You’re sitting at the doctor’s office, going down the alphabet list of vaccines you need, and here come hepatitis A, hepatitis B…but where’s hepatitis C? Hepatitis C is the most common long-term blood borne illness in the United States, but until recently, no cure or vaccine existed to combat the disease. But even with new cures for hep C on the frontier of medicine, it’s unclear how accessible they’ll be to people suffering from the disease.
Hepatitis refers to a range of viruses that attack the liver. Hepatitis C specifically is caused by the hepatitis C virus (HCV), which is transmitted via blood-to-blood contact. The most common form of transmission is intravenous drug usage and blood transfusions. Many people upon first infection are able to combat the disease naturally and don’t suffer from further complications. But between 55 and 85 percent of infected people develop a chronic infection that can lead to severe liver problems. Hepatitis C evolves quickly, making it difficult to target with vaccines and antiviral medications. It’s also the most likely hepatitis virus to cause permanent liver damage, which means it’s particularly threatening.
More than 100 million people worldwide are infected with chronic hepatitis C, making it a pressing public health concern and the subject of much research. Until recently, doctors have treated hepatitis C with a combination drug consisting of two components: ribavirin and interferon. Ribavirin works by mimicking the RNA building blocks of a virus. Disguised as RNA, ribavirin inserts itself into the virus, thereby disabling it and preventing it from reproducing. The second drug, interferon alpha-2a, belongs to a group of proteins called interferons, which boost the body’s natural immune response to viral infections.
This drug combination of ribavirin and interferon cures approximately 50 percent of patients over a 48-week span. However, adverse and often incredibly severe reactions to the drug combination are fairly common, and include severe flu-like symptoms, low blood cell counts, and seizures. Added to the fact that it only works half the time, this drug combination is less than ideal for most patients.
In comes sofosbuvir, a new drug developed at Pharmasset (now Gilead) by Michael Sofia. Sofia figured out a way to deliver the drug directly to the liver, thus preventing the myriad of side effects that arise when traditional drug intake methods are used. Whereas ribavirin must pass through the stomach before reaching its target, causing many side effects, sofosbuvir bypasses the stomach and enters into the liver directly. When sofosbuvir combined with ribavirin was given to patients over the course of 12 weeks, 67 percent of patients in a controlled study showed no traces of HCV in their blood. In 2013, sofosbuvir in combination with ribavirin was approved by the FDA, and it seemed as if there was finally a cure for hepatitis C.
That is, until the price tag came out.
One sofosbuvir pill costs $1,000, and a full 12-week course of the drug is appraised at $84,000. A combination pill that includes another complimentary drug will be even more expensive. The cost of the drug will make it largely inaccessible to the worldwide population of people infected with HCV, which is most prevalent in Africa and certain areas of East Asia. Furthermore, it’s likely that insurance companies won’t cover the cost of such a drug because treating one person for HCV would cost well over $100,000. Representatives at Gilead say that the company plans to license the drug out to generic manufacturers, to provide patient assistance in the U.S., and to lower the cost of the drug in less wealthy countries, but it’s still too early to determine the full financial burden of the drug.
Another hope in combating HCV is the potential for a new HCV vaccine. Researchers at the Nuffield Department of Medicine at Oxford University have developed a two-part vaccine that stimulates the immune system against HCV. The vaccine was tested in 15 healthy volunteers as part of a Phase I clinical trial. The volunteers were first given a vaccine that primed their immune systems against HCV. Eight weeks later, they were given a vaccine that boosts the immune response against HCV. Instead of activating antibodies to HCV, which is ineffective since HCV evolves so frequently, the vaccine targets the T-cell production of the immune response. In turn, the T-cell response in the 15 volunteers mimicked that of people who were able to naturally fight off HCV. However, the vaccine is currently entering Phase II of clinical trials, so it’ll be a while before it becomes available to patients, and who knows at what price.
Until a remedy is available, the best ways to decrease the contraction of hepatitis C include preventing blood-to-blood contact and frequent screening. Avoiding improper sterilization of medical tools and needle-sharing is the primary way to keep HCV out. There’s hope that one day there will be a cure to HCV accessible to everyone regardless of where they live or how much they earn, and hopefully that day will come soon.
Stephanie Smelyansky is a freshman in Timothy Dwight College. Contact her at email@example.com.
Featured image by Stephanie Smelyansky.