Santa Fe New Mexican - Healthy Living
New drug, new hope
Southwest Care Center offers cutting-edge treatment for hepatitis C
Yara Pitchford remembers what it was like to undergo treatment for hepatitis C (HCV) before the introduction of new antiviral drugs a little more than a year ago.
“It was like chemotherapy,” Pitchford said of the threedrug cocktail (interferon, Ribaviram and bocaprevir) that she began after the onset of severe symptoms in 2011 — 28 years after she contracted the virus from a blood transfusion during surgery in Washington, D.C.
She took 12 to 14 pills each day, but the side effects — nausea, fatigue, headaches, loss of appetite — were intolerable, said Pitchford, 72. “I only lasted two weeks.”
Three years later, she was one of the first patients in Santa Fe to receive treatment when the Southwest Care Center began offering Harvoni, a drug developed by Gilead Pharmaceuticals in San Francisco and approved by the Food and Drug Administration in October 2014.
“This treatment is a little over a year old,” she said. “It’s wonderful. It’s a miracle drug.”
After taking one pill a day for 87 days — and suffering no ill effects — Pitchford was declared free of HCV. Now, she said, “I feel wonderful.”
Silent scarring
Unlike many people who are infected with HCV and feel no symptoms for decades, Pitchford knew shortly after her 1983 surgery that something was amiss. “Six weeks later, I was hospitalized and almost died,” she recalled. “I turned yellow.”
Doctors didn’t identify HCV until 1989, according to the Centers for Disease Control and Prevention. With no way to test for — or treat — the disease, “my body just had to fight it,” Pitchford said.
She recovered from her initial illness, but the virus lingered in her body, slowly scarring her liver and causing chronic fatigue. While her symptoms were relatively mild, Pitchford had to quit her job as an information technology specialist with the U.S. House of Representatives and begin receiving disability benefits. She and her husband moved to Santa Fe in 1991.
“They never recommended treatment (once it was introduced),” she said. “I was always told that until they came out with something less toxic, it wasn’t recommended.”
When Pitchford began experiencing the effects of cirrhosis, or extensive liver damage, her doctors at Johns Hopkins Hospital urged her to try the interferon cocktail. It made her feel worse than the illness, she said. New drugs were being introduced every year, but it wasn’t until the Southwest Care Center offered Harvoni that Pitchford found a protocol she could tolerate.
The clinic’s medical team monitors patients closely to maximize the chance of eradicating the virus. The newest HCV treatment has a cure rate higher than 90 percent.
State of the art
Southwest Care’s cutting-edge treatment began under Dr. Trevor Hawkins, the clinic’s founder and former medical director, who left Santa Fe in September 2015 to work at Gilead.
“We have a huge problem with hepatitis C; it’s higher than in most states,” said Dr. Joel Gallant, who runs the center’s specialized medical services for HIV and HCV patients and manages its research program, which runs clinical trials of experimental medications. “There’s one reason for the high prevalence of HCV in New Mexico: injection drug use. We have very high rates of active and former injection drug use in New Mexico, especially with heroin. And, as in any state, injection drug use is highly linked to poverty.”
The clinic offers fast, free and confidential testing for the presence of antibodies that indicate exposure to hepatitis C, Gallant said. If that test is positive, a free follow-up blood test measures the patient’s viral load, or the number of viral particles present.
If the individual’s immune system has eliminated the disease, no particles will be present. If the test discloses the virus, a genotype test is performed to identify its type. That information determines what therapy should be pursued.
Once doctors verify that the individual has hepatitis C, in-house care coordinators work with the individual to review all treatment options. New medications can cost up to $85,000, but that’s still cheaper than a liver transplant. And treatment durations are much shorter than in the past — as short as two months and no longer than six months.
“Very few people pay out of pocket for these treatments,” Gallant said. “Medicare is better, as private insurers are more reluctant to pay. [The patient] needs to show some degree of liver fibrosis and loss of function.”
Care coordinators work with patients and their insurers to secure coverage. If that fails, the center will apply to pharmaceutical companies for free drug samples or to assistance programs that help with out-of-pocket expenses associated with HCV treatment.
The clinic’s medical team monitors patients closely to maximize the chance of eradicating the virus. The newest HCV treatment has a cure rate higher than 90 percent.