Hepatitis C

Five years ago: freaked out about hepatitis C

With World Hepatitis Day coming next month, I’ve been looking back to where the world was five years ago when I was diagnosed, when the world of hep C treatment had just begun to change. I didn’t come fast enough for me, a least I thought so five years ago today. My biggest memory of the time was that I was freaked out. I was freaked out because

  • I had learned I had contracted hepatitis C.
  • I didn’t know how I had contracted it.
  • The only approved treatment was interferon, a debilitating drug with no promise of a cure.
  • I was waiting for an appointment with a gastroenterologist. It was more than two months off. I had been put on the cancellation list but my chances of an earlier appointment seemed slight.
  • I was yet to learn the extent of my liver damage.

Millions of people were just as freaked out as me, with many of the same reasons.

With World Hepatitis Day coming next month, the freak-out level over hepatitis C has lowered somewhat for most newly diagnosed people. That’s thanks to the widespread use of drugs that cure almost all instances of the disease. The drugs have significantly decreased the instance of chronic hep C infections.

On World Hepatitis Day 2018 the World Health Organization had estimated 71 million cases of chronic hepatitis C worldwide. That’s less than half of the WHO’s estimate for the year I was diagnosed.

The world has come a long way in hepatitis C treatment. Announcements on a further dip in infections are expected next month. Stay tuned and stay vigilant. There’s still a lot more to be done to eradicate this horrendous disease from the earth.

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ABSTRACT

Chronic hepatitis C virus (HCV) infection is well-recognized as a common blood borne infection with global public health impact, affecting 3 to 5 million persons in the U.S. and over 170 million persons worldwide. Chronic HCV infection is associated with significant morbidity and mortality due to complications of liver cirrhosis and hepatocellular carcinoma (HCC). Current therapies with all-oral directly acting antiviral agents (DAAs) are associated with high rates of sustained virologic response (SVR), generally exceeding 90%. SVR is associated with a reduced risk of liver cirrhosis, hepatic decompensation, need for liver transplantation, and both liver-related and all-cause mortality. However, a subset of patients who achieve SVR will remain at long-term risk for progression to cirrhosis, liver failure, HCC, and liver-related mortality. Limited evidence is available to guide clinicians on which post-SVR patients should be monitored versus discharged, how to monitor and with which tests, how frequently should monitoring occur, and for how long. In this clinical practice update, available evidence and expert opinion are used to generate best practice recommendations on the care of patients with chronic HCV who have achieved SVR.

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