Hepatitis 'C' Cures Now Common
Existing Treatments Eradicate Hepatitis C Virus
By Salynn Boyles
WebMD Medical NewsReviewed by Louise Chang, MDMay 21, 2007 -- A new report shows that patients with hepatitis C infection can not only be successfully treated by the best available drug therapies, but they also can be cured.
Up to seven years after treatment, 99% of close to 1,000 successfully treated patients showed no evidence of hepatitis C virus (HCV) infection.
Hepatitis C is caused by the hepatitis C virus, which is transmitted from contact with infected blood. HCV infection is the leading cause of cirrhosis, liver cancer, and liver transplants in the United States. Roughly 4 million Americans are infected, but only about a quarter of them know they have the virus, hepatitis treatment expert John Vierling, MD, tells WebMD.
“We have to start identifying infected people earlier so they can be treated earlier,” he says. “It is true that about half of patients can be cured with the treatments available now.”
‘Virus Won’t Come Back’
Those treatments include a long-acting version of the drug interferon, known as pegylated interferon, and the antiviral drug ribavirin.
The long-term follow-up study included 997 patients who achieved sustained virologic responses with pegylated interferon with or without ribavirin, meaning they had no evidence of the virus in their blood six months after treatment.
All but eight of the patients were still free of the virus an average of four years after treatment. Some patients were followed for as long as seven years.
Two of the eight patients showed evidence of a second HCV infection, and it was not clear if the remaining five relapsed or were reinfected.
Virginia Commonwealth University Medical Center chief of hepatology Mitchell Shiffman, MD, presented the follow-up data Monday in Washington at Digestive Disease Week, an annual meeting of liver and gastric disease specialists from around the world.
“When we achieve sustained virologic responses, less than 1% of patients will get the virus back,” he tells WebMD. “We know the virus will not come back in a year or two or three. These patients are cured.”
Not All Respond
But between 45% and 50% of patients treated in the United States do not respond to treatment or have incomplete responses, according to Shiffman.
He adds that roughly 70% of infected Americans have genotype 1, a genetic type of the disease that tends to be less responsive to treatment than other genotypes.
Bruce Bacon, MD, of St. Louis University, tells WebMD that specialists know much more now than they did a few years ago about individualizing interferon treatment.
Patients who respond very quickly may not need to be treated for as long, while those who respond slowly may need a longer course of treatment -- as long as 1.5 years for very slow responders.
Bacon, who directs the division of hepatology at Saint Louis University School of Medicine, says many patients -- and even their primary care physicians -- still do not understand that HCV infection can be cured.
“The overwhelming perception is that this is a disease that can be controlled, but not cured,” he says. “That is why infected people are often hesitant to even consider treatment.”
Better Treatments to Come
The message, the experts agree, is that a cure is possible, even for people who already have liver damage and for those with conditions like HIV co-infection.
They also agree that highly anticipated new treatments could improve cure rates in the years to come.
Phase II trials of highly specific drugs that target HCV are now under way, and Bacon says they could be approved within two to three years.
Vierling says he has high hopes that a multidrug approach to HCV treatment, similar to the approach that has turned HIV from a uniformly deadly to largely manageable disease, can improve treatment outcomes for a larger number of patients.
“New drugs may allow us to use existing treatments at lower doses or for shorter periods,” he says. “The future looks bright.”
Living With Hepatitis C
If you just found out that you have hepatitis C, remember two things. First, you probably have decades of a healthy life ahead of you. Second, living with any chronic disease can make you feel isolated. It's important to get support.
"When people first get diagnosed, they feel infectious," says Alan Franciscus, executive director of the Hepatitis C Support Project in San Francisco. "They often look at themselves as a disease more than as a person."
To get past that feeling, get the right type of support -- both medical and emotional.
Medical Support
Start by finding a good doctor. Hepatitis is a chronic disease, so you'll probably be seeing your doctor for many years. Make sure to get someone you like and who's an expert at treating hepatitis C.
