The last time I wrote about a new avenue of treatment with Hepatitis C was in 2009. And it was a very new, very far-out kinda treatment.
Now in 2011, I have another treatment breakthrough to talk about– its more of a traditional antiviral therapy (protease inhibitor), and it works (especially on a variant of HepC that is difficult to treat, in racial populations that are difficult to treat), but Ive still got a Star-Wars-esque ‘bad feeling about this…’
Long story short– We have very limited options for treating HepC infections. Two drugs. Lots of people cannot finish the drug course due to side-effects. Even those who can tolerate the side-effects arent guaranteed a ‘cure’– depending on the HepC variant, ~25-50% people cannot clear the virus. This leads to extensive liver damage, the need for a liver transplant, and lots of HepC related deaths via chronic liver disease, cirrhosis, or cancer.
Merck created an anti-HCV drug, Boceprevir, that apparently works well against a particularly difficult HCV variant to treat, Genotype 1. It is a protease inhibitor, a phrase many on ERV will already be familiar with, but just in case youre a newb or forgot– we use protease inhibitors against HIV-1 all the time. Lots of RNA viruses are what I call ‘sheet cake’ viruses– One promoter, ‘one’ mRNA (which can get cut into lots of different mRNAs), and ‘one’ protein (which gets cut into lots of different proteins). If a virus can cut up its mRNA and proteins into the appropriate slices of ‘cake’, it has a fun party. If take away the viruses knife (protease) via a protease inhibitor, it cannot cut up its proteins/caek, no one gets a slice, and the virus has a crappy party.
When people who either a) had not been treated or b) had previously been treated but didnt clear the virus with Boceprevir, it almost doubled the number of people who cleared the virus.
Except… like I said… I have a bad feeling about this. Viral evolution is what I do… So what happened to the virus in the people who were treated with Boceprevir, but did not clear the virus?
Boceprevir resistant HCV.
This is an RNA virus we are talking about, here. Quasispecies. You cant just treat with ‘one’ protease inhibitor and not expect this to happen. And then we have no idea if this resistance comes at any fitness cost, some escapes might, some might not, which means we are just *asking* Boceprevir resistant HCV to replace ‘regular’ HCV on the global scale.
But I guess we can save some people with this therapy before that happens, and then we are just SOL again, LOL.