The Conversation

Dr. Vishal Gupta appeared as the special guest on Dr. Ali Kasraeian’s weekly radio show The Conversation, on NEWS WOKV. On this episode, Dr. Gupta was invited mainly to discuss Hepatitis C. From the causes to its treatments, this a must-listen show.

Listen to the April 11, 2015 episode of The Conversation

Kevin Rafuse: And this is The Conversation on News 1045 WOKV. I’m Kevin Rafuse joined here by Dr Ali Kasraeian. The number is 904-340-1045, to join in on The Conversation today. Doctor, how do you doing?

Dr. Ali Kasraeian: Good afternoon. Happy Saturday to everyone. Went to One Spark today.

Kevin Rafuse: Yeah? How was that?

Dr. Ali Kasraeian: It was interesting, nice to see people downtown. My question for One Spark is it seems to be a very much of a festival theme and you’re in the media you may know, where would one look to find out where those innovative ideas that are you know the groundbreaking things that people are looking for is there a place they can go to? Onespark.com… something of that nature?

Kevin Rafuse: Yeah, I believe that its either onespark.com or onespark.org, I know they have a big website set up and I know they have all the winners and you know big ideas and big, you know vendors down there where…

Dr. Ali Kasraeian: I recommend everyone go check it out. It is a nice way to support Jacksonville and it is fun, the weather out there is pretty good and it goes on until tomorrow I think.

Kevin Rafuse: Yeah, the weather has been great. I think tomorrow’s the last day. They said they’re expecting a 250,000 people down there.

Dr. Ali Kasraeian: That’s impressive.

Kevin Rafuse: Yeah it’s going to be another nice night today down here on the First Coast so definitely go check it out downtown.

Dr. Ali Kasraeian: Very good, I may do that after the show.

Kevin Rafuse: So we have some guests here today.

Dr. Ali Kasraeian: We do. In studio with me right now there are Andrew Eriksen who is my dear friend and a savant in terms of the world of how to manage the world of medical business and the economy of healthcare policy, so thanks for joining us.

Andrew Eriksen: My pleasure.

Dr. Ali Kasraeian: And also on the line today is Dr. Vishal Gupta who is a gastroenterologist from the Orlando area with expertise among many other things Hepatitis C, and some of the very new and novel things in the world of hepatitis C. So we’re going to talk about that. It’s a very hot topic right now that may not get the media attention of some of the other things going on these days but there are a lot of innovative new things going on in the world of hepatitis C. which is interestingly one of the if not, the most common blood borne chronic illness in the United States and it causes chronic liver disease, liver failure, liver cancer and is the most common cause of liver transplants here in the United States, so it is an important disease. So, Vishal thank you for joining us.

Dr. Vishal Gupta: Ali thanks for having me. Thanks for having me. Welcome. Thank you thank you. So yeah I mean you’re you’re seeing me right I mean hepatitis C as has come a long way from something that truthfully years ago we didn’t even know what it was when we couldn’t figure out what it was we used to call it non-hepatitis A, non hepatitis-B, liver borne illness and beyond that we couldn’t give much insight into it.

Dr. Ali Kasraeian: Let me ask you this: What is the hepatitis?

Dr. Vishal Gupta: Hepatitis is a rather generic term just referring to any sort of inflammation in the liver and it could be autoimmune hepatitis meaning since you the body is attacking the liver, to drug induced and then most commonly everyone thinks of hepatitis as the infectious hepatitis and this would typically be our hepatitis A, hepatitis B and hepatitis C. Hepatitis A and hepatitis B are typically not long lasting. Almost all patients with hepatitis A, gets spontaneously resolves and goes away. Hepatitis B, in one percent of the population can only develop chronic illness and then finally there’s hepatitis C, that ninety nine percent of patients that are exposed to it develop chronic hepatitis B. And that’s where you exactly like you pointed out where it’s a major cause of liver related deaths in this country and worldwide.

