For a while, it looked like there really was a  “miracle cure” for people with hepatitis C—a cure that would simply get rid of the dangerous virus with no risky side effects. But now we know different. The cure for “hep C” is still wonderful and lifesaving, but it comes with a potential dark side.

The danger: For some people with hepatitis C who previously had hepatitis B (another serious liver virus) but recovered from it, the new “direct-acting antiviral agents” that eradicate hepatitis C can reactivate hepatitis B, making patients sick with hep B again.

Researchers don’t know why this is happening and can’t predict which patients will experience it, but it’s likely tied to the fact that proteins and/or DNA from the hep B virus can lie dormant in the body—and something in the direct-acting antiviral treatments wakes them up and leads them to start replicating to disease levels. Previously, hep B reactivation had been seen in people whose immune systems became suppressed, but that’s not the reason in this case because the treatments don’t have that effect on the immune system. More research is under way to determine why it’s happening and what can be done about it.  Meanwhile, if you know that you have or find out that you have hepatitis C, understanding the disease and the latest drugs for it will help you navigate successfully through your own treatment.

TWO VIRUSES, ONE PATIENT

It’s been only 20 years since hepatitis C was named as its own form of hepatitis, the umbrella term for liver disease characterized by inflammation—the itis.

For some patients, hep C is an acute, or short-lived, infection lasting six months or less and clearing on its own. For many others, it’s a chronic, or long-lasting, infection that the body is not able to fight off on its own. Many people with the chronic form can be symptom-free for years or even decades, so you could have the infection and not know it. In fact, despite awareness campaigns, three-quarters of the estimated five million Americans—mostly baby boomers—infected by the hep C virus are unaware that they have it.

A simple blood test can screen for hep C and find it before it has a chance to damage the liver. Without treatment, hep C can lead to cirrhosis, liver failure and liver cancer.

The good news is that hep C treatment has improved by leaps and bounds, moving from weekly injections and daily medications to pills alone, and with an impressive success rate thanks to direct-acting antivirals. The first of these drugs was approved in 2013, and since then, many more have been developed that can target the different genotypes, or forms, of the hep C virus—offering hope to more and more people with the infection. These drugs stop the virus from replicating in the body, are taken for just a few months and have fewer side effects than the original treatments.

AVOIDING THE BIG SIDE EFFECT

According to a review of cases of hep B reinfection reported to the FDA and published in Annals of Internal Medicine, there’s no way to know which patients will experience a relapse of hep B from being treated for hep C. That’s why everyone with a history of hep B being treated for hep C with a direct-acting antiviral should be carefully monitored for a return of the hep B infection. It’s especially important for you to bring this up with your doctor if you’re being treated by a general practitioner, who may not be aware of this development, as opposed to a liver specialist. There are effective drugs for hepatitis B—in fact,  some practitioners may even give them to hep C patients prophylactically in hopes of preventing reactivation of hep B.

Bottom line: Direct-acting antiviral drugs can not cause hep B infection in patients who have never had hep B before. And these drugs are still considered a safe and effective treatment for hep C—as long as the possibility of a hep B reactivation is taken into account and monitored. If you’re a baby boomer who’s still on the fence about getting tested for hepatitis C, that testing (and treatment) could well save your life—don’t delay…get it done.