HIV Expertise Helps UAB Fight Wave of Hepatitis C-Related Disease
By Matt Windsor
As the HIV-driven AIDS epidemic has slowed, another infectious agent is breaking on the scene. The hepatitis C virus (HCV) was endemic in the blood supply from the 1960s through the 1980s, and millions who received blood transfusions during that period were infected, says Michael Saag, M.D., chair of the UAB Division of Infectious Diseases. HCV also spread through the sharing of infected needles among drug users. One in every 33 baby boomers is living with hepatitis C infection, according to the Centers for Disease Control and Prevention (CDC).
Many of these people have no idea they are infected, however, because it can be decades before symptoms become evident. “The clinical latency of HCV can be up to 40 years,” Saag explains. “A lot of the people who were infected from the 1960s through the 1980s are now starting to appear in clinics with disease in the form of cirrhosis or liver cancer.” Experts believe that more than 10 million people in the United States may be infected with HCV, says Saag. “Twenty to 25 percent of those people will develop cirrhosis, and maybe 4 percent will develop cancer.”
A CDC study published in early 2012 reported that there were 15,000 deaths related to hepatitis C in the United States in 2007—compared with 13,000 deaths attributable to AIDS. And death rates will continue to rise for another decade or more, experts predict.
The good news is that HCV and HIV share several traits, Saag says, which means that UAB physicians have an edge in tackling the problem. Both are RNA viruses that replicate at high levels, and they can be attacked using similar drugs. But there is a big difference: HCV can be cured within 12 to 24 weeks in many patients. “HIV, as part of its life cycle, comes into a cell and inserts itself into that host’s genetic DNA,” Saag says. “HCV does not do that, and that’s one of the fundamental reasons why we can cure hepatitis C and we can’t cure AIDS.”
Dozens of new anti-HCV drugs are now available or in the pipeline. “What’s happening in hepatitis C today is very similar to what happened in HIV in the 1990s,” Saag says. “When you add some of these newer drugs to the existing HCV treatments, you can take the cure rate up to 90 percent.” The new drugs are more potent, can be taken only once a day instead of multiple daily doses, and have fewer side effects.
But choosing the correct drug regimen for each patient takes expertise, Saag says. That is why the Division of Infectious Diseases is “rapidly gearing up” a hepatitis C clinic that “will be modeled very much on what we did in HIV” at the UAB 1917 Clinic. Infectious diseases experts working with Saag will “address treatment of the virus,” and members of the UAB Division of Gastroenterology and Hepatology and the UAB Liver Center will work on the complications of liver disease and liver cancer, plus liver transplants. “When we bring all that expertise to the table,” Saag says, “it makes for a very powerful team.”