Dr. Ali Kasraeian: So with this you know in terms of statistics, it’s just amazing. 3.2 million people in the United States currently are living with a diagnosis of hepatitis C. And as I mentioned before, it’s the most common longterm blood-borne illness in the United States and the severity of it recently became more significant in terms of its implication in people with HIV infections.

Dr. Vishal Gupta: Absolutely, absolutely so and this is those are rather even conservative estimates. You know there’s so much of a hepatitis C population out there that’s never been tested even though we have an actual guideline where everyone at the age of fifty should really be tested for Hepatitis C, only 20% of our population ever gets checked.

Dr. Ali Kasraeian: And it’s interesting you know they’re fairly interesting we got to look online for those in our audience are a lot of different resources that you can go to that talk about who should be tested because of the increased risk of getting hepatitis C in terms of his modes of transmission with the most common being I.V. drug users. Current and former. With this Vishal, what do you notice in terms of your general patient population in terms of the people that do get hepatitis C?

Dr. Vishal Gupta: You know there’s so many risk factors for it I mean some of the common ones that we look for is anyone that’s had a blood transfusion now the blood the blood bank that we do have currently is very safe but years ago people that got transfusion we didn’t really know what hepatitis was so we didn’t know how to screen for the blood that was given. And then of course we think about other things on the health care workers that are possible that they could have had an I.V. stick. Things like having a tattoo, sometimes those are not sterilized but not sterilize the way that it should be. So all of these are the most common causes and of course I.V. drug abuse as you mentioned.

Dr. Ali Kasraeian: Now interestingly you know about 60% of the cases of hepatitis C come from I.V. drug use and that’s a very, very important thing. And it’s not even just current users, it’s previous users. The blood transfusion that you mentioned again the same kind of concept. Hepatitis C is transferred with the contact of the blood of or blood bodily fluids such as semen for example of people who have an infection. With regard to the blood transfusions one can make a nice easy leap that if the means of transmission are blood borne then if someone gets a transfusion it could be the case. One thing to put out there is as a reassuring fact for those in our in our audience listening people that have a transfusion before 1992, you worry about the possibility of hepatitis C, because screening as we know it today began around that time. And nowadays the likelihood of getting hepatitis C, or even HIV from a blood transfusion is so low because of very aggressive and very standardized screening of blood products before they’re transfused or transferred to someone else.

Dr. Vishal Gupta: Absolutely, absolutely I think our blood bank that’s safe as it’s ever been at this point.

Dr. Ali Kasraeian: Now with regards to the body piercing and tattoos, what are some things that are in place in terms that someone if you’re looking to get a tattoo or body piercing should look to in terms of making sure that sterile instruments are being used?

Dr. Vishal Gupta: You know it becomes a very challenging question. I’ve had patients ask me this some just recently, and people you know. So number one there are sterilization and such that are in place and enforced to make sure that facilities are doing the right thing. The problem is, once when the places aren’t being policed quite well we don’t know exactly what happens. So the only thing that we can say is, number one to choose a reputable place. And number two, I even had one patient that purchased the actual tattooing equipment and had them use that. I think that’s a little more of the minority of patients.

Dr. Ali Kasraeian: That’s a very innovative means of pursuing a tattoo. You know, any time an illness that the infection is associated with a blood borne entity the idea of sexual transmission comes into play which for hepatitis is in fact one of the lower percentage causes of Hepatitis C. Is that true still today?

Dr. Vishal Gupta: Absolutely, so it’s interesting. We have done studies looking at monogamous couples over years and over 20 to 30 years we haven’t ever found a documented case in a monogamous couple of transmission. Now that being said, interestingly when it’s not a monogamous couple that’s been together for a while the rate increases and the hypothesis is out there that perhaps you know a little more passion, a little more craziness is occurring and perhaps that it leads to some more trauma and subsequently blood issues.

