatitis C treatments is often prioritized. Dr. Simon Robson, MD, confirms that health insurers frequently limit coverage. Treatment is often reserved for patients with the most advanced disease to manage overall healthcare costs.
Priority groups include patients with advanced liver fibrosis or cirrhosis, those who have received a liver transplant, and individuals experiencing serious extrahepatic complications. These complications can include kidney disease (such as MPGN) or systemic vasculitis caused by the virus. Dr. Anton Titov, MD, and Dr. Robson discuss how this strategy focuses resources on those at highest immediate risk.
Future of Hepatitis C Eradication
The ultimate goal is to make these curative treatments accessible to a much broader patient population. Dr. Simon Robson, MD, is optimistic about the future, stating that eventually, we will work towards eradicating the Hepatitis C virus entirely. Widespread treatment is key to achieving this public health milestone.
The arrival of generic versions of these medications, potentially within a year or two, is expected to dramatically reduce costs and expand access globally. Companies like Gilead, which markets sofosbuvir, are currently recouping their substantial research and development investments. As Dr. Robson points out, broader treatment will become feasible as these financial barriers are lowered, moving us closer to worldwide Hepatitis C elimination.
Full Transcript
Dr. Anton Titov, MD: New Hepatitis C treatments are reviewed by a leading expert in liver diseases. How have new oral Hepatitis C therapies changed the prognosis for viral hepatitis patients? How does the current cost of a cure from Hepatitis C compare with the cost of life-long therapy for Hepatitis B or HIV treatment?
This is an update on Hepatitis B therapy. Dr. Simon Robson, MD, is a leading expert in hepatitis and liver diseases at Harvard Medical School. What is next for Hepatitis C therapy? Treatment of complications from hepatitis C outside the liver includes kidney disease caused by hepatitis.
New Hepatitis C treatments in 2020 are becoming more available. Vasculitis can be caused by hepatitis B or hepatitis C. New hepatitis C medications can treat infections after transplantations.
A medical second opinion helps to ensure the diagnosis of Hepatitis C, Hepatitis B, or Hepatitis E is correct and complete. A medical second opinion also helps to choose the best treatment for viral hepatitis.
Dr. Simon Robson, MD: New Hepatitis C medications include ombitasvir, paritaprevir, and ritonavir combination, which is called Viekira Pak; boceprevir, or Victrelis; and Harvoni. The duration of hepatitis C treatment is 8 to 12 weeks. Hepatitis B patients have to be treated indefinitely.
Dr. Anton Titov, MD: New Hepatitis C treatment protocols in 2020 are better for a wider number of patients with Hepatitis C.
Recently, effective new oral hepatitis C treatments became available, but a course of treatment can cost $100,000. New oral hepatitis C medications include sofosbuvir, ledipasvir, telaprevir or Incivek, and sofosbuvir or Sovaldi.
Pharmaceutical companies that developed new oral hepatitis C medications might license these medications at a cheaper price to some countries, like India. Hepatitis C medications include ombitasvir, paritaprevir, ritonavir combination, called Viekira Pak; boceprevir or Victrelis; and Harvoni.
On the other hand, new oral medications to treat Hepatitis C are very effective. They can cure a patient with Hepatitis C in 95% of cases and only require weeks of treatment. Some Hepatitis C medications include simeprevir or Olysio.
This is in contrast to the need for life-long treatment of HIV. New oral hepatitis C medications can achieve a cure for the patient. The patient does not need to take new hepatitis C medications for the rest of their life.
Dr. Simon Robson, MD: Those are excellent points. Hepatitis B treatment is similar to HIV therapy. Hepatitis B virus is suppressed while the patient takes medications. Hepatitis B virus is almost like a defective retrovirus. HIV is a retrovirus.
Hepatitis B virus is similar to HIV in its manner of replication. There are reservoirs of Hepatitis B in the body, just like with HIV. Hepatitis B virus has to be continuously suppressed.
Sometimes if you stop HIV therapy, the HIV viral load increases. Sometimes if you stop Hepatitis B treatment, a large proportion of the patients can relapse. Hepatitis B disease will reactivate in these patients again.
Hepatitis C is completely different. Sometimes you treat Hepatitis C with effective new medications for 8 to 12 weeks, and there is no Hepatitis C virus in the body. Hepatitis C is an RNA virus.
Once Hepatitis C virus is eradicated from the body, the virus stays away. Only a new infection can lead to the appearance of Hepatitis C virus again.
The duration of new effective treatment of Hepatitis C is 8 to 12 weeks, and the cost is $80,000 to $100,000. The cost of HIV treatment is $10,000 to $15,000 per year. The cost of Hepatitis C treatment is like 10 years of HIV treatment.
Dr. Anton Titov, MD: But new Hepatitis C treatment eradicates the virus. Then the patient no longer needs any treatment. But budgets are limited, and health insurance companies often do not agree to pay for new Hepatitis C treatment.
Only Hepatitis C patients with advanced liver disease are currently being treated with new oral Hepatitis C medications. These are patients with advanced liver disease who may have complications, patients after transplantations.
Those hepatitis C patients are being treated first. Patients who have complications from hepatitis C outside the liver, such as kidney disease or vasculitis, also receive treatment first. But eventually, we will eradicate Hepatitis C virus.
We will treat a much broader spectrum of patients. But right now, we are treating Hepatitis C patients with more advanced disease. We are treating patients with Hepatitis C who have the highest risk of worsening liver function.
Dr. Simon Robson, MD: Those are excellent points that you make. Generic versions of new oral Hepatitis C medications will probably not be sold in the open market for one year or two years.
I must say that I am not participating in any licensing efforts or activities. Currently, Gilead Pharmaceuticals is recouping their investment. This is the pharmaceutical company that sells sofosbuvir.
It is the first new Hepatitis C medication that came to market. Gilead obtained this medication by buying Pharmasset, the company that developed sofosbuvir (Sovaldi).