November 10, 2009
The Liver Conference held in Boston October 30-Nov 3 was in many ways a defining moment for significant changes in Hepatitis C (HCV) in two important ways. First new classes of drugs to treat HCV are in early and mid stage clinical trials, including protease and polymerase inhibitors. Strategies to use these new classes of drugs together -- without pegylated alpha interferon and ribavirin, which are highly toxic and not highly effective in HCV genotype 1 -- are ushering in a new era of treating hepatitis C disease. Several other studies of the newer drug classes were presented that offer different pros and cons in terms of dosing and toxicities yet it will be some time before the new drugs are proven effective and ready for prime time. It is extremely encouraging to see these developments for both mono-infected Hepatitis C mono-infection and HCV and HIV co-infection.
Secondly, advocacy efforts are building with the Viral Hepatitis and Liver Cancer Control and Prevention Act of 2009 bill being introduced in the Capitol while the scientists were presenting data in Boston. Advocates have worked for years for legislation to increase funding for testing and treatment of HCV. Also, Project Inform has joined with Treatment Action Group and other Hepatitis C advocates to create an Hepatitis C Treatment Issues Committee which will work to follow and monitor the abundant clinical trials and drug development pipeline.
Though HCV infection is known to be mostly contracted though injection drug use, sexually transmitted cases in MSM (men who have sex with men) are increasing worldwide. One small study in New York City followed men who had sexually contracted HCV and were treated in the acute phase. 75% had sustained virologic response, the best indication that the drugs will work with the standard of care treatment. However, unprotected anal intercourse, unprotected receptive oral sex with ejaculation, use of sex toys, sex while high and marijuana use were factors associated with a significant risk of acquiring HCV. Fisting and injection drug use or sharing of injection equipment were not associated in this small case controlled study of 21 matched pairs. Also of great concern was confirmation that liver fibrosis was seen in this early disease phase that normally takes years to develop. The study authors state that these data are confirmation to detect HCV and treat as early as possible.