In October I, like many, was saddened to learn that Lou Reed, the legendary punk rock poet and icon, had died from complications of hepatitis C.
An estimated 3 million Americans like Lou Reed are chronically infected with hepatitis C, which has been called the "silent epidemic" since many people with the infection have few if any symptoms. Indeed, decades typically pass between acquiring infection from blood exposure, and life-threatening complications including cirrhosis and liver cancer. However, the number killed by hepatitis C is now greater than those lost to HIV/AIDS.
For the last two decades, the mainstay therapy for hepatitis C has been interferon, an injection drug with myriad side effects, including flu-like symptoms, extreme fatigue and depression. Many patients I have treated with interferon have likened it to chemotherapy -- and despite miserable side effects, it does not work in most patients. Understandably, many hepatitis C patients have been reluctant to be treated with such a toxic drug. Fortunately, like the revolution in HIV therapy that dramatically improved survival more than 15 years ago, hepatitis C therapy is about to undergo its own sea change.
In the coming months, the FDA will approve a number of oral drugs which attack the hepatitis virus directly, have very few side effects, and offer a high chance of cure, upwards of 90 percent with most regimens. With approval of these novel agents, more than 30 of which are in various stages of development, interferon-based therapy will soon become history.
Lou Reed's passing is particularly tragic, coming as we quickly enter a new age that promises almost everyone with hepatitis C can and should be cured. But a cure is impossible without a diagnosis. Certainly anyone with risk factors for hepatitis C, such as health care workers exposed to infected blood, injection drug users and people with HIV, should be tested. Current recommendations are that all baby boomers, whether they have conventional risk factors or not, should also be tested.