"You need a doctor who understands the disease and who really has the time to sit with you for 30 or 40 minutes and explain it," says Howard J. Worman, MD, associate professor of medicine at Columbia University's College of Physicians and Surgeons. "If your doctor will only see you for fifteen minutes, or if he or she isn't really explaining it, you should get a new doctor."
Also, try to educate yourself. Learn about the disease and its treatments. Worman suggests you turn to reliable sources like the National Institutes of Health or the American Liver Foundation.
"Unfortunately, there are a lot of wacky books out there about hepatitis C," Worman tells WebMD.
Take care when getting treatment information from the Internet. "The problem is that no one regulates the information that's on the Internet," says Paul Berk, MD, professor of medicine at Mt. Sinai School of Medicine and Chairman of the American Liver Foundation. A lot of information on the Internet is based on anecdotes, which may have little to do with your own particular case.
"There's some good stuff out there and plenty of stuff that's not so good," says Berk.
Hepatitis C and Depression
Living with any chronic disease can make some people depressed. But depression is a special risk for people taking peginterferon for hepatitis C.
"People getting treated for hepatitis C need to be prepared for emotional side effects," says Worman. "You can become anxious or agitated or depressed."
Worman suggests that people with a history of depression consult a psychiatrist before beginning treatment. Some people may need to postpone treatment until they're more emotionally stable. In other cases, a person may start on antidepressants as a precaution before even beginning treatment for hepatitis C.
In addition to medication, regular exercise may help prevent or improve depression in people getting treatment, says to David Thomas, MD, professor of Medicine at Johns Hopkins School of Medicine.
Thomas always asks his patients to bring in their partners or spouses before beginning treatment. "It's important that the spouse know about the risks of depression when on treatment," he says. "That way, he or she knows to tell me if the person starts acting strangely."
Some people with hepatitis C see a therapist to help them cope. Ask your doctor to refer you to someone who specializes in treating people with chronic diseases.
Seeking Out Support Groups
As helpful as family and friends are, it's still hard for them to understand exactly what you're going through. You may want to seek out other people living with the virus.
"I'm a huge fan of support groups," says Franciscus. "I think anyone in treatment should be in a support group, since it allows you to connect with people who are in the same position as you."
You can ask your doctor about support groups in your area. You may also find support groups on the Internet.
But take care in choosing a support group, and switch if the one you joined doesn't feel right. Sometimes, support groups -- especially on the Internet -- can devolve into people trading scary stories that don't reflect the experiences of most people with the disease, cautions Thelma King Thiel, chair and CEO of the Hepatitis Foundation International in Maryland.
"Just make sure to find a support group that makes you feel better," she tells WebMD, "rather than one that makes you feel worse."
Coping With Hepatitis C
Living with a chronic disease like hepatitis C can be depressing and nerve-wracking. Coping with the side effects of treatment isn't easy either. But another difficult aspect of having the disease is how it can interfere with your relationships. "
People with hepatitis C experience a lot of stigma," says Alan Franciscus, executive director of the Hepatitis C Support Project in San Francisco. "It can be really hard."
You may avoid talking to friends or family about the disease because you're worried about how they'll react. You may feel a temptation to pull away from people you care about rather than risk them knowing.
But you can't. The fact is that now, more than ever, you could use people to rely on. Keeping open and honest relationships with your family and close friends is key to your own well-being.
Coping With Stigma
People with hepatitis C are often anxious about how other people view them. In reality, hepatitis C is a disease that infects all sorts of people from all sorts of socioeconomic backgrounds. And public perceptions of people with hepatitis C may be more sympathetic than you think.
The American Gastrointestinal Association recently conducted a survey of public understanding of hepatitis C, questioning about 500 people with the disease and about 1,230 people without it.
