Hepatitis C: 25 Years From Discovery to Cure

John W. Ward, MD, Centers for Disease Control and Prevention

November 10, 2014

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1989: Discovery of the Hepatitis C Virus
Hepatitis C, previously known only as non-A, non-B hepatitis, was first identified by scientists at the Centers for Disease Control and Prevention (CDC), the National Institutes of Health, and industry. The hepatitis C virus was initially isolated from the serum of a person with non-A, non-B hepatitis in 1989 by Choo and colleagues.[1] Following the discovery, hepatitis C was found to be the cause of nearly all cases of non-A, non-B hepatitis in the United States. Its discovery also spurred research into virologic targets of candidate vaccines and therapeutic agents. The genetic diversity of hepatitis C and the relatively weak immune response elicited by the infection posed formidable barriers to vaccine development.

Image courtesy of Science Photo Library

Slide 1.

1991: First-Ever Hepatitis C Treatments
The US Food and Drug Administration (FDA) approved the first-ever treatment for hepatitis C in 1991. This treatment consisted of interferon alpha-2b, but few patients receiving treatment achieved a sustained virologic response. The cure rate was only 6%. Since 1991, the efficacy of hepatitis C treatments has increased significantly, with some of the most recent therapies clearing the virus in up to 90% of patients.[2]

Image from iStock

Slide 2.

1992: US Blood Supply Safe From Hepatitis C
Routine testing of the US blood supply for hepatitis C began in 1990. By 1992, more sensitive—multiantigen—testing was implemented, thereby further reducing the risk for infection and virtually eliminating transfusion-associated hepatitis C transmission. This event resulted in the CDC recommendation of hepatitis C screening for those persons who received a transfusion of blood or blood components or an organ transplant before July 1992.

Image from iStock

Slide 3.

1996: Hepatitis C Infections Dramatically Decline
The annual number of reported new hepatitis C infections declined by more than 80% by 1996. Many attributed the decline to the implementation of routine testing of the US blood supply, along with new prevention and infection control measures designed to curb the spread of hepatitis C.

Image courtesy of CDC

Slide 4.

1998: CDC Expands Hepatitis C Testing Recommendations
The CDC released the first recommendations for prevention and control of hepatitis C, including the testing of at-risk populations.[3] These broader recommendations supplemented previous recommendations that focused on screening and follow-up of blood, plasma, organ, tissue, and semen donors.

Image courtesy of CDC

Slide 5.

2007: US Deaths From Hepatitis C Surpass Those From HIV
Despite the decline of new hepatitis C infections, deaths from hepatitis C increased to almost 5 per 100,000 in 2007, an increase from 3 per 100,000 in 1999. Deaths from HIV, however, declined to 4 per 100,000 in 2007, from more than 6 per 100,000 in 1999. Notably, hepatitis C is 10 times more infectious than HIV.[4]

Image courtesy of CDC

Slide 6.

2010: First Rapid Test Becomes Available
The FDA approval of the first rapid blood test for hepatitis C allows at-risk patients aged 15 years or older to be tested for hepatitis C, with results available in only 20 minutes.[5]

Image courtesy of OraSure Technologies, Inc.

Slide 7.

2011: First World Hepatitis Day; New Drugs Developed
In light of the global burden of hepatitis C, affecting approximately 150-170 million people worldwide, the World Health Organization and President Obama declared July 28 to be officially recognized as World Hepatitis Day.

This year also heralded the first generation of antiviral agents called protease inhibitors. These agents were found to act directly on the nonstructural proteins of the hepatitis C virus to interrupt viral replication and assembly in host hepatocytes. When they were combined with 24-48 weeks of pegylated interferon and ribavirin, cure rates among persons infected with hepatitis C genotype 1 improved to 70%.[6]

Image courtesy of CDC

Slide 8.

