Hepatitis C Treatment Center

Information may not be reliable

HEPATITIS DOCTOR HOME since October 1998

Welcome to patients with chronic viral hepatitis B or C and to their loved ones. We can cure about
half of the patients with chronic hepatitis C, including some with advanced cirrhosis and liver failure.
If you are cured, your viral level falls to undetectable during treatment and stays undetectable the
rest of your life, after you stop the medications. If your HCV-RNA level becomes detectable in your
blood, you were not cured. If your HCV-RNA is undetectable 6 months after your last injection of
interferon, you have a 99% chance of permanent cure. Liver damage stops and liver healing starts.

I add information to this web site as often as I can, and I want to make it a resource for patients whom
are often incorrectly told that they cannot be helped. The opinions expressed here are entirely my
own, and are based on my experience in treating more than 3,000 patients with hepatitis C.
I am especially excited about the new oral medicines for patients with hepatitis C. I am a board
certified in internal medicine and gastroenterology. In addition, I completed 2 years of residency
in pathology at Duke University Medical Center. I have been a physician for 33 years. I spend about
95% of my time treating patients with chronic viral hepatitis C. I enjoy helping as many patients as
possible cure this infection. Once HCV is permanently eradicated in a patient, the liver injury stops
and the liver begins to heal. Over time, the liver fibrosis will regress and survival improves.

I am very excited about the HCV protease inhibitor from Vertex Pharmaceuticals called VX-950. The
generic name is telaprevir. It is taken by mouth every 8 hours and drops the viral level by about
99.9% in a week or so. When combined with Pegasys plus ribavirin, it greatly improves the cure
rate in genotype one patients. Telaprevir plus Pegasys and ribavirin eliminated HCV in 75% of patients
in the ADVANCE study with only 24 weeks of therapy. This treatment was successful in 62% of African-
American patients and 62% of patients with stage 3 or stage 4 fibrosis (cirrhosis). Only 7% of patients
had to stop the treatment because of side effects. Another HCV protease inhibitor,
BOCEPREVIR, from Merck is also promising. We expect 2011 to be a happy year for patients
after the FDA approves these medicines.

My office: 1009A Dupont Square North, Louisville KY 40207

If you have previously failed or could not tolerate standard antiviral therapy, you should consider
individualized therapy. Some patients need to start with lower doses of interferon. Some need to take
higher doses. A few respond to one brand of interferon but not another. Many patients need longer
duration of treatment than the standard 48 weeks. Some patients who do not respond to one type of
interferon are able to respond to another. If there is no response, Infergen 15 mcg daily plus
ribavirin eliminates HCV in about 10% of patients as demonstrated in the DIRECT Trial.

Ribavirin does not add much to the fall in the viral level. It is the interferon that is the muscle drug.
Ribavirin does not transform a nonresponder into a responder. What ribavirin does is greatly reduce
the chance of viral breakthrough (HCV-RNA falls with treatment, but then rises even
though treatment is continuing) or relapse in patients who respond to interferon. A relapser is a
patient who became undetectable for HCV-RNA on her previous treatment, but the virus came back
when the treatment ended. Cirrhotic patients who take telaprevir or boceprevir plus pegylated
interferon plus ribavirin have more success with shorter duration of treatment. Many succeed with
only six months of treatment.

800 mg of ribavirin daily is optimal for easy to treat genotype 2 or 3 infected patients. In fact, 400 mg
daily was as good as 800 mg daily in an European study of genotype 2 or 3 patients presented at DDW
Chicago May 2005. Genotype 1 patients do better with 1,000 or 1,200 mg of ribavirin daily. Even higher
doses are being used in very heavy patients. The Roche brand of ribavirin (Copegus) competes with
Rebetol. Three Rivers pharmacy sells generic ribavirin called Ribasphere. They also sell RibaPak which
lowers the number of pills and improves compliance. This is lowering the cost of treatment for

The CDC now recommends that Americans be tested for HIV routinely. They should have also
recommended that all American middle aged persons be tested for HCV and HBV. Their data indicate
that 7.1% of men and 2.3% of women between 45 and 49 are infected with HCV. Identify infected
persons and offer treatment is the logical strategy. We can lower the death rate from HCV if we are
aggressive in identifying infected patients. Cure the curable patients and lower the death toll.
Five million Americans are infected and we can cure TWO MILLION TODAY with currently available

I am an advocate for patients infected with HCV. The medical insurance companies place too many
obstacles to block patients from going on or staying on the medications. I have seen many curable
patients fail because of this. Medicaid cancels Rx Even though treatment is now less expensive and
more effective, the insurance companies are shifting more of the cost of treatment to patients.
Stage 3 and stage 4 HCV liver disease is life threatening and should be covered like cancer treatment,
coronary artery bypass surgery and kidney dialysis. HCV cirrhosis is just as deadly as these other
life-threatening diseases. Insurance companies should not discriminate against treatment of HCV, just
as they are forbidden to discriminate against treatment of HIV/AIDS.

I can give information, but cannot practice medicine over the internet. Patients with HCV should
consult a knowledgeable medical provider who treats large numbers of HCV infected patients

You can find more HCV information in the links below and the links on the left side of this page.

the National Library of Medicine

FDA analysis Pegasys + Ribavirin
HCC 77 months after cure of HCV
Details about Pegays plus ribavirin

US vital statistics report
http://www.healthyhepper.com/index.htm

Individualized treatment with Rebetron
1.8% of African American military recruits were infected with HCV
http://hepatitis.va.govhttp://frontline-hepatitis-awareness.com

http://www.hcvinprison.org/
HCV from unsterile needles in Egypt
http://www.internet-health-directory.com/

http://www.liverfoundation.org/
Standard Treatment for HCV does not work

Antiviral Rx reverses cirrhosis
liver biopsy is not accurate

http://www.liverhealthtoday.org/
Hep C straightup