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New Hep C Meds Help Infected Liver Transplant Recipients

October 3, 2016

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The future is brighter than ever before for those with Hepatitis C who undergo a liver transplant.

Liver transplant recipients with Hepatitis C have many obstacles to tackle after they receive a new liver. Because the Hepatitis C virus almost always returns after transplantation, one of those obstacles is viral elimination. Getting rid of Hepatitis C post-liver transplant had previously presented a formidable challenge; however, the new direct-acting antiviral medications are much more effective.

Between three and four million Americans are believed to have chronic Hepatitis C, and many surmise this to be a conservative estimate. Hepatitis C viral infections cause approximately 40 percent of all chronic liver disease cases in the United States. If chronic liver disease progresses enough in severity, it can become cirrhosis. Hepatitis C-related cirrhosis is the most frequent indication for liver transplantation in adults. For those who have severe liver damage from an advanced case of Hepatitis C infection, receiving a liver transplant may be their only option for survival.

Liver transplantation is a complicated surgery, requiring lifelong follow-up care. While a liver transplant gives those affected a second chance, it is not a cure for the Hepatitis C virus:

  • Although Hepatitis C is a viral infection of the liver, the virus also resides in the bloodstream.
  • Infection of the new, transplanted liver occurs nearly universally in patients with untreated Hepatitis C infection.
  • Reinfection has been documented to occur as soon as reperfusion of the new liver takes place in the operating room.
  • Hepatitis C viral titers have been detected to reach pre-transplantation levels within 72 hours of the transplant surgery.
  • The course of liver disease in those with Hepatitis C after a liver transplant is much faster than prior to a liver transplant.
  • Among post-transplantation patients with untreated Hepatitis C infection, 10 to 20 percent will develop cirrhosis within 5 years of the transplant.

While treating liver transplant recipients with Hepatitis C right away seems to be the obvious choice, this has been a historically challenging proposition. This is for three primary reasons. The older treatment protocols (including interferon) for Hepatitis C had:

  1. poor success rates
  2. frequent adverse side effects
  3. significant drug-drug interactions

The great news is that the new direct-acting antiviral medications are changing the outlook of liver transplantation with Hepatitis C. As published in a September 2016 edition of the journal Transplant Infectious Disease, researchers investigated the effect of direct-acting antivirals on the enzymatic liver function of liver transplant recipients with recurrent Hepatitis C. They found that antiviral treatment with direct-acting antivirals enabled sustained elimination of recurrent Hepatitis C in liver transplant recipients and was associated with a significant improvement of enzymatic liver function.

The new direct-acting antivirals are making a huge difference in post-transplant success with Hepatitis C, but there are several medication issues to know about. Post-transplant patients (including those with compensated cirrhosis) are advised to avoid the following medications:

  • Regimens containing peg-interferon
  • Monotherapy with peg-interferon, ribavirin or a direct-acting antiviral
  • Regimens using Incivek, Victrelis, or Zepatier
  • Post-transplant recipients for those with decompensated cirrhosis are advised to avoid the following medications:
  • Regimens containing Incivek, Olysio, Incivek, peg-interferon, Technivie, Victrelis, Viekira Pak, or Zepatier
  • Monotherapy with peg-interferon, ribavirin or a direct-acting antiviral

According to the American Association for the Study of Liver Diseases, there are preferred protocols for different presentations of Hepatitis C post-liver transplantation. The protocols differ per genotype, treatment experience and stage of liver cirrhosis. It is clear that the treatment of Hepatitis C in patients who have received a liver transplant is an actively evolving field. Recommendations for deciding on the best course of action may change as new data emerges and new medications are approved.

