VIGILANCE NEEDED DURING HCV TREATMENT

Nicole Cutler L.Ac.

March 19, 2015

Improve your chance of success and prevent drug resistance by religiously sticking to your Hepatitis C dosing schedule.

Just a few decades ago, antibiotics were revered as wonder drugs because they were so effective at curing deadly diseases. While a majority of Americans have benefitted from some form of antibiotics, the evolution of drug resistance has reduced antibiotic effectiveness and created even more dangerous strains of bacteria.

Drug treatment for Hepatitis C is approaching the same miraculous status as antibiotics used to occupy. New drug combinations are eliminating the Hepatitis C virus in record numbers; however, resistance to these medications is yet to be fully realized.

The antibiotic era began in 1929 with Alexander Fleming’s observation that bacteria would not grow near colonies of the mold Penicillium. Following this discovery, penicillin drastically reduced deaths from bacterial diseases. Many lives were saved by this medical marvel. But, eventually, drug resistance began to emerge. The sexually transmitted disease gonorrhea exemplifies this change:

• In the 1960s the antibiotics penicillin and ampicillin were able to control most cases of gonorrhea.
• Today, more than 24 percent of gonorrheal bacteria in the U.S. are resistant to at least one antibiotic.
• Today, 98 percent of gonorrheal bacteria in Southeast Asia are resistant to penicillin.

The pharmaceutical industry is well aware of the problem of drug resistance, the ability of microbes to mutate and grow in the presence of a chemical (drug) that would normally kill or limit its growth. A challenge present in most healthcare settings today, MRSA (methicillin-resistant Staphylococcus aureus) is a type of staph bacteria that is resistant to several antibiotics. Likely a result of decades of overprescribing antibiotics and the evolution of superbugs, an estimated two percent of the population now carry MRSA – a severe and very difficult to treat infection.

Considering how stubborn the Hepatitis C virus is, and how long it has taken to create effective treatments, clinicians are rightfully cautious about Hepatitis C drug resistance. Just like humans, microbes will evolve (mutate) to escape their demise. As such, there is a risk of drug resistance when attempting to annihilate any pathogen. In general, there are three concepts heeded to minimize Hepatitis C drug resistance:

1. Full Strength – Take the prescribed medications at full strength to prevent viral survivors. Any particles that survive a mild drug dose are likely to be somewhat resistant.
2. Combinations – All of the current Hepatitis C drug regimens rely on a combination of drugs to improve effectiveness and reduce the chance of drug resistance. Combining medications applies different types of pressure to the virus, doing a better job of causing their extinction, not their evolution.
3. Dosing Schedule – Each Hepatitis C drug treatment has its own dosing schedule; whether it is taking one pill once a day, three pills three times a day, or six pills daily with a weekly injection. Regardless of the schedule requested, it is vitally important to adhere to it. Missing a few doses could give the virus enough forgiveness to develop drug resistance.

Up to 90 percent effective, the newer Hepatitis C drugs stop the virus from making more copies of itself. These drugs have fewer side effects and need to be taken for a shorter duration than previous treatments. However, forgetting to take the medications poses the biggest threat for halting progress and allowing the virus to mutate. Most people would not knowingly take a lower dosage or just pick one medicine out of three prescribed for Hepatitis C treatment. Unfortunately, human error does occur. Especially if feeling overwhelmed or having issues remembering, accidentally skipping medications is a reality.

The new medications for Hepatitis C have not been used long enough to pinpoint how drug resistance will arise. Although it is relatively rare, studies have documented mutations of the Hepatitis C virus resulting from treatment. Just like with all microbe-killing drugs, the more people treat, the greater these incidences will become.

If dose skipping seems like a possibility, utilize pill counters or reminders to stick with your treatment regimen. The new drugs for eliminating the Hepatitis C virus are the result of millions of dollars in research, countless trials and medical perseverance. By reducing the emergence of drug resistance, we have an opportunity to wipe out Hepatitis C before it mutates into an even harder to kill pathogen.
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