2012|By Don Sapatkin, Inquirer Staff
Roughly two million to three million baby boomers are chronically infected
with hepatitis C, putting them at risk of serious liver damage if left
untreated. Dramatic improvements in what is now a very unpleasant drug regimen
are expected over the next several years.
Should they wait?
Before deciding that this story doesn't apply to you, note that chronic
hepatitis C can lie dormant for decades with no symptoms. Most people who have
it are unaware of the infection. So the first step is to get a blood test, which
the Centers for Disease Control and Prevention last month proposed recommending
for everyone born from 1945 to 1965.
If it's positive, the short answer about what to do next is - sorry - ask
your doctor. People with significant liver disease need to be treated now while
others may have reason to hold off. But physicians say that complexities of the
condition, other medical issues, classes of drugs and their side effects mean
that patients should not attempt to choose on their own.
"This is a rapidly evolving field," said Rajender Reddy, director of
hepatology for the University of Pennsylvania Health System, where about a dozen
different drug combinations are in clinical trials.
Baby boomers account for more than 75 percent of Americans infected with the
blood-borne virus. That's partly because transfusions and blood products weren't
screened until 1992 but mostly due to drug use with shared needles, even just
once or twice, as teenagers or young adults. After years of chronic infection,
more and more people are arriving at hepatologists' offices with advanced liver
disease, which also makes the underlying virus harder to suppress.
But there have been plenty of reasons to avoid treatment.
The longtime standard regimen - weekly injections of immune-boosting
pegylated interferon plus twice-daily ribavirin pills - takes 48 weeks, causes
nasty side effects, and works less than 50 percent of the time.
In May 2011, the Food and Drug Administration approved the first changes in a
decade: adding to the standard either Merck's Victrelis (also called boceprevir)
or Vertex Pharmaceuticals' Incivek (telaprevir). The direct-acting antivirals
nearly doubled the percentage of patients whose virus was reduced to
undetectable levels, essentially a cure. In the case of telaprevir, the duration
of treatment for some patients was cut to 24 weeks or less.