Fourth time's a charm: A patient almost gave up, but his doctor knew better

Suffering with hepatitis C well before the illness was recognized in 1991, Andrew Mongiardo had already participated in three clinical trials, but to no avail. Now he was about to embark upon another. But on that May 2007 day, Mr. Mongiardo was feeling discouraged. Extremely tired and forlorn, he carried all the medicine and medical supplies he received for his new treatment regimen back to his physician’s office.

“I brought every single thing back [to the North Shore-LIJ Center for Liver Disease],” said Mr. Mongiardo, then 56 years old. “I don’t know if I was starting to worry about the enormous time commitment to the trial, the possible side effects of the new treatment or the potential disappointment of not responding to the medicine. I was looking forward to a nice relaxing summer, and I didn’t think I had it in me this time around.”

Maly Tiev, RN, NP, asked if his doctor could see him before he left. Mr. Mongiardo will never forget the life changing exchange. “My doctor said ‘Look, you’ve been a patient of mine a long time, and I know you’ve been through a lot, and have tried so many different things. This treatment is new, it looks very promising and it’s the only one for your condition. I don’t know what else is coming out and I would strongly recommend you try this one because I have good vibes about it.’ And boy am I glad I listened.”

His doctor is David Bernstein, MD, chief of hepatology and director of the North Shore-LIJ Health System’s Center for Liver Disease, who had the pleasure of telling his longtime patient he was cured of the virus six months after starting on the investigational treatment protocol.

A curable virus

“In the early 90s, initial therapies cured only six percent of hepatitis C cases,” said Dr. Bernstein. “Now, 22 years later, we are curing 90 percent of patients with tolerable medications. It is the only viral disease we can cure. We can treat hepatitis B and HIV disease to suppress the virus. We treat the common cold virus to shorten the symptoms, but we treat hepatitis C to cure it.”

Hepatitis C, or Hep C for short, affects nearly seven million Americans and about 150 million people are chronically infected worldwide. A disease caused by a virus that infects the liver, it can eventually lead to permanent liver damage as well as cirrhosis, liver cancer and liver failure. Because the disease rarely presents symptoms, most people don’t know that they have Hep C until they already have significant liver damage, which can take many years or even decades to manifest.

“There are tremendous misunderstandings about liver diseases,” said Dr. Bernstein. “People equate liver disease with alcohol abuse. But there are many other diseases of the liver that are more common than alcohol-related disease. Some examples are hepatitis B, hepatitis C and nonalcoholic fatty liver disease, or NAFLD. NAFLD is present in 90 percent of patients with diabetes and is projected to be the leading indication for liver transplantation in the United States by the year 2020. One of our major roles in the Center for Liver Disease is to get the word out and educate our communities about the real causes of liver disease and their treatments.”

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