Hepatitis C

Hepatitis C (HCV) is the most common chronic liver disease in the United States. It is also the most frequent reason cause leading to liver transplantation in this country. Many people with hepatitis C have no symptoms at all, but others will have a yellow cast to their skin and eyes (jaundice), as well as mild to severe flu-like symptoms. These may include:

• Abdominal discomfort
• Fatigue
• Loss of appetite
• Nausea
• Vomiting
• Weight loss

People who have high risk factors for hepatitis C should be routinely screened for HCV. Risk factors include:

• A history of using illicit drugs via injection or the nose
• HIV, dialysis treatment, or elevated liver enzymes of unknown origin
• Blood transfusion or transplantation prior to 1992
• Children born to HCV-infected mothers
• Health care workers after needle stick injury from known HCV patient
• Individuals from a geographic region where HCV is prevalent, such as the former Soviet Union, Pakistan, or Egypt.

Treating Hepatitis C

At Mount Sinai, our physicians have participated in multiple clinical trials testing new drugs that have improved overall treatment response to Hepatitis C. These drugs are:

• Boceprevir
• Telaprevir
• Lambda Interferon

In addition, mulitple new direct-acting antivirals (DAA) are in the early stages of clinical development.

The Liver Disease FPA physicians are studying other treatments, as current treatments result in significant side effects including fatigue, nausea, and depression. Also, with current treatments it is difficult to achieve a cure, defined as the virus being undetectable six months after HCV treatment, in patients with a form of HCV known as genotype 1. With our current clinical trials, we hope to alleviate the strong side effects and achieve high cure rates.

The drugs currently being tested in clinical trials at Mount Sinai are:

• HCV Protease Inhibitors
• Telaprevir
• Boceprevir

These drugs, when combined with PEG-interferon and Ribavirin, increase treatment success in patients with genotype 1. These drugs are expected to be approved by the FDA in late 2011. Their use is expected to increase the response rate to HCV treatment of genotype 1 from about 40 percent to about 75 percent. This will revolutionize the treatment of HCV and prevent many of the predicted deaths from HCV.

Several HCV polymerase inhibitors are actively being studied in clinical trials now at Mount Sinai. These drugs can be used along with HCV protease inhibitors to cure HCV in cases where the virus is resistant to treatment with pegylated interferon and ribavirin.

Today, we continue to work to develop a combination of drugs to create an oral cocktail to treat and cure HCV.