Today is World Hepatitis Day.

Over 400 million people around the world suffer from a form of Viral Hepatitis. In the United States Over 36,000 people die every year from liver disease.

Around the world over 4,000 people die every day from Viral Hepatitis.

It's known as the silent epidemic, because for years it hides, not displaying any symptoms.

I spend a lot of time talking about Hepatitis C, because it's been eating away at my body since I was born.

But this post is different. It's mostly about the other two major forms of Hepatitis.

Both Hepatitis A and B have vaccines. While Hepatitis A is unlikely to kill you it will make you sick...for months. Hepatitis A can run its course and rarely develops into anything worse. In an otherwise healthy adult Hepatitis A will be like the worst flu you've ever had. In a person with a compromised immune system, it can be life-threatening.

Hepatitis A is transmitted typically via the fecal-oral route. Like C. Diff and other forms of food poisoning you'll get it from (feces)tainted food or water.

Hepatitis B usually develops into a chronic illness. Like Hep C it is a silent killer often slowly destroying the liver. There are treatments for Hep B, but since there is a vaccine, focus is more on prevention than treatment. Like Hep C(HCV) there is no cure, while someone with HCV can be cured by clearing the virus through Sustained Viral Response, this is not the case for Hep B.

When someone is diagnosed with Chronic Hep B it is (for now) a life sentence. Treatment for it often is required as a daily pill to prevent the viral load from increasing and causing more damage.

This year the WHO announced its first ever treatment guidelines for Hep B.


If a person with Chronic Hep B or Chronic Hep C is exposed to Hep A, the effects can be crippling.

Hep A and B vaccinations are available for infants, and can be taken at any time/age and still be effective.

Every year we move leaps and bounds toward better prevention methods, better testing and better treatment options for all forms of Viral Hepatitis.

World Hepatitis Day is about taking preventative measures against Viral Hepatitis, getting tested, and getting treatment.

I am a person with Hepatitis C Genotype 1a Q80k Polymorphism with a decompensated stage two liver.
I was put into the stage four category two years ago.

One year mortality rates

As this chart shows, my odds get slimmer ever year. I'm lucky though.

This year I have an ~89% chance of complete liver failure. If a new treatment option does not appear by the fall, I would not be surprised to need a transplant come winter.

A transplant for individuals with HCV or HBV is not a cure. It's far from it. When the transplant takes, I will re-infect that new liver.

My odds after that do not exist.

Because there isn't a large enough sample size who have done this at such a young age. I've heard estimates of 10-15 years, as I'll likely re-infect the new liver soon after it takes.





Oh! Hello there! Still reading?

Wondering where that 400 million comes from? Well If you look at CDC data it'll point to WHO, if you look at WHO fact sheets it either doesn't say or points to the WHO, The Lancet, or CDC data...So i did some digging. (The Lancet article is about deaths, not in total)

400 million people have Viral Hepatitis which comes from about 240 million for HBV, and 130-150 Million for HCV.

Plus or minus 10 million is a silly think to throw out there when their own fact sheets would have them add up to 370-390 million.

240 million is actually a ten year old low-ball estimate.
The number is based off something called an empirical Bayesian hierarchical model. The number was about 223 million back in 1990, but a 2005 estimate had the number at that 240 we see today. 

They just haven't updated fact sheets to respond to the increase, and i have yet to come across new data. While i lack the knowledge to employ the model it's reasonable to assume millions more for HBV.

So what about HCV? that crazy range of 130-150 million people? The numbers are all over the place estimates go as high as 180 million.

Hopefully we'll see a study soon with application of the model so that we can have a more accurate picture.

So I'm sad to say that 400 million is probably a conservative estimate.

Host with the most, am i cured already?

This month I completed the Harvoni treatment, which was a heart pounding 24 weeks. The longest single treatment I've been on yet. My longest one, prior to this was Incivek at 17 weeks.

In total I've spent over a year of my life on treatment, and it's been a roller-coaster ride the entire time.

As in every year, they add a new more dangerous yet exciting roller coaster.

Last week I also took my end of treatment blood test, and I should have the results back on Tuesday.

Okay Rick, that means you're cured! Right!?

Well... no.

What. All of that, and it's a no!!?

Yea, sorry viruses have a schedule all their own, and they don't need no man!

No seriously, they can exist on surfaces for like 6 weeks on their own, which is more than some teenagers nowadays.

Anyway, the point is that there are essentially three(sometime four) test markers that determine success or failure.

The first marker is around  a halfway point, or the first zero, whichever comes first.

The second crucial test is the end of treatment test, it determines if the treatment is immediately successful, so that's two zeros needed.

The last marker... WAIIITTT!

Oh yea, there are two markers next, SVR 4 and SVR 12. SVR 4 is done four weeks post treatment it is done to make sure that the treatment worked, it's about 99% accurate as a marker for Sustained Viral Response. End of Treatment and SVR 4 are important as if they fail they're used in determining if another treatment, or if something else is needed.

SVR=Sustained Viral Response, I'll get more into what that is later, but know it's the closest thing to a cure with these bad boys.

SVR 12 is a blood test taken 12 weeks post treatment and SVR 12 is >99...% so it's an accurate marker, SVR 24 is clearly even better, but really not by much.

Lets go into a lil Virology lesson, why isn't it a cure?

The RX I was taking, Harvoni, doesn't kill the virus. Only anti-bodies can do that. What Harvoni does is target a non-structural protein in the liver hindering the viruses ability to replicate.

Old meds: boost interferon and give antibodies the tools to fight the virus, also mess with way the virus begins to replicate using Ribavirin. Ribavirin is an amazing tool and it works exceptionally well against many viruses. Hep C included.

Interferon with Ribavirin has an SVR rate of around 56%. And for a long time was the only tool to fight HCV. Compare that rate to modern HCV meds boasting over 90%

In 2011 two new drugs took to the market and changed how we look at the process. Boceprevir(Victrelis) and Telaprevir (Incivek) were both fantastic changes.  Victrelis was a small step in the way the meds changed, both meds were not large-scale changes on the patient side. They included new pills, with new restrictions, and in the case of Incivek would be a trial by fire.

These old meds had a large problem: the process was grueling, and it could take near a year, which lowered the completion rate.

In 2013 everything changed. Sovaldi, Olysio and Viekira Pak were in last phases of testing and readying FDA approval, instead of focusing on the initial processes of HCV infection, they turned their attention to the liver cell itself.

Before the meds targeted the virus in areas 1 2, and 3. Whereas now, the process if focused more on 3,4 and 5.

This super cool graphic illustrates a lot of stuff. Don't worry about most of it. They key part to understand is that each of these new meds targets those points after the NS2-NS3 protease cleavage site (the red arrow). Instead of going for the virus itself, the new meds altered the host via these nonstructural proteins to be less effective for reproduction.

This is a simple breakdown of SVR:

Think of the meds like this: If you have a house infested with ants, do you kill the ants themselves? Or do you poison their food supply? Or maybe even both!

It's a lot like that. New meds poison the food supply, and destroy the queen (the ability to reproduce)

So the Sustained Viral Response that occurs isn't so much an eradication of the virus, because the virus can linger for a while. Eventually without replication/reproduction, those viruses will die. The Sustained Viral Response (SVR) is the goal of any treatment, and I cannot wait for SVR 12.