Health Hero: Dr. Jonathan McCone

Health Hero: Dr. Jonathan McCone

Recently, the FDA approved a new hepatitis C drug that shows vast improvement among African-Americans. sat down with the lead researcher of the study's African-American cohort to talk about the new drug and its impact on our community.

Published May 27, 2011

Recently, the Food and Drug Administration released some exciting news for African-Americans with chronic hepatitis C virus (HCV). They announced the approval of Merk's Victrelis (boceprevir)—the latest HCV therapy in 10 years.

With the current HCV therapy, African-American patients haven't seen much success. But researchers say that Blacks who have taken that treatment along with the Victrelis HCV treatment have shown a significant improvement in being treated and cured of the disease.

HCV—a blood-borne virus that attacks the liver—affects almost 4 million Americans, and African-Americans account for almost 22 percent of those cases. But the reality is that so many people have HCV and don't even know it.

I sat down with Jonathan McCone, MD, the lead researcher of the African-American cohort, to talk about HCV, this medical breakthrough and the importance of getting screened for this disease. Can you explain what is HCV and how does one contract it?

Dr. Jonathan McCone: HCV is a disease caused by a virus that infects the liver. Essentially, the liver kills itself. In time, it can lead to permanent liver damage as well as cirrhosis, liver cancer and liver failure.

People who are at risk are people who received blood transfusions before 1992 (because labs were not checking for HCV in the blood before then), people who have gotten stuck with infected needles,  IV drug users who share infected needles, and people who have received piercing and tattoos with used needles that are infected.

This basically is not a sexually transmitted disease, unless there is blood involved. You don’t get it by kissing, breathing, it's generally a blood to blood illness, but if it's not specially checked for, it's not picked up; it doesn’t mean that damaging isn’t occurring.

Can you tell us a little bit about Victrelis?

Victrelis is the first new medicine in a decade that has been approved in treating HCV. It's a pill that must be taken three times a day along with the other treatment of a once-a-week interfon shot and another twice-a-day pill. You need all three forms of medicine to reap the benefits of the treatment. Victrelis will not work without the other treatments.

And the most important to know is that HCV can be cured.

Before Victrelis, we were seeing overall cure rates of just 40 percent in Caucasian Americans and only 23 percent cure rates in African-Americans.  But when we added Victrelis, African-Americans, who didn't have cirrhosis of the liver—improved two-fold.

Why would cirrhosis make a difference in the success of HCV treatment?

If someone has cirrhosis, advanced damaging is occurring. The liver tries to fight the virus by releasing cells to attack it. But what ends up happening is that virus kills the cells, and then turns the cells into scar tissue. The more scar tissue, the harder it for the liver to do what it's supposed to do. The more advanced the disease, the harder it is to treat HCV.

I've seen patients who didn't know they had HCV and for 20-30 years their livers were getting worse and worse. If your disease gets really advanced, you might need a liver transplant or end up dying. This is why you have to get tested and treated early.

What were some of the side effects of HCV therapy including Victrelis?

First the most common side effects from HCV treatment are fatigue, developing anemia, feeling like you have the flu, headache, depression, weight loss and being irritable. But the good thing is that when people begin therapy, doctors check for all of these side effects and know how to modify certain things.

With Victrelis, there have been some complaints about having a metallic taste, but from what we know, it's not an overwhelming taste.  

How long does HCV therapy usually last?

Before Victrelis, therapy usually lasted for one year in hopes to achieve a cure. But we have found that when Victrelis was added, for most patients, therapy time was cut down to six months. That's half the time.

And yes, there are a lot of pills and side effects to deal with, but I tell my patients, you don’t have a virus that gives a cold, you have a virus that makes you get a liver transplant, and will kill you. Now you only have take it for six months to reduce your viral load and even cure your disease so you can enjoy your life. That’s worth it all.

Why have African-Americans had such little success with past HCV therapies?

Genetics. People who have good configurations of IL28B have a higher chance of being cured from HCV when on therapy. And what we have found is that African-Americans were most likely to have bad configurations of IL28B, and so even when adhered to the therapy and did everything right, the treatment was less likely to be successful.

But when Victrelis was added to the existing therapies, even the people who had bad configurations had a better chance of being cured than without Victrelis. This is why this is such great news for the African-American community.

Is there a vaccine for HCV?

No there is no vaccine for HCV—there are vaccines for hep A and B, though. This is why it's important to get tested and get tested early. It's estimated that 75 percent of people who have HCV don't even know they have it. They are walking around, feeling good, but little do they know that damage is being done to their liver.

But also, doctors need to do a better job in making sure that they screen people and stop assuming who they think are the usual HCV suspects.

Learn more about HCV here.

Written by Kellee Terrell


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