Dr. Ali Kasraeian: Well, so the potential, you know with multiple partners you have multiple risk of exposure especially if someone has other sexually transmitted diseases and HIV. In fact if someone has HIV that they that they achieved from I.V. drug use for example there’s about a fifty to ninety percent concordance of possibly having hepatitis C. So if someone like that is undergoing multiple partner intercourse with people who may be at exposed for having other sexually transmitted diseases that may be someone that may look into getting tested for hepatitis C as well.

Dr. Vishal Gupta: Absolutely, in fact we do vice versa for any of our patients diagnosed with hepatitis C, as would be just because the means of transmission can be very similar. We go ahead and make sure everyone’s also tested for HIV and same vice versa.

Dr. Ali Kasraeian: Now let me ask you this in terms of reassuring those, how are some ways that you can not get Hepatitis C?

Dr. Vishal Gupta: You know the best things are, a good clean life. Avoiding sharing razors with other people, avoiding sharing needles with anyone. Being very careful about if we are going to get a tattoo where we get it at.

Dr. Ali Kasraeian: Just precautionary measures.

Dr. Vishal Gupta: Absolutely, absolutely that’s the best thing. Prevention is the best way still.

Dr. Ali Kasraeian: Now with regards to other things to think about with, when someone approaches with the concern of getting hepatitis C. Such as you know when when we in the health care field are concerned about an I.V. exposure or a needle stick or something like that there are very strict criteria in place for the testing that we have to do in the timing with which that we have to do these testing. If someone is concerned about an exposure or whatever means it may be how quickly should they see a doctor?

Dr. Vishal Gupta: You know it’s good to see a physician as soon as possible if we know that the exposure was actually from a Hepatitis C-infected individual. In those cases, we will actually go ahead and start an empiric therapy for hepatitis C for a short period of time. And the thought process is that if we do that we can actually prevent the infection drom taking place. We have to stratify.

Dr. Ali Kasraeian: And so with that as an interesting thing that will segue into the rest of the hour. Some of the innovative things that they’re going into treatment. So you bring that up in terms of looking at Rick’s risk assessment and beginning treatment. You know the differences between acute hepatitis and the possibility of acute hepatitis turning into chronic hepatitis C, when you see someone that’s got an acute infection usually takes about six to seven weeks to potentially beginning… begin to have symptoms and things of that nature. Are there anything that people should keep in mind in terms of the possibility of an exposure?

Dr. Vishal Gupta: Yes some of the symptoms that you can typically see with this. Sometimes there’s honestly no. And that’s what makes it very difficult and sometimes that it prevents a type of cold type symptoms like you were coming down a little bit of a cold, just not feeling right a little fatigue and it typically resolves. Symptoms you want to look out for.

Dr. Ali Kasraeian: And interesting– So basically flu. Like symptoms things of that nature the other thing that’s interesting like you mentioned about seventy to eighty percent percent of people who have an acute exposure to acute hepatitis C don’t have symptoms so it becomes very challenging to know who actually gets an exposure that translates into an infection.

Dr. Vishal Gupta: Absolutely and that’s what makes this so difficult is there’s no clear signs or symptoms of it. That’s what we’re recommending just generic screening for the entire population of the age of 50.

Andrew Eriksen: Is there a typical time frame of the onset of chronic hepatitis C? Like if you have hepatitis C, is what I mean I’ve heard you can live with it for years without really having any you know effects physically or anything like that. What what is your experience with that?

Dr. Vishal Gupta: So with the hepatitis C. You’re actually right Andrew, Hepatitis C sometimes can go undiagnosed for twenty to thirty years and sometimes I have patients at their first visit to me is unfortunately the visit where they develop liver cirrhosis because this infection has been silently damaging their liver without any clear signs or symptoms. Sometimes in certain individuals and we don’t know exactly what it is it’s their particular virus that they have or something in their body that makes them more predisposed to having an aggressive infection. What makes it sometimes an individual take twenty to thirty years and sometimes take 5 years.

