Hepatitis C affects approximately 4 million or 2% of Americans, and more than 100 million persons worldwide. Chronic hepatitis C can progress to cirrhosis and liver cancer. Endstage liver disease and liver cancer due to hepatitis C account for 30%-50% of adult liver transplantations in western countries. Most people with chronic hepatitis C do not have symptoms and are not diagnosed until they have advanced liver disease. There is as yet no vaccine for hepatitis C.

Currently, the only treatment is combination therapy with pegylated interferon and ribavirin. This treatment can lead to virus clearance in roughly 50% of patients. However, the treatment is expensive and associated with many side effects. Only a small percent of hepatitis C patients are treated because of lack of access to medical care or presence of other medical conditions that preclude them from treatment. Of those who are started on treatment, 15%-30% are unable to complete the course of treatment due to inability to tolerate the side effects. Thus, there is a need to develop more effective and better tolerated treatments. There is also an urgent need to develop treatments that would be effective for those who have failed to respond to currently available treatments.

The Viral Hepatitis program is the center piece of the University of Michigan Hepatology Program. This program is led by Drs. Anna Lok, Hari Conjeevaram and Robert Fontana, national and international leaders in the field. The program integrates state-of-the-art care with cutting edge research.

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Our Program is also active in hepatitis B research. The University of Michigan Viral Hepatitis Program is one of the top programs in the country, with more than $1million/year grant funding from the NIH and more than 20 peer-reviewed scientific publications each year.

Anna S. Lok, MD Dr. Lok is Professor of Internal Medicine and Director of Clinical Hepatology. She is a world renowned investigator in viral hepatitis. She has lectured all over the world and has published more than 200 scientific papers. She is currently an Associate Editor of HEPATOLOGY, the official journal of the American Association for the Study of Liver Diseases. She is also a member of the National Board of Directors of the American Liver Foundation. Dr. Lok is listed in "Who's Who" and "Best Doctors" of America. She has trained more than 20 young doctors in the care of patients with liver diseases and in research on viral hepatitis. She also participates in community education and recently won an "Award for Outstanding Contribution to Health" from the Community Health Charities.

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All viruses are parasites in that they require a host cell to reproduce. Hepatitis C virus (HCV) is no exception to this rule. Indeed, work done by myself and several other groups have shown that literally hundreds of human proteins appear to play important roles in viral entry, replication, and release from liver cells.

My goals are (1) to characterize, at a molecular level, how some of these human proteins help HCV replicate and (2) to continue to identify new proteins that participate in the HCV life cycle. Some of these human proteins may be good targets for drugs that block their ability to help HCV replicate and thus may result in new therapies for HCV infection. One advantage to this strategy is that it may be more difficult for HCV to develop resistance mutations to such drugs compared to drugs that directly target viral proteins.

Dr. Andrew Tai Dr. Andrew Tai is a new faculty member in the Division of Gastroenterology at the University of Michigan. His research focus is on the molecular mechanisms by which host factors support hepatitis C virus (HCV) replication. Andrew obtained an undergraduate degree in biochemistry from Harvard University, followed by a combined MD-PhD training program at the Weill Medical College of Cornell University. He then moved to Boston to complete a residency in internal medicine at the Brigham and Women’s Hospital followed by a clinical and research fellowship in gastroenterology at the Massachusetts General Hospital. Under the mentorship of Dr. Raymond Chung at MGH, Andrew carried out a whole-genome RNAi screen for host cofactors of HCV replication. This effort led to the identification of nearly 100 previously unknown genes involved in HCV replication. He is now continuing his work at the University of Michigan on the mechanisms by which HCV depends on host factors for its life cycle.

We recently helped fund a research project headed by Michael Volk, MD, MSc, which measured the public health impact of current Hepatitis C treatments.

Update: The descriptive study on treatment rates of hepatitis C, titled “Alarming Trend: Antiviral Therapy to Treat Hepatitis C is Declining in the US” was published in the Dec. 2009 issue of Hepatology, the official journal of the American Association for the Study of Liver Diseases. An abstract is available here and more detailed summaries are available at ScienceDaily, EurekAlert, PhysOrg, and the Life Sciences Blog.

Future donations will go towards, among other things, the development of a patient education tool and decision aid for the treatment of Hepatitis C. This is intended to improve the quality of care for patients with Hepatitis C.

Other research topics may include optimizing treatment response in clinical practice (for example, research into methods to reduce side effects and to improve dose adherence), or evaluation of new treatment strategies (for example, research on impact of weight reduction or treatment of associated metabolic conditions such as insulin resistance on rate of viral decline during antiviral therapy.

Below are some links to websites containing information on Hepatitis C:

• HCV Advocate
• American Liver Foundation

We have been receiving several inquiries on how to get financial assistance for HCV treatment both in the U.S. and abroad. We are not able to provide any money from the Greenview Hepatitis C Fund for this purpose, but are interested in steering people to available resources.

Most major pharmaceutical companies offer “Patient Assistance Programs” to provide free or low cost medications to those unable to pay. Here are some sources:

• Merck/Schering-Plough
• General search
• Roche
• Pegasys
• BioPlus Specialty Pharmacy Services
• NeedyMeds