Hepatitis is a disease that causes inflammation in the liver. Viral hepatitis may be caused by the hepatitis A, B, C, D, or E viruses (with A, B, and C being the most common). Chronic viral hepatitis can lead to cirrhosis (scarring and dysfunction of the liver), liver cancer, liver failure, and death. While advances have been made over decades in care of hepatitis A and B, hepatitis C was discovered much more recently and has proven harder to treat. Numerous advancements in care have been made in the past decade, led by physicians and researchers at NewYork-Presbyterian/Weill Cornell Medical Center.
The doctors at the Center for Advanced Digestive Care at NewYork-Presbyterian/Weill Cornell Medical Center are experts in the care of patients with viral hepatitis, and are especially renowned for pioneering new approaches to the treatment of hepatitis C (HCV). NewYork-Presbyterian physicians have directed and participated in major studies that led to the development of the standard HCV therapies used today, as well as those evaluating investigational drugs and new treatment regimens for patients with HCV.
Patients at the CADC receive the full range of care, including personalized medical therapy with the latest medications and monitoring. NewYork-Presbyterian's Center for Liver Disease and Transplantation excels in providing liver surgery to patients with HCV and has more clinical experience caring for these patients than most hospitals.
Causes of Hepatitis C
Hepatitis C (once called non-A, non-B hepatitis) is a liver disease caused by a blood-borne virus discovered in 1989. Approximately 4.1 million Americans, or 1.6 percent of the population, are infected with HCV, and of these, about 3.2 million are chronically infected. New infections have declined from about 240,000 per year in the 1980s to approximately 16,000 annually in 2009.
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Symptoms of Hepatitis C
Many people who are chronically infected with HCV do not have any symptoms, and may have normal blood tests. Others may experience fever, fatigue, nausea, lack of appetite, mild upper-right abdominal pain or discomfort, or diarrhea. Individuals with more advanced disease may have jaundice, light-colored stools, or darker urine.
Patients whose hepatitis has caused cirrhosis may experience fatigue, weakness, itching, dark urine, fluid buildup in the legs (edema) or abdomen (ascites), nausea, and reduced appetite.
Diagnosis of Hepatitis C
Blood tests can determine a hepatitis C diagnosis by detecting certain antigens and antibodies in a patient's blood. These antigens and antibodies can reveal whether an individual is acutely or chronically infected. Blood tests may also be performed to examine a patient's liver enzymes.
In some patients, our physicians may perform a computed tomography (CT) scan, ultrasound, magnetic resonance imaging (MRI), or liver biopsy (removal and examination of a sample of liver tissue) to further assess liver damage.
Hepatitis C Treatment
A small portion of people infected with hepatitis C will overcome the infection without treatment, although it is unclear why. Unlike hepatitis A and B, there is no vaccine currently available to prevent hepatitis C.
Due to the lack of vaccine plus the chronic nature of HCV, treatments must instead focus on curing the virus after infection while managing damaging effects of the virus along the way, including liver damage.
The standard treatment for HCV has been a combination of the antiviral drug ribavirin with pegylated interferon (a type of interferon designed to remain in the body longer). Depending on the subtype of HCV, treatment may last 24 or 48 weeks. Our physicians monitor patients with HCV regularly with blood tests and sometimes liver biopsy.
Interferon is associated with significant side effects, however. About 40 percent of patients require a reduction in their interferon dose because of severe side effects, and about 15 percent stop treatment, diminishing its effectiveness.
In 2011, the field of HCV care was boosted with the approval by the U.S. Food and Drug Administration of two new drugs: boceprevir and telaprevir. CADC physicians were leaders in the clinical trials that ultimately led to the approval of these drugs, which are known as "protease inhibitors." Another protease inhibitor, simeprevir, was approved in November 2013. Each of these drugs, when given in combination with ribavirin and pegylated interferon, can actually cure patients of HCV infection.
CADC physicians also led or participated in clinical trials of the drug sofosbuvir, which belongs to a class of drugs called "nucleotide polymerase inhibitors." Sofosbuvir was approved by the FDA in December 2013. It is used in combination with other antiviral drugs. Some patients can take sofosbuvir and ribavirin without the need for interferon. These studies represent a new model for HCV management and have the potential to change the standard of care for this challenging viral infection.
NewYork-Presbyterian's Center for Liver Disease and Transplantation provides liver surgery for treatment of HCV, including liver transplantation.
Hepatitis C Research
CADC investigators continue to lead studies of new hepatitis C treatments and highly promising targeted agents, including interferon-free regimens. Patients who come to the CADC for their hepatitis care may have opportunities to participate in these clinical trials.
NewYork-Presbyterian also participates in the Center for the Study of Hepatitis C, a collaborative research and treatment partnership comprised of physicians and researchers from Weill Cornell Medical College, The Rockefeller University, and NewYork-Presbyterian Hospital.
The Center for Advanced Digestive Care works in partnership with the dual-campus Center for Liver Disease and Transplantation (CLDT), a collaborative research and treatment partnership comprised of physicians and researchers from Weill Cornell Medical College and Columbia University College of Physicians & Surgeons. The CLDT leads care and for liver diseases across the NewYork-Presbyterian hospital system, and is a top center for living donor liver transplantation, wait-list times and thought leadership in liver disease surgery and transplantation.