Today’s Hep C Drugs Work Better
Hep C patients are being cured with fewer side effects, and researchers are working on a hep C vaccine.
Dr. Diana Sylvester and Peter Howe discuss hepatitis C at Oasis Clinic.
Photo by Lance Yamamoto
Peter Howe knows firsthand that hepatitis C treatments have improved in recent years. The 51-year-old was diagnosed 10 years ago with hep C, and at the time, he was fatigued, with a bad case of a bacterial skin infection, cellulitis, that often begins with red and tender skin. For Howe, that showed up as a mysterious scab on his shin that continued to worsen over four days.
Howe said he knew he wasn’t in good health because he was homeless and went to a doctor after talking with members of a street outreach program. He is cured and now runs the peer support group at Oasis Clinic in Oakland, a nonprofit medical treatment clinic dedicated to treating and providing health care to marginalized hep C patients. As a hep C elder-leader, he lets patients with newer diagnoses understand that “when your liver feels better, you do feel better. I didn’t realize how sick I was until I got well.”
An estimated 3.2 million to 5 million Americans have hepatitis C. According to the Alameda Health Consortium, high rates of hep C are prevalent in the East Bay, yet many do not know that they have this illness. Celebrities through the ages who have endured hep C include: Gregg Allman, Pamela Anderson (who was cured in 2015), Natalie Cole, David Crosby, Larry Hagman, Naomi Judd, Evel Knievel, Linda Lovelace, Natasha Lyonne, Mickey Mantle, Anita Pallenberg, and Steven Tyler.
Findings from the Centers for Disease Control and Prevention show that baby boomers—those born between 1945 and 1964—may unknowingly carry hepatitis C, which is a contagious viral infection that causes inflammation and potential damage to one’s liver. Because the disease’s symptoms can take 30 years to show—if the symptoms show at all—hep C is widely called a “silent killer.”
Dr. Diana Sylvestre, founding physician of Oasis Clinic, said that getting tested and treated for hep C is especially important for boomers, regardless of risk factors. Intravenous drug usage is the biggest factor, though others at risk include anyone who had a transfusion of blood or blood products before 1992, when the hep C virus was identified.
Hep C is a serious long-term illness that can lead to liver failure and cirrhosis (or scarring of the liver) as well as liver cancer. Hepatitis A, B, and C are diseases caused by three different viruses, and patients with hepatitis A tend to improve because it is not chronic in nature. There are vaccines for hepatitis A and B, with research underway for a hep C vaccine. When hep C is untreated and progresses over 20 to 30 years, it may lead to liver cancer or cirrhosis and even death. However, due to advances in treatment, it can also be managed and cured.
When Howe first started treatment with Sylvestre, the drugs approved for the market were Pegylated interferon, or Peg-IFN, and Ribavirin, or RBV. These drugs worsened some mental conditions—something that more recent medications such as Epclusa, Zepatier, and Daklinsa, FDA-approved in 2015 and 2016, thankfully do not do in such dramatic ways. Howe said that when his bipolar condition became magnified under the first round of interferon drugs, he felt like he was “losing it” because the line of treatment notably changed his mental chemistry. Thus, it was important—and greatly helpful—for Sylvestre to use her psychiatric training to quickly address the issue by prescribing Howe antidepressants.
Attending the support group that Howe now runs was, in his early days of treatment, the one place where he could talk about the debilitating changes, he said. A fellow male patient, Charles, affirmed what Howe felt and shared; Charles, too, had experienced the same side effects as Howe. Checking in weekly is an important form of face-to-face support for patients like these.
Sylvestre said that the current era of hep C is easy and more promising for patients: “From a pure medical standpoint, the new medications are game changers. You can in a short period of time take a medication with virtually no side effects and get your hep C cured.”
With today’s treatments, Howe said that means close to a 98 percent cure rate is the standard, versus earlier cure rates that hovered in the 20 percent to 40 percent range.
Because hep C affects the liver, one telling symptom can be having pain in the abdomen, according to Perla Nolasco, program coordinator for Tri-City Health Center in Fremont. Nolasco said that if symptoms show up, a patient may feel a lot of fatigue, suffer appetite loss, experience nausea, exhibit yellowing of skin and eyes, face depression, and/or lose weight. The color of one’s stool may also change and become the color of light cream-hued masking tape, according to Nolasco.
Hep C is transmitted through bodily secretions—most often, via blood—and lives in the liver. Infection rates are higher with homeless populations, as well as with all drug users, alcoholics, and anyone who’s been exposed to blood. The testing and health care access stemming from 2015’s Get East Bay Tested! Initiative led to more than 20,000 tests, 500 chronic hep C cases, treatment for 150 clients (patients), and a cure for at least 65 individuals. The pharmaceutical company Gilead Sciences sponsored the program, which was run by the Alameda Health Consortium. Participating health centers that are also great health resources for those with hep C include: Asian Health Services, La Clínica, LifeLong Medical Care, Tiburcio Vasquez Health Center, and Tri-City Health Center, where Nolasco works.
Nolasco said treatments for hep C may vary, but that hep C can usually be cured. Often, patients take one Zepatier pill a day for eight to 12 weeks, although some patients may require multiple drugs, such as Technivie, which is used in combination with ribavirin. Nolasco pointed out that the kind of medication depends on which hep C genome type the patient has—out of three genome types, type 1 is most common.
There are patient-assistance plans—when a pharmaceutical company helps with the cost of medications—available. This is a helpful avenue worth pursuing, according to Silvestre, who has patients pursue this assistance when the anticipated cost of treatment seems initially as high as $5,000, but instead cost the patient $3.32.
Finding out if you have hep C is done via a simple, inexpensive blood test. One surprising fact to keep in mind when talking with a doctor is that the hep C test is not a standard test included in annual or regular screenings; the CDC has recommended that those born in United States between 1945 and 1964 should be tested. Nolasco’s team tests everyone over the age of 13 and recommends that if someone can’t remember whether he or she has been tested, to go ahead and get the test done. Sylvestre said that risk factors, age, and symptoms are all factors in deciding to get tested. Howe said that “you must ask for it” when getting blood work. With the advances in hep C care, it’s a worthwhile step.