Dr. Ali Kasraeian: Very interesting, and so we’ll delve into that when we get into the break about all the things that one could think about in terms of avoiding and what to look for if you’re if you are concerned about hepatitis and then all the very innovative new things going on in terms of treatments available that didn’t used to be available even to a few short years ago.

Kevin Rafuse: That’s right, all that and more on the conversation with Dr. Ali Kasraeian. I’m Kevin Rafuse, the number to call in is 904-340-1045. This is News 1045 WOKV.

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Kevin Rafuse: Welcome back everyone. This is The Conversation on News 1045 WOKV, I’m Kevin Rafuse joined in studio by Dr. Ali Kasraeian. The number to call in is 904-340-1045 if you want to join in on the conversation and today we are talking hepatitis C right now.

Dr. Ali Kasraeian: We are everyone, thank you for joining us on The Conversation. We have Dr. Vishal Gupta, from Orlando gastroenterologist specializing among other things Hepatitis C. And we’re talking about all the new innovative things or will be talking about all the new innovative things going on in the world of hepatitis C treatment. But before we start, Dr. Gupta just made it into the studio so I want to kind of share some stories. So when I was a young third year med student doing my first couple rotations on my medicine service, which were my first two rotations as a third year medical student. So my immediate move from the classroom to the floors, Dr Gupta was my chief resident of our VA medicine rotation and we had a blast. It was a really fun month I learned a whole lot of things that we ended up staying friends but that you ended up doing your fellowship as well as your internal medicine residency at the University of Florida where I did all my training and it was just interesting to see all of us grow up and then to do a radio show together by just sheer, you know, happenstance of the way the week played out the way the topic shaped up. It’s come as a real honor says very fun.

Dr. Vishal Gupta: No it’s my pleasure.

Dr. Ali Kasraeian: So as a chief resident on the on the medicine service, how did I do?

Andrew Eriksen: Yeah he was absolutely the shining star.

Dr. Ali Kasraeian: So it’s interesting, we’re talking about hepatitis C. and the challenge with this stuff. It doesn’t get the media attention that and other things do like breast cancer and things of that nature but it’s a very important disease because one, it’s silent for a lot of people until the liver stops working.

Dr. Vishal Gupta: Absolutely, it’s it literally cost this country billions of dollars a year for untreated patients.

Dr. Ali Kasraeian: So when someone you know for us and the world of surgery when we get needle sticks and things of that nature which fortunately is a rare occurrence and there’s so much that goes into the universal precautions and things of that nature. We get tested with various different blood tests. Six months later we get tested because it may not show up right away. What is the natural history of this disease from the time someone is exposed to the progression to a disease that is essentially potentially lethal?

Dr. Vishal Gupta: From the time someone’s exposed the first time we can really actually detect it in their blood stream is usually anywhere from three to five months out and at that point the person starts making antibodies to the hepatitis C, which is our first sign that they may be infected. Following that like we said it can essentially lie dormant for years or it can start causing chronic liver problems very rapidly.

Dr. Ali Kasraeian: And so with regard to this whenever someone you know gets a hepatitis A infection if they have symptoms, which again like you mention are flu like symptoms you know one thing is urologist at sometimes we kind of get beat and our brains a little bit if someone has very very dark colored urine we kind of think to make sure that their livers OK. Abdominal pain loss of appetite fever you know and so you get jaundice and things of that nature potentially clay colored bowel movements is very non-specific symptomatology. So a lot of people could not think that anything was going on.

Dr. Vishal Gupta: Absolutely the average person thinks that they’re perhaps coming down with a cold.

Dr. Ali Kasraeian: Interesting, so what is the trigger point whenever someone is it is the difference you know just to kind of put the information out there if someone is treated with medications and honestly some of the newer sexier medications that are out there now. To the other one what is the timeframe and so on the next half hour when we kind of get into this stuff I think it is so much interesting things going on in terms of the treatments now that didn’t used to be around. It’ll be an interesting conversation about what we have available now that we didn’t have before.