The survey found that about 74% of the people infected with hepatitis C believe that others think the disease only infects unhealthy people or drug addicts. However, when uninfected people were asked, it turned out that only 30% had this impression. Only 12% said that "people like themselves" didn't get hepatitis C.
Obviously, plenty of people with hepatitis C do experience stigma, and plenty of uninfected people have wrong ideas about the disease. But take comfort from the fact that people may not be as hostile as you expect.
Talking to Your Family and Friends
Of course, whom you tell about your disease is up to you, but there are some people who really should know. You need to tell your family, your spouse, your sexual partners, and anyone else who might have caught the disease from you. The chances are small that any of these people have hepatitis C, but it's important that they know so that they can be tested and treated if necessary.
Telling other people isn't only for their benefit. You also need the support of family and possibly some close friends -- in coping with your illness. "Some of the biggest problems people have with treatment stem from not being supported at home," says Franciscus. "People really need help from family and friends to get through it."
It happens occasionally that family or friends react harshly to the news, says Franciscus. They may be both worried about your health as well as their own. They may be afraid of the future. They may be unsure whether they'll need to take care of you. As you might imagine, these conversations -- and their aftermath -- don't always go smoothly.
So to make things easier and reduce the risks of misunderstanding, prepare for the conversation before you sit down to talk.
"When you talk with people about the disease, you need to be armed with the facts," says Franciscus. Explain that:
Hepatitis C progresses slowly and may not cause symptoms for decades, if ever.
Hepatitis C is a manageable disease. If you ever do get symptoms, treatment may help.
Hepatitis C is difficult to pass on to someone else, so the risk of transmission within a family is very low.
If you have information to give people right away, it will make the conversation a lot easier.
Talking to Your Partner
Because hepatitis C can be spread sexually, it's especially important to talk to your partner or spouse about it.
Happily, the risks of catching the virus through sex are low. Of course, if you have multiple sexual partners, you should still use a condom. Condoms protect them from hepatitis C and protect you from dangerous sexually transmitted diseases. But if you're in a long-term monogamous relationship, the CDC considers the risk of sexual transmission so low that it doesn't even recommend using protection.
"It's very reassuring to people (in monogamous relationships) when they find out that they don't need to change their sex practices," Franciscus tells WebMD. Still, never keep your partner in the dark about your condition. You need to talk about it.
David Thomas, MD, professor of medicine at Johns Hopkins School of Medicine, says that he always makes sure that his patients with hepatitis C bring their spouses along to at least one appointment. In part, he says, it's to make sure that both people fully understand the risks of sexual transmission.
Thomas says that people react very differently to the news. Some couples are comfortable with the small risk and don't feel like they need to use condoms. Others are more nervous and want to use protection. There's no right answer. The key is this: You and your partner must talk about it openly and come to a decision together.
Shorter Hepatitis C Treatment Works for Some
For Those With Hepatitis Type 2 or 3, 3-Month Treatment May Suffice
By Daniel J. DeNoon
WebMD Medical NewsJune 22, 2005 -- Some people with hepatitis C may get by with only three months of treatment, an Italian study shows.
The findings apply only to people infected with type 2 or type 3 hepatitis C virus. They do not apply to people infected with the more common type 1 virus. In the U.S., about 70% of hepatitis C infections are type 1, about 5% are type 2, and about 20% are type 3.
Treatment for hepatitis C isn't easy. The drugs of choice are a once-a-week form of interferon alpha (peg-interferon) plus ribavirin, an antiviral drug. The side effects -- including flu-like symptoms, fatigue, and depression -- can be very hard to handle.
Current guidelines call for six months of treatment for hepatitis C type 2 and type 3 infections. A year of treatment is needed for type 1 infections.
But Alessandra Mangia, MD, of Casa Sollielo della Sofferenza Hospital, in San Giovanni Rotondo, Italy, and colleagues report that some patients with hepatitis C type 2 or type 3 infections may be able to cut their treatment time in half.
Fast Response, Shorter Treatment?
