Warnings For New Drugs That Cure Hepatitis C
The new direct-acting antiviral drugs have enabled viral eradication rates in the high 90th percentile; this gave new hope that the Hepatitis C virus can be eradicated. Until recently, the only major difficulty with these Hepatitis C medications has been their very high cost, although now we have proof that the much cheaper generic versions of these drugs are just as effective as brand name drugs.
Reactivation of hepatitis B infection
New drugs that cure hepatitis C (called direct acting anti-viral drugs) can reactivate the hepatitis B virus in people who have had previous infections with hepatitis B virus or who are currently infected with hepatitis B virus. Thus, it is vital to test all patients who are about to start drugs for hepatitis C to be tested for previous infection with the hepatitis B virus. During treatment for hepatitis C, patients must be tested for flare ups of hepatitis B during and after treatment.
Between November 2013 and July 2016, the FDA became aware of 24 cases of reactivation of the hepatitis B virus in patients being treated with drugs for hepatitis C infection. Two of these cases were fatal and one patient required a liver transplant.
Reactivation of the hepatitis B virus can cause severe liver damage, and usually occurs within 4 to 8 weeks of starting the drugs for hepatitis C. Patients commencing drug treatment for hepatitis C should be advised to see a doctor urgently if they get symptoms of hepatitis such as nausea, vomiting and jaundice. It is also thought that liver cancer recurrence can be stimulated by taking direct anti-viral drugs for hepatitis C in patients co-infected with hepatitis B.
The direct anti-viral drugs linked to reactivation of the hepatitis B virus are –
- Daclatasvir
- Ledipasvir,
- Sofosbuvir
- Simeprevir
- Dasabuvir
- Ombitasvir
- Paritaprevir
- Ritonavir
- Elbasvir
- Grazoprevir
- Direct-acting antiviral drugs do not appear to increase liver cancer risk for people with Hepatitis C and cirrhosis.
- Direct-acting antiviral drugs appear to make previously undetected cancers worse and harder to treat.
- 50 percent of those studied who developed a tumor early during Hepatitis C treatment or just after stopping treatment, developed a more aggressive tumor than average.
- The severity of hepatocellular carcinoma (primary liver cancer) seemed to correlate with the antiviral therapy over a 540-day follow-up period.
- The incidence rates of liver cancer were no different in those who received direct-acting antiviral therapy and those who did not receive the therapy.
- Patients with Hepatitis C who receive treatment with direct-acting antiviral medications must be monitored for liver cancer (hepatocellular carcinoma).
- Even if the Hepatitis C virus has been eliminated, liver monitoring and care must persist.
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