Dr. Vishal Gupta: Absolutely.

Kevin Rafuse: And we have all that and more plus the FOX News update coming up. This is The Conversation on News 1045 WOKV on Kevin Rafuse in for Jay Gray. Joined by Dr. Ali Kasraeian, number is 904-340-1045 to join in The Conversation today, on News 1045 WOKV.

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Kevin Rafuse: Welcome back to The Conversation on News WOKV. I’m Kevin refuse filling in for Jake gray. We’re joined by Dr. Ali Kasraeian again the number is 340-1045 and you can join in on The Conversation today. So we’re talking hepatitis C right now delays treatments ways to diagnose it

Dr. Ali Kasraeian: So we’re talking all have ties to right and if you have any questions give us a call I’m flanked here by my good friend Andrew Eriksen and Dr. Vishal Gupta who is an expert in is a gastroenterologist and also with some expertise in Hepatitis C. but even more importantly he was my chief resident when I was a medical student on my medicine service which probably trumps everything else is suspect. OK So you know one of the most interesting and exciting things in terms of evolutions of treatment in the world of Hepatitis C, is in my eyes two for one the beginnings of moving beyond Interferon, which is a is a very difficult to take medication that stirs up your immune system to essentially fight the virus, and some other medications that work along the same vibe affair. Nothing was out until about2011 where we found newer medications being introduced to the to the field and really made improvements and curious from twenty percent to forty percent to eighty percent now some of them ninety to ninety five percent cure rates. The other thing I want to talk about is some of the new studies looking at introducing vaccines as a possibility. So along the first run, how has the innovation in pharmaceuticals for treatment changed things over the past few years really?

Dr. Vishal Gupta: Like I said Hepatitis C is a constant evolving thing. We’re at the best place and we’ve ever been years ago. We went from not knowing what habitat to see was calling it non a non the infection having no clue how to treat it or even diagnose it. To something that we years ago had Interferon and Ribavirin-based therapies and with those therapies essentially you know I think a biggest one most famous person that made some news with it was Pamela Anderson even with her infection. Years worth of therapy. Essentially most patients that were on it felt horribly sick. Best thing I can say is we’ve all had the flu at one point. That’s what it feels like, week on week for the first few days after injection and at the end of that year you were looking at anywhere from a 45-52 % cure rate. That’s after a year of therapy. So things have changed a lot and with the new therapies out right now, for most patients we’re looking at 95 – 98% percent cure rates after three months of therapy depending on your genome type.

Dr. Ali Kasraeian: So let me ask you you know one thing I had a question about for myself and I would assume that anyone who has this would ask this question. When along the course of the disease does treatment have the most benefit, or is as beneficial? Again with a disease of the natural history of it a lot it’s a lot of times as have people presenting when their liver is also already damaged.

Dr. Vishal Gupta: Absolutely and you know the earlier the better is what we know now.

Dr. Ali Kasraeian: The longer you wait, the more damage just is constantly happening on a daily basis to your liver which again put puts forth the importance of screening.

Dr. Vishal Gupta: Absolutely.

Dr. Ali Kasraeian: So with this you know some of the medications the newer medications that are out there you know they talk about the Harvoni medication and Viekira Pak, two medications it really recently in October of 2014, another one December of 2014 have come out and these are oral medications that you take between twelve to twenty four weeks and they have between 90 to 95% percent cure rates. What’s so innovative about these medications?

Dr. Vishal Gupta: Well we finally got an away from Interferon-based medicines. You still have a component of Ribavirin and most of these medications but we’ve finally gotten away from Interferon based medicines for a lot of these. Some of them still use some component. But for the most part we’ve gotten away from so people tolerate it extremely well now.

