Hepatitis C: Does "cured" mean cured?
Updated: Aug 26, 2020
Although you have probably (hopefully!) had your vaccinations against hepatitis A and B, there is still no vaccine that can protect against hepatitis C. In fact, hepatitis C isn't even very closely related to the A and B varieties, although symptoms that these viruses cause are similar. Nowadays, we hear a lot more about HIV as a sexually– and blood–transmitted disease than we do about HepC, but it wasn't always that way. Before the HepC virus was discovered in 1989, the virus caused a large-scale "silent epidemic" of patients, which resulted in millions of cases of chronic liver disease worldwide. So, how come there isn't as much awareness of HepC now?
I would argue that, in the same way that the high efficacy of vaccines have made us less aware of severe diseases like whooping cough and measles, excellent antiviral drugs have reduced awareness about HepC. However, although these drugs are a great step forward for patients, we shouldn't get too cocky and forget that HepC means pretty serious business – when untreated, it can result in liver cancer and liver failure. Furthermore, as suggested by the title of today's blog, although these antiviral drugs are often hailed as such, some scientists have been critical of this perhaps overly optimistic stance. As one paper put it, "The use of the word 'cure' is not adequate".
Generally, when a patient infected with HepC is put on a drug treatment plan, the read-out for whether the drugs are working or not is something called "sustained virologic response". This is a fancy phrase that simply means that the genome of the virus, which is made of RNA, can't be found in the patient's body anymore. Although for most patients – over 90% – this means that the virus never rears its ugly head again and that symptoms are considerably improved, there are more and more reports of the HepC genome reappearing in these very same patients. It can be difficult to sort out for sure if this is because of a re-infection with a new HepC virus versus a relapse of the same old pesky virus. However, by studying the genomes of the reappearing viruses, some scientists have become convinced that patients can relapse after a "successful" antiviral treatment.
But don't despair! I have two pieces of good news for you still.
Firstly, if you already have been infected with HepC, not only are the existing antiviral drugs over 90% effective, but there are also researchers developing new ones. Scientists like François Jean, at UBC in Vancouver, Canada, are working hard to better understand the life cycle of HepC in human cells, with the ultimate goal of developing better and better antiviral drugs. There is definitely hope for the future here!
Secondly, there are a lot of simple actions you can take to prevent being infected with HepC. WebMD gives a nice overview that I'll paraphrase here:
Practice safe sex – use a condom!
If you use intravenous drugs, don't share needles
Avoid being exposed to other peoples' blood. Don't share razors or toothbrushes, for instance, and if you are in a first-aid situation use gloves and other plastic/blood-proof protection gear.
If you get a tattoo, choose the parlor carefully. Speaking as a microbiologist/immunologist who has two tattoos herself, this is something I'd plan way ahead of time – and definitely not something I'd do while travelling or intoxicated.
Until next week – no drunken tattoos please!