Sunday, May 17, 2015

Curing Hepatitis C - A Liver Expert [Dr. Tram T. Tran] Explains Revolutionary New Treatments _By Lori Newman


Dr. Tram Thuy Tran, Director of Center For Liver Diseases, LA.

New therapies are revolutionizing treatment of hepatitis C, curing the disease more effectively, more quickly and with fewer side effects than previous medications. A leading liver specialist explains how they work in Ask the Doctor, a women’s health video series produced in partnership with Cedars-Sinai Medical Center...

When medical advancements regularly appear in the news, it can be difficult to tell which ones are the most important. But a new class of treatments for hepatitis C has truly been a game-changer, says Tram T. Tran, M.D., medical director of liver transplantation at Cedars-Sinai’s Comprehensive Transplant Center in Los Angeles.

Many people with the potentially deadly viral liver infection can now take pills for about three months, instead of enduring almost a year of painful weekly injections that may not be effective.

“The treatments we [have now] are revolutionary in terms of tolerability and ability to get over 90% of patients cured,” Dr. Tran says. 


Hepatitis C affects 3.2 million Americans, according to the Centers for Disease Control and Prevention (CDC). Many don’t know they have it because symptoms often don’t show for years, even decades, after infection.

New therapies are revolutionizing treatment of hepatitis C, curing the disease more effectively, more quickly and with fewer side effects than previous medications. A leading liver specialist explains how they work in Ask the Doctor, a women’s health video series produced in partnership with Cedars-Sinai Medical Center...

When medical advancements regularly appear in the news, it can be difficult to tell which ones are the most important. But a new class of treatments for hepatitis C has truly been a game-changer, says Tram T. Tran, M.D., medical director of liver transplantation at Cedars-Sinai’s Comprehensive Transplant Center in Los Angeles.

Many people with the potentially deadly viral liver infection can now take pills for about three months, instead of enduring almost a year of painful weekly injections that may not be effective.

“The treatments we [have now] are revolutionary in terms of tolerability and ability to get over 90% of patients cured,” Dr. Tran says.

Hepatitis C affects 3.2 million Americans, according to the Centers for Disease Control and Prevention (CDC). Many don’t know they have it because symptoms often don’t show for years, even decades, after infection.

“You feel like you have the flu because your body is trying to fight the virus, and we’re trying to boost that response [with interferon],” Dr. Tran says. “We give that with a medication called ribavirin, which causes anemia and other potential side effects.”

Still, doctors “felt pretty happy that we could cure the virus 40% to 50% [of the time],” she says.

The first new hepatitis C drugs – sofosbuvir and simeprevir – were approved by the U.S. Food and Drug Administration (FDA) in late 2013. These pills have few of the side effects of the injected interferon regimen, and have a 90% to 95% cure rate when used correctly, Dr. Tran says.

Sofosbuvir shuts down the virus’s ability to replicate itself, Dr. Tran says. It’s prescribed to patients with genotype 1 – the most common strain of the virus, which infects three-quarters of Americans who have hepatitis C.

For genotype 2 or 3 patients, sofosbuvir is paired with ribavirin, which prevents the disease from returning, Dr. Tran says.

Simeprevir prevents fragments of the virus from growing and reproducing, until, eventually, the hepatitis C virus dies out. The FDA has also approved simeprevir and sofosbuvir to be used together.

In 2014, the FDA approved a pill combining sofosbuvir with ledipasvir, which blocks proteins crucial to the virus's replication. This combination drug is taken once daily and doesn’t require treatment with interferon or ribavirin; patients with low viral load only need to take it for 8 weeks.

“With these new medicines, relapse rates [are] so low that most of my patients are super-happy,” Dr. Tran says.

Also in 2014, the FDA approved a combination of 3 different pills that inhibit the growth of the hepatitis C virus – ombitasvir, paritaprevir and dasabuvir – along with ritonavir, which increases blood levels of paritaprevir. These drugs may be taken with or without ribavirin, the FDA says.

The new class of medications is so effective that in the future, “very few patients will need to use interferon-based therapies,” according to Dr. Tran.

In 2015 and beyond, medications will offer even shorter treatment times.

“We’ll see a decrease in duration from 12 to 6 weeks,” Dr. Tran says.

New therapy combinations will also be available for genotype 3 and special populations, she adds.

Who’s at risk 

Hepatitis C is transmitted through contact with the blood of an infected person. It can’t be transmitted through casual contact, such as kissing, coughing, breast milk or by sharing food or eating utensils, according to the CDC.

If you’re a baby boomer, you’re five times more likely to be infected with the hepatitis C virus than people in other age groups, Dr. Tran says. In fact, 75% of hepatitis C patients are baby boomers, according to the CDC. 

That’s because they came of age when the dangers of unprotected sex with multiple partners – and of sharing needles for injecting recreational drugs – weren’t yet fully understood, the CDC reports.

Also, donated blood wasn’t widely tested for the hepatitis C virus until 1992, according to the CDC. Some people born before 1965 contracted the virus through blood transfusions.

You can live for many years with no symptoms, but a hepatitis C infection becomes a chronic condition in 75% to 85% of cases, the CDC says.


“Every person born between 1945 and 1965, by CDC recommendations, is advised to get a one-time blood test” to measure hepatitis C antibody levels, Dr. Tran says. 

The antibody test isn’t routinely administered during annual health checkups, so you need to ask for it.

Besides baby boomers, people most at risk for hepatitis C include anyone who:

Injects recreational drugs or did so in the past, even once

Received blood transfusions or an organ transplant before 1992, when widespread blood screening began

Received clotting factor concentrates produced before 1987

Is a dialysis patient or was one for years

Has had body piercing or tattoos done with nonsterile instruments

Is a nurse or doctor and has been injured by a contaminated needle

Has HIV (human immunodeficiency virus)

Was born to a mother infected with hepatitis C

Getting diagnosed

Don’t assume you’re hepatitis C-free because you have no symptoms, she warns.

“When you have an active virus in your system, your immune system is probably altered in some way that you may not even realize,” she says.

So you may feel exhausted and have joint pains, nausea and insomnia, she says, and blame those symptoms on too much hard work, stress or aging.

Still, discuss these symptoms with your doctor, and ask for a hepatitis C antibody test at your next health checkup, she advises.

“If you’re negative, great,” Dr. Tran says. “If you’re positive, we need to make sure you get treatment if you need it.”

Tram T. Tran, M.D., is medical director of liver transplantation at the Liver Disease and Transplant Center at Cedars-Sinai. 

Ask the Doctor is produced by Lifescript.com in partnership with Cedars-Sinai, a world-renowned medical and research institution based in Los Angeles. Cedars-Sinai is at the forefront of research and healthcare in heart disease, diabetes, brain health, gynecology and other key women's health conditions.

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