Dr. Ali Kasraeian: And so with these it looks like things are moving a little bit more into the world of combination therapies where you add different medications together to try to help. And right now I’m reading this book called The Emperor of All Maladies which is just this amazing book about the history of cancer and recently, a few weeks ago PBS. did a big three part series going over these. The evolution of thought from from day one to now is impressive and one of the you know one of the points of this that I found very interesting it’s going from using one medication with severe side effects to accepting combination medications with side effects and then moving to towards the idea that we have to manage the side effects better from this. Seems like you know the history of Hepatitis C is kind of the same way we started with one medicine that was poorly tolerant with not spectacular cure rates. Added another medication and now we’re advancing towards medications that not only do better but they have better cure rates.

Dr. Vishal Gupta: Absolutely like I said we’ve gone from one year 50% eradication rate, in one year of taking medications that made you feel horrible and fifty percent eradication rate on a bet. On a best case scenario two now as you mentioned ninety five percent after twelve weeks of therapy. So it’s essentially become something we’ve cured.

Dr. Ali Kasraeian: Now with this you know one criticism of this is these are profoundly expensive medications. You know some of them cost more than $1000 dollars a pill.

Dr. Vishal Gupta: Absolutely you know Dr. Ali Kasraeian, and I’m so glad that you brought that up this is something that unfortunately in today’s society I find really quite difficult to swallow and accept. I see patients every single day that can’t afford to get therapy, and insurance companies that are unwilling to and honestly can’t afford to pay for the therapy.

Dr. Ali Kasraeian: Because I mean if you look at a 12 week course costs more than $94,000 and with the amount 3.2 million people that have hepatitis C, how is that possible to sustain with the healthcare economy that we have currently?

Dr. Vishal Gupta: It’s not possible. It’s not possible, we see some of the companies, Sovaldi for instance when they first came out with their hepatitis C drug, their profits were literally one billion dollars per month. One billion dollars. I think at some point you know we’ve talked about some controlling drug costs and such. Unfortunately it hasn’t happened.

Dr. Ali Kasraeian: Well I mean the challenge with this, also you know that it costs billions of dollars to conduct a research to get exciting drugs from this. So as soon as a company was putting forth that you need to recover a change or you know as as a health care person who deals with the economy of health care on and on a day to day basis with much more in-depth thought, what is your thought with that component of this? We have a cure potentially. A medication with great results that is just exorbitantly costly.

Andrew Eriksen: Well I think like you said there is some research that goes into it so on the one hand I’m a capitalist, so I believe the company has a right to recoup the investment they’ve made in creating this amazing treatment. But on the other hand I realize that as a society and as a country we can’t really afford to pay for this long term. I think what we’ve seen already though is a number of other manufacturers have come out with competing drugs and I think as they do, it will drive the cost down in the time. What’s happening right now with the insurance companies is that doctors rightly so are calling people like myself are concerned about what should we do we have patients coming or office wanting these drugs. The insurance companies are telling us basically you know we’re not going to get it or they come and now the doctor gives the drugs but now they’re showing up on the insurance company’s radar is being high priced, you know high cost provider and so the docs are unfortunately as you both can attest to are stuck in the middle. You know on the one hand they want to provider this treatment but on the other hand they also have to to make a decision that won’t hurt them long term with the insurance company. So honestly there’s not an easy answer I mean I think that the best solution is going to be more competition, drive down costs and then I mean yeah I think there is some room for regulation but I don’t I believe in innovation. I think with too much regulation you lose that.

Dr. Ali Kasraeian: Now with this you know, are there some patients who aren’t candidates for this medication? Or is everyone that has hepatitis C a candidate for these newer medications with the better cure rates?

Andrew Eriksen: Essentially everyone’s a candidate. The only thing that changes is, if someone has advanced liver disease such as liver cirrhosis or they have a different genome type of the… hepatitis C has 4 main genome types. 1 through 4 and depending on your genome type, and depending on how advanced your liver diseases, we decide treatment courses. Some people may need more than twelve weeks of therapy.

