By: Dr. Frank MacMillan
“Another one bites the dust” was a catchy tune in the 80’s popularized by the British band Queen, whose band leader Freddie Mercury ultimately succumbed to complications of AIDS, caused by the HIV virus. Basic research, clinical research and drug development in the mid 1990s turned an infectious disease from a certain death sentence, to a treatable chronic condition where people live largely normal lives for many years to decades. While HIV is not yet cured, it has been controlled with remarkable speed; I think we can score that one a win.
The title of the song resonated with me when I considered where we are in 2014 with another serious infectious disease, viral hepatitis C. This time, the virus and not the victim, is on the ropes. Not so many years ago, a diagnosis of hepatitis C meant a slow deterioration of liver function, liver failure, liver cancer, transplantation or death. While some may carry the hepatitis C virus without symptoms, over many years it can damage the liver, leading to agonizing deterioration in health and quality of life.
This will be the year that we make history, and on the near horizon, hepatitis C will soon become history. For a disease we only discovered in 1989, and after less than three decades, $4 billion in basic research and $40 billion invested in clinical research and drug development, we now have two recent entries into the treatment of hepatitis C that are game changers, sofosbuvir and simeprevir. Several more new drugs are expected later this year. It is estimated that there are 4 to 5 million Americans with hepatitis C infection and most do not know that they are infected. Very few people actually get sick when infected; mild flu-like symptoms are not uncommon, resolving within a few weeks at most. When these mild and non-specific symptoms subside, they often don’t remember even being sick.
If you were born between 1945 and 1965, the US Preventative Services Task Force and the Centers for Disease Control recommend universal screening of this age cohort for hepatitis C infection. A simple and inexpensive blood test, ordered by your doctor, can tell you if you have been exposed to hepatitis C virus. Until a year or so ago, we used targeted screening based on risk factors. This behavior targeted strategy proved to be poor at identifying most people who may carry the virus, as most people do not recall an exposure event, many people with hepatitis C do not feel sick, and many do not have abnormal liver chemistry tests on blood testing. If your birthday falls between 1945 and 1965, you should ask your doctor to include a hepatitis C test with your cholesterol and other routine blood tests. The results could be life-changing.
In the United States, hepatitis C is the leading cause of liver failure, liver transplantation and liver disease related death. That is about to change, and the change is beginning this year, and right now. Your neighbors, friends and family will all benefit. New FDA approved therapies are now available that will cure almost all patients, often with a short 12 week course of oral pill based medications that are well tolerated and that have a low incidence of side effects. What a game changer from previous treatment which was often more intolerable than cancer chemotherapy!
So, what I am saying is that this is the beginning of the end of hepatitis C in the United States. There are 5 million of us infected who need to be identified and treated, and treatment has never been easier or more effective; 12 weeks to cure was unimaginable as recently as 18 months ago. Just get tested.
Another one bites the dust, indeed!
Dr. MacMillan specializes in Gastroenterology and Liver diseases, is a Fellow of the American College of Gastroenterology and its Massachusetts Governor. He is Vice President of the Massachusetts Gastroenterology Association. Dr, MacMillan is a native of North Andover and practices Gastroenterology in Haverhill at Merrimack Valley Hospital, where he currently serves as the Chief of Medicine. He has also been a member of the North Andover Board of Health since 2007. You can Email Dr. MacMillan at fpmacmillan@comcast.net