2012: CDC Recommends Hepatitis C Screening for Baby Boomers
Data show that persons born between 1945 and 1965 account for approximately 75% of all hepatitis C infections in the United States and 73% of hepatitis C-associated mortality.[7] The CDC expanded testing recommendations to include one-time testing for this baby boomer demographic.[7] If fully implemented, this CDC recommendation to test all individuals born in 1945-1965 would result in approximately 1 million more people being identified as having the hepatitis C infection who then could be treated.

Image courtesy of CDC

Slide 9.

2013: Treatment Landscape Brightens Considerably
The FDA approved new antiviral agents in 2013. When used in combination as all-oral therapies or together with pegylated interferon and ribavirin, an estimated 90% of treated patients achieved cure after 12-24 weeks of therapy, with few major adverse events.[6]

Image from iStock

Slide 10.

2014: 25 Years From Discovery
Our scientific understanding of the hepatitis C virus has evolved substantially over the past 25 years. As such, so has the collective response to addressing this serious disease in the United States and worldwide, which has included the development of evidence-based recommendations for hepatitis C management.[8] With the introduction of the most recent and highly effective treatments for hepatitis C, the pace of positive change is only expected to continue.

Image courtesy of CDC

Slide 11.

Looking Ahead: Elimination of Hepatitis C May be Possible
The treatment of hepatitis C has evolved substantially through the years, from the first-ever approved treatments to the introduction of the highly effective protease inhibitor therapies in 2011, followed by the approval of additional antiviral agents in 2013. This pace of change is expected to increase rapidly, as numerous new drugs with different mechanisms of action are expected to become available over the next few years. For the first time, elimination of hepatitis C may be possible.

Image from iStock

Slide 12.

Contributor Information

John W. Ward, MD
Director, Division of Viral Hepatitis
Centers for Disease Control and Prevention
Atlanta, Georgia

Disclosure: John W. Ward, MD, has disclosed no relevant financial relationships.

References

  1. Choo QL, Kuo G, Weiner AJ, Overby LR, Bradley DW, Houghton M. Isolation of a cDNA clone derived from a blood-borne non-A, non-B viral hepatitis genome. Science. 1989;244:359-62.
  2. Marinho RT, Barreira DP. Hepatitis C, stigma and cure. World J Gastroenterol. 2013;19:6703-6709. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3812468/ Accessed October 21, 2014.
  3. [No authors listed]. Recommendations for prevention and control of hepatitis C virus (HCV) infection and HCV-related chronic disease. Centers for Disease Control and Prevention. MMWR Recomm Rep. 1998 Oct 16;47(RR-19):1-39. http://www.cdc.gov/mmwr/PDF/RR/RR4719.pdf Accessed October 21, 2014.
  4. [No authors listed]. 1999 USPHS/IDSA guidelines for the prevention of opportunistic infections in persons infected with human immunodeficiency virus. U.S. Public Health Service (USPHS) and Infectious Diseases Society of America (IDSA). MMWR Recomm Rep. 1999 Aug 20;48(RR-10):1-59, 61-6. http://www.cdc.gov/mmwr/PDF/RR/RR4810.pdf Accessed October 21, 2014.
  5. US Food and Drug Administration. FDA approves rapid test for antibodies to hepatitis C virus. June 25, 2010. Accessed October 20, 2014. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm217318.htm Accessed October 21, 2014.
  6. Au JS, Pockros PJ. Novel therapeutic approaches for hepatitis C. Clin Pharmacol Ther. 2014;95:78-88.
  7. Smith BD, Morgan RL, Beckett GA, et al; Centers for Disease Control and Prevention. Recommendations for the identification of chronic hepatitis C virus infection among persons born during 1945-1965. MMWR Recomm Rep. 2012 Aug 17;61(RR-4):1-32. http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6104a1.htm Accessed October 21, 2014.
  8. American Association for the Study of Liver Diseases, Infectious Diseases Society of America, International Antiviral Society-USA. Recommendations for testing, managing, and treating hepatitis C. http://www.hcvguidelines.org/fullreport Accessed October 21, 2014.
 

 

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