The goal of hepatitis C treatment is what doctors call a sustained virologic response. That's when the hepatitis C virus can no longer be detected in the blood. Many experts call this a cure; others are more cautious. Whatever it's called, patients with sustained virologic responses to treatment almost never see their hepatitis C infection come back to dangerous levels.
Side effects force some patients to quit treatment early. Usually, that means treatment failure; usually -- but not always.
"We saw that a few patients, who withdrew from therapy before the standard six-month period, had sustained virologic responses anyway despite their short course of treatment," Mangia tells WebMD. "And we saw that some patients show a very fast reduction of hepatitis C virus levels after their first interferon treatment."
Did early response to treatment predict who would do well with short-term therapy? The researchers designed an experiment. They enrolled 283 people with hepatitis type 2 or type 3 infection. Seventy of the patients got the full six months of peg-interferon plus ribavirin. The other 213 patients started with the same treatment. If, after four weeks, their blood levels of hepatitis C virus became undetectable, these "fast responders" got only three months of treatment -- called variable-length treatment.
Mangia and colleagues report their findings in the June 23 issue of The New England Journal of Medicine.
What happened?
The researchers had good news for patients with hepatitis C type 2 or 3 that had no evidence of the virus after four weeks of treatment. "Patients treated for 12 weeks were spared the expense and inconvenience of extended treatment and still had a high response rate."
Shorter Hepatitis C Treatment Works for Some
For Those With Hepatitis Type 2 or 3, 3-Month Treatment May Suffice(continued)
Too Good to Be True?
The response rates were similar between those treated for three months and those treated for six months. Overall, 76% of patients getting standard treatment and 77% of patients getting the variable-length treatment had a sustained virologic response.
But there were some differences.
At first, early responders -- those who had undetectable levels of hepatitis C virus after four weeks of treatment -- looked the same in both the standard and variable treatment groups. Ninety-three percent of early responders treated for six months and 95% of those treated for three months still had no detectable virus at the end of treatment. Six months later, that percentage dropped from 93% to 91% in those treated for six months. But it dropped from 95% to 85% in those treated for three months.
Although it sounds like the variable-length group have more viral "rebound," Mangia notes that the results were very similar between the two groups. And of the 13 patients who rebounded after three months of treatment, 10 agreed to 24 more weeks of treatment. This second course of treatment was successful for nine of these 10 rebounders.
"Only this small number of persons rebounded, without any major side effects, and without any reduction in the response rate for [further] treatment," Mangia says.
But these numbers worry hepatitis C expert Robert Fontana, MD, associate professor of medicine and medical director for liver transplant at the University of Michigan in Ann Arbor.
"Is this really an efficient way to manage patients? If you are going to go through this therapy, you would rather get rid of the virus," Fontana tells WebMD. "Yes, you have less of the side effects with 12 vs. 24 weeks of treatment. But if someone is tolerating it well, why risk the relapse? Plus there is the whole psychological letdown from learning you've had a rebound. ... If you can get by with less treatment, great. But when you start to have a trend toward rebound, I don't think it's worth the risk."
Mangia says her hospital already is using the variable-treatment strategy for all patients with type 2 or type 3 hepatitis C infection.
Based on the study findings, Fontana doesn't think this is a good idea. He praises the Mangia study. Though he notes that it was carefully done and that it addresses crucial issues in hepatitis C treatment, he says doctors and patients would do better to focus on managing side effects than by trying to shorten treatment.
"During the first 12 weeks, the most severe side effects are flu-like symptoms," Fontana says. "Beyond 12 weeks, the depression, the weakness, and the sort of mental aspect becomes more prominent. That is where a lot of patients going out to 48 weeks just can't hack it. By reducing the dose, by seeing patients more often, by introducing antidepressants, and by helping with sleep, you can get a lot of those patients through."
2007-06-02 01:33:38
·
answer #10
·
answered by legermarianne 3
·
2⤊
0⤋