Douglas Dieterich MD, Professor, Department of Medicine, Division of Liver Diseases, Director of the Institute for Liver Medicine, Mount Sinai Health System
Guest blog written by Douglas Dieterich MD, Professor, Department of Medicine, Division of Liver Diseases, Director of the Institute for Liver Medicine, Mount Sinai Health System
Viral hepatitis is liver inflammation caused by an infection with one of several different hepatitis viruses. According to Centers for Disease Control and Prevention (CDC), more than five million people in the United States live with some form of the disease—with the World Health Organization estimating 400 million affected worldwide.
The CDC estimates that 70 – 80 percent of people with hepatitis C, a blood-borne form of the disease, have no symptoms. Because of this, approximately 50 percent of those with the illness are unaware of their infection. Without proper treatment, hepatitis C can lead to permanent liver scarring—known as cirrhosis—or even liver cancer. Common symptoms include nausea and vomiting, mild fever, muscle or joint pain, fatigue, abdominal pain, jaundice (yellowing of the skin or eyes), dark urine, and loss of appetite.
Recently, the Institute for Safe Medication Practices, a nonprofit that studies drug safety, published a report regarding newer hepatitis C drugs, such as Sovaldi and Harvoni. The study suggested that these drugs may cause severe side effects, including liver failure. If you or someone you may know has hepatitis C, are taking these medications, or are about to start treatment, it is vital to use caution when considering this report.
Medications like Sovaldi and Harvoni have treated and cured thousands of patients since their approval. Hepatitis C patients should keep in mind that the report’s data does not conclusively prove that Sovaldi and Harvoni caused the liver failure in the study participants. Participants’ medical histories were not included in the report. This is important because external medical factors may have contributed to the reported liver failure and death. Patients may have been taking other medications, may have been waiting for or have recently undergone a liver transplant, or may have had an advanced case of hepatitis C that could not be reversed by treatment.
In addition, the report cited 165 deaths out of the 250,000 participants who used the medications in question. This equates to a fatality rate of .066 percent. Even if these medications were the cause of these patients’ liver failure and death, this rate is likely much lower than that of liver disease itself. Compared with the medications’ minimal side effects and high cure rate, this is a very small number.
Without clear evidence of cause and effect, patients should not be deterred from seeking care and treatment. At the Mount Sinai Health System, we have cured more than 5,000 patients of hepatitis C using drugs like Sovaldi and Harvoni. In the United States, more than 500,000 people have been treated and cured in the last three years. Worldwide, these drugs have cured more than one million people. We continuously conduct clinical trials with new generations of oral drug regimens that have limited or no side effects. More than 40 new drugs are currently being tested for treatment in the United States alone.
Don’t get discouraged, but do get tested. Those at increased risk of contracting the disease meet one or more of the following criteria:
- were born between 1945-1965; “Baby Boomers” are five times more likely to be infected
- have a history of intravenous illicit drug use
- received a blood transfusion or transplantation before 1992
- have been exposed to the blood of a person with hepatitis C
- received an organ donation from someone who tested positive for hepatitis C
- received tattoos or body piercings with unsterilized tools, or at an unlicensed parlor
- had a manicure or pedicure with unsterilized tools
- had unprotected sex
- are HIV positive
- are on dialysis, or have received long-term dialysis treatment
- have elevated liver enzymes
- originate from a geographic area where viral hepatitis is prevalent, such as Russia, Pakistan, or Egypt.
If you have been recently diagnosed with viral hepatitis, or are currently struggling with the disease and want to learn more about new therapies, please feel free to make an appointment to consult with me at the Institute for Liver Medicine.