Dr. Ali Kasraeian: Now with regards to this you know, if you have a disease that could potentially cause habitat hepatocellular carcinoma which is a very common cause of death in liver transplantation. Once you go through these, if you have a disease that could potentially be cured one thing to keep in mind as a society, the cost incurred with liver failure and liver transplantation is not cheap either.

Dr. Vishal Gupta: Absolutely.

Dr. Ali Kasraeian: I was kind of like a very very interesting cost benefits analysis where if you spend a little bit more on prevention once the disease has been diagnosed, do you save money with avoiding people from getting transplantations and managing chronic liver disease. or is a cause for these two insurmountable right now to sustain.

Dr. Vishal Gupta: I think that’s exactly the questions everyone has. No one doubts that.

Andrew Eriksen: I mean obviously we don’t have any studies to point to I mean we know what the cost of the things you mention as far as liver failure and those but you know we don’t have enough long term data really to say which is. But I think to Dr. Gupta’s point is that when, I see a continuous count of these patients coming to his office wanting this I think he’s going to be the one partnering with the insurance company to evaluate whether this patient… and that’s a tough… whether they were qualified for it or and like he said everyone does but at some point and say OK well this this person is is experiencing a lot of you know issues in their body and let’s get them on as quickly as possible. If it’s dormant, it’s been doing for 10 years you know I think those ones maybe can wait a little bit until the costs go down.

Dr. Vishal Gupta: Absolutely, that’s the risk perception we’re doing every day. Some of the insurance companies have actually already said that we need to wait until patients are sicker in order to treat.

Dr. Ali Kasraeian: See, that intuitively makes no sense to me as a physician in terms of if I was not sick I kind of would want to avoid getting sick.

Dr. Vishal Gupta: One hundred percent, one hundred percent.

Dr. Ali Kasraeian: It’s really difficult. I can imagine that’s a very difficult issue that we as physicians cannot deal with every day and you know all day long and it’s becoming more and more of a conversation piece in our clinic which is very, very challenging and disheartening because at the end of the day we want the best for our patients but we also don’t want to bankrupt our patients.

Dr. Vishal Gupta: Absolutely. It would be like someone coming into your office and you having to try to say, “well you have prostate cancer. we’re just going to let this be until it gets a little bigger and then I might take it out for you”.

Dr. Ali Kasraeian: There is a beautiful thing called active surveillance. I mean and it’s interesting some people are looking at the cost benefits analysis of doing active surveillance where one monitor prostate cancers. So this may be a similar kind of question, does your hepatitis C. A. Point is dormant enough to monitor until we have to do something? On the flip side of that you know there are some new studies that have come out and there are some studies ongoing to look at the benefits for hepatitis C vaccines which is a relatively new concept.

Dr. Vishal Gupta: We’ve been working on that for years and along the way, hopes have been that we’ve found the cure for hepatitis C, HIV and other things. There’s been a lot of progress made and we’ve seen some new innovative studies. As of yet though we’ve yet to pin down the true vaccine. But yes that would be wonderful.

Dr. Ali Kasraeian: Now in terms of one study that came out of Oxford. They looked and found that about one in four people who who have hepatitis C could in certain scenarios could potentially clear the infection and they kind of look at the immune system and from that believed that they came up with a kind of like a two tiered vaccine approach where they gave one to one and again the study was really small — 15 people. And they gave the volunteers a first vaccine a kind of prime the immune system. Some 8 weeks later they gave a second vaccine and with that there they found a T. cell responded that time the person’s immune system to fight the infection and hopefully protect someone from from progressing and having hepatitis C vaccine that translated into a chronic disease with all the side effects associated U.S. trials are ongoing with this. Where in your opinion are we along that front at this point?

Dr. Vishal Gupta: You know I’d love to say that we were a lot further. I think that we’re probably still years out from the true cure. Actually from a preventative vaccine. Actually, so time will tell.

Dr. Ali Kasraeian: Because we have that for hepatitis B and any health care professional that sets foot in a hospital or medical school your residency has to have a series of hepatitis B vaccines to make sure that get your immune system’s primed for. And so with that you know, what in your opinion and this is I know this is a loaded question that are the next steps for the possibility of a hepatitis C vaccine?

