For the estimated one-third of HIV-positive folks who also have hep C (HCV), watching drug development is a must. Standard HCV therapy—pegylated interferon (to help the immune system fight C) plus ribavirin (to curb relapse)—has side effects so bad they feel like “the flu from hell,” and works in fewer than half of cases. Experimental meds attack HCV itself, disrupting its reproduction (as HIV meds do to HIV) while causing fewer side effects. The hope: drugs with more oomph but fewer ughs.
One that could be approved in late 2008 is Vertex’s HCV protease inhibitor (PI), telaprevir (VX-950). Alone or with interferon, telaprevir suppresses HCV and by itself hasn’t caused nasty side effects. Other novel meds, including two more PIs and two that inhibit another HCV enzyme, polymerase, are also close to approval.
Further, researchers have found a protein, claudin-1, that HCV uses to enter cells, offering another possible future drug target. As with HIV meds, combining drugs would add punch and delay drug resistance. So look for hep combos that tackle HCV at various life-cycle stages.
In grimmer news, recent studies confirm HCV transmission via sex, not only shared needles. First, outbreaks erupted among HIV-positive gay men in the UK and Europe; this year, a British study found it among HIV-negative gay men too. Sexual transmission is linked to anal sex, fisting, the presence of other STDs and use of non-injected drugs like crystal. If you indulge, reach for condoms and latex gloves. C ya.