『English Hepatitis C Progress』のカバーアート

English Hepatitis C Progress

English Hepatitis C Progress

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This week we talk about the liver, viral infections, and the NHS.We also discuss blood scandals, needle usage, and Nobel Prizes.Recommended Book: A World Appears by Michael PollanTranscriptThe term “hepatitis” refers to the inflammation of the liver, which can result from all kinds of things, including environmental toxins, the consumption of alcohol, or autoimmune diseases. It can also result from viral infections, and the most prominent liver-inflaming viruses are called viral hepatitis.There are five types of viral hepatitis, A, B, C, D, and E, and each of these viruses are distinct, not part of the same viral family, they’re just similarly named because they impact the same organ.Hepatitis A and E are primarily spread through contaminated food and water, and generally resolve on their own, untreated, and cause relatively mild symptoms. Hepatitis B and C are spread through blood and other bodily fluids, and can linger in a host’s body for decades before even showing symptoms. Hepatitis D is a parasite of Hepatitis B, and thus only infects people who carry Hepatitis B.Now again, these are all different conditions that just happen to inflame the liver, so impact and treatment also vary quite a lot. As I mentioned, A and E generally present with mild symptoms and tend to go away on their own, while B and C can stick around a long time. There’s a vaccine for B, but no cure; you can treat it, but that treatment involves suppressing it, and keeping it suppressed, forever. Hep C, in contrast, is curable, and has been since 2014 using what are called direct-acting antiviral pills, but these pills, which are taken for 8 to 12 weeks, are expensive—ranging from $22-95k without insurance, though that price is often reduced substantially for those with insurance, down to as low as $5. This category of drug coverage is often rejected by insurance companies, though, in part because they’re so expensive, that expense the result of little competition in this space; few companies make this type of drug, so those that do can charge more or less whatever they like.Some people with Hepatitis C clear it on their own; about 30% of people who contract it, in fact, clear it within a few months, medication-free. Which is good, because our understanding of this virus is relatively new. Up until 1989, Hep C didn’t even have its own name: it was established as its own thing, not Hep A and not Hep B, back in the 1970s, and doctors knew that something that wasn’t those two viruses, that was being spread by transfusions, was causing hepatitis symptoms, but they didn’t know any real specifics, so they just called it “non-A, non-B hepatitis,” and that name stuck for more than a decade.In 1989 the virus was cloned using molecular techniques (as opposed to simply growing the virus, which wasn’t proving fruitful in trying to isolate and identify the thing), and the folks who managed that cloning, and the person who later proved that the genome they cloned, alone, caused the disease, received a Nobel Prize in Medicine for their efforts in 2020.By 1991, antibody tests were available for Hep C, and many countries began screening donated blood for this virus, to ensure it wasn’t working its way into their blood supply.And one instance of that screening process, or I suppose, an event that led up to mass screening, and the consequences that followed, are what I’d like to talk about today. The UK’s efforts in trying to eliminate Hep C, and England’s recently announced near-success in that pursuit.—Hepatitis C is an RNA virus with high genetic variability that makes developing a reliable vaccine difficult. And though somewhere between a quarter and a third of all cases clear on their own, those that don’t clear on their own become chronic, lying in wait for twenty to thirty years, slowly accumulating fibrosis—thick scar tissue in the liver—which eventually results in cirrhosis, which means a liver that’s so heavily scarred that the organ is no longer fully functional and the damage is permanent. From there, infected people often experience liver failure or hepatocellular (huh-pah-toe) carcinoma, liver cancer.So this virus is a sleeper, and unless it’s caught by accident somewhere along the way, it slowly causes damage over time until the damage is too severe to reverse. About 80% of people who have it don’t know they have it, and in some parts of the world medical injections are the most common transmitter, but in higher-income areas, it’s usually transmitted by injectable drugs.Pre-2014 treatments for Hep C were pretty horrible, involving a combination antiviral therapy called pegylated interferon plus ribavirin that was injected weekly for six months to a year, and this was terribly tolerated by pretty much everyone, causing anemia, depression, and flu-like symptoms for the duration. It also only cured about 50% of people who received the full treatment, and a lot of people had to stop ...
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