New drug, new hope

South­west Care Cen­ter of­fers cut­ting-edge treat­ment for hep­ati­tis C

Santa Fe New Mexican - Healthy Living - - NEWS - Story by Sandy Nel­son Pho­tos by Kerry Sherck

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.

Yara Pitch­ford is free of hep­ati­tis C, thanks to a new drug called Har­voni.

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