Hepatitis C that has progressed to cirrhosis may require a liver transplant to improve the odds of survival. Those who have gone down this path before direct-acting antivirals were available had a much lower success rate than today. As supported by the new study described above, antiviral treatment with direct-acting antivirals makes a big impact on virus elimination and improvement of liver function.

http://www.hepatitisc.uw.edu/pdf/special-populations-situations/treatment-post-transplantation/core-concept/all, Treatment of Recurrent HCV Infection following Liver Transplantation, Retrieved September 17, 2016, Hepatitis C Online, 2016.

https://www.hepmag.com/basics/hepatitis-c-basics/transplantation, Complications of Hepatitis C – Liver Transplant, Retrieved September 17, 2016, hepmag.com, 2016.

http://www.ncbi.nlm.nih.gov/pubmed/27632190, The impact of directly acting antivirals on the enzymatic liver function of liver transplant recipients with recurrent hepatitis C, Raschzok, N, et al, Retrieved September 16, 2016, Transplant Infectious Disease, September 2016.

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  • Roc Dosland

    What difference does any of this make when liver transplants, pre and post hep c cure medicines are unaffordable to the majority who suffer from hep c? You may call this medical progress but once again it’s dangling a false hope to those that are afflicted and are poor and or have insurance that call these medicines non-formulatory. It’s not a medicine they cover or a procedure they cover.

    • Sandy Robertson

      True, sadly. I have just had Harvoni treatment after being on waiting list in UK for a few years, and my last blood test says I have zero detectable virus. Our National Health Service often struggles but I’m amazed that some Americans are against Obamacare as if it would be creeping communism for freeloaders. We pay taxes to fund the NHS. I’m so sorry for those who can’t afford treatment and hope your government can do something for you.

      • Roc Dosland

        I totally agree with you about how my fellow Americans feel about Obamacare. Sadly most are influenced by the bad pr that’s pushed by the pharmaceutical companies and insurance companies etc that make less $$. If Americans would think for themselves and actually study Obamacare they’d see how it benefits them. My doctor said my insurance would pay for Harvoni because they see that it would be cheaper to cure me than pay for the cost of my getting liver cancer or needing a transplant yet they denied me. Strangely, Gilead who makes Harvoni defends the cost by the same reasoning that people will pay for it rather than having to pay the cost of liver cancer etc. How stupid is that. If I get liver cancer my insurance and the government will have to pay for my care!!

        • Sandy Robertson

          The price of Harvoni is immoral given Gilead bought the company that created it and whose balsnce sheet shows it was relatively cheap to develop at $324 million. I read they made that sum back in less than a year. To charge $1,125 per pill is obscene. Millions are suffering because they can’t afford meds. The government can seize land from individuals on the basis of the greater good being served by using it for an air base or whatever it seems so why can’t they just say this is a national emergency and start making Harvoni-generics. Hope you get treated soon.

    • trotter

      If you and/or others from your state can find a lawyer to help for free, sue your state. That’s what some people have done successfully. The ACLU has also intervened and helped get it changed. If you are on Medicare Disability, Medicare federally has stated they should legally cover it. Try, even by yourself to do something. It does pay off many times. Get the local media involved. Push, your life depends on it. If you’re endstage, they will pay. Speak up – HOLLER. Good luck, Roc.

  • trotter

    Gilead also had a leaked memo about 7-8 years before they let out Solvaldi. It said that there were not enough Hep C sufferers yet to make it worth their while.
    As to the Affordable Care Act, I head a support group for Hepatitis C and have heard from quite a few people that had not been able to see a doctor for their disease. After the Act, they can then see a doctor, get tests done, etc.

    • Dee

      I have friends who have HCV and are under the affordable care act. Their doctors tell them the insurance won’t pay. It does pay but first you have to get your doctor to understand that and fight for you. It’s very sad that many people are told they aren’t “sick” enough yet.
      There is so much ignorance out there it is a fight to get treated.

  • trotter

    Hepatitis Central again, made a mistake. Hepatitis C is a disease of the BLOOD, that affects the liver, then other things: esophogous, pancreas, kidneys, stomach, eyes, etc.
    This site is not completely capable of always being correct, verify things here.

    • Dee

      Thank you so much for your information.