Dr. Vishal Gupta: But you know, some of these viruses are very difficult to kind of get a hold of if you will it’s like you know we’ve tried for years for HIV vaccine and it hasn’t really happened. By the time you come up with a vaccine, that HIV mutates and we’re seeing a similar type issue with hepatitis C. as far as how we can prevent it. You know the same way years ago. We never imagined this type of medications available to treat hepatitis C, the same day we hope to one day be surprised at how well we can do with preventing it in the first place with a vaccine.

Dr. Ali Kasraeian: I mean the interesting thing I find as we get you know more education more knowledge. You know it’s up like the human the human genome project, the more we learn about the human body the more we learn about the diseases, the more we learn about the viruses, the bacteria, the cancers, the more we’re amazed by how little we know. So how much more there is to know and how smart these things are and how well they adapt to survive. And that’s one interesting challenge with all the things that we do. And you know where we are today compared to where we were 50 years ago as it is unbelievable and so that’s kind of where we’re going to be in the future I think is in my opinion is going to be we’re going to find out a lot of things that we didn’t know. We need to know more things and hopefully we can come up with preventative measures such as vaccines and the knowledge to even consider some of these preventative measures. So it’s an amazing field, this an amazing concept and where are we at today compared to where we were even 5 years ago and where we’re going to be in five years. Kind of blows your minds a very exciting time to be a physician, but it’s also a very frustrating time to be a physician, because you have to think of the economy and the policies in place to give the patient in front of you the best care you want to give them and the best care they want.

Kevin Rafuse: We do have to take one final commercial break. This is The Conversation on News WOKV, I’m Kevin Rafuse in for Jay grey joined by Dr. Ali Kasraeian. Number is 340-1045 if you want to get in any last minute questions here on News WOKV.

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Kevin Rafuse: I’m Kevin Rafuse is joined by Dr. Ali Kasraeian in the umber is 340-1045 to join in on the conversation today. We were talking hepatitis C and we do have one quick phone call that we want to get to. We’ve got a phone call from Teresa, she’s got a question for the doctor. Teresa how are you?

Teresa: I’m great thank you.

Dr. Ali Kasraeian: Welcome to The Conversation, how can we help you today?

Teresa: When I was diagnosed with hep C back in 2007 the latter part of 2005 into 2006, I was told by the specialist that I was saying at the time that in probably been dormant a good 26 years in my system and fortunately overall I was always healthy, active, athletic and so on and so forth. So I don’t know what the time frame is from conception if you will, I guess exposure is better word but I had a had a birth of a child one of my children was born in a military hospital prior to 1990. And I did have a blood transfusion she was just just delivered and they had to give me a transfusion almost immediately. So and that as best as we can track that where I got it.

Dr. Ali Kasraeian: Interesting, so Dr Gupta What are your thoughts?

Dr. Vishal Gupta: So number one we don’t know exactly how much it’s… when we say lie dormant, it’s probably been active in some degree we don’t know how active. With the blood work and ultrasounds and non-invasive testing that we have, they will essentially give us some ideas or clues into this but we don’t see things until things are really quite far damaged.

Dr. Ali Kasraeian: You know that the data going to shows maybe something in a twenty three year window only sixty to seventy percent of people historically that have the time to see their fellow chronic liver disease only five to twenty percent gets to the system only one in five percent die and I think a lot of that’s on the stem of a lot of that in the end. There’s a great therapy that are place right now so the big thing is if you have any concerns if you are of the right age if you have the appropriate risk factors get screened because the earlier you catch is the better.

Kevin Rafuse: Unfortunately we’re out of time here on The conversation with Dr. Ali Kasraeian. Thank you everyone for joining us. We will be back next week same time 5 to 6PM. I’m Kevin Rafuse in for Jay Gray here on News 1045 WOKV.

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