Hepatitis C Treatment: a brief interview with Sanjay Bhagani

I caught up with Sanjay Bhagani and asked him about his comments from day 1 about the timing of hepatitis C treatment commencement:

Could you elaborate on the safety of delaying treatment in people with advancing hepatitis C disease both in mono infection and HIV co-infection:

The question is 'When is it too late to treat hepatitis C?' In other words, when are people started on hepatitis C treatment not going to benefit; when are you are not going to prevent decompensating and needing liver transplant? This is a key area where we are going to get data over the next year or two. A number of countries are advocating the treatment of people with end-stage liver disease because of the high cost of treatment. The NHS has put in an scheme to treat 500 people with advanced disease Child-Pugh B or liver cirrhosis and I can tell you that at the Royal Free we have a number of people who are decompensating despite having started treatment. This will certainly give us an idea of when is it too late to treat people.

So when should we start?

Hepatitis C is not just a disease affecting the liver. It is a multi-system disease. It can cause renal disease, brain disease, cardio vascular disease as well as liver disease. All of these need to be considered. The concept of simply waiting until the liver is diseased might be delaying too late.

Many of these comorbidities are seen in HIV. Do they have a cumulative effect?

Certainly the data is emerging that having another virus as well as hepatitis C means that you are doubling-up on your inflammatory response. Controlling HIV is all well and good and we have been able to do that fairly effectively for some time. But if you have another virus that causes inflammation that may defeat the objective of reducing the inflammatory effect.

Thank you.