May 21, 2007 — A new report shows that patients with hepatitis C infectioncan not only be successfully treated by the best available drug therapies, butthey also can be cured.
Up to seven years after treatment, 99% of close to 1,000 successfullytreated patients showed no evidence of hepatitis C virus (HCV) infection.
Hepatitis C is caused by the hepatitis C virus, which is transmitted fromcontact with infected blood. HCV infection is the leading cause of cirrhosis,liver cancer, and livertransplants in the United States. Roughly 4 millionAmericans are infected, but only about a quarter of them know they have thevirus, hepatitis treatment expert John Vierling, MD, tells WebMD.
“We have to start identifying infected people earlier so they can be treatedearlier,” he says. “It is true that about half of patients can be cured withthe treatments available now.”
‘Virus Won’t Come Back’
Those treatments include a long-acting version of the drug interferon, knownas pegylated interferon, and the antiviral drug ribavirin.
The long-term follow-up study included 997 patients who achieved sustainedvirologic responses with pegylated interferon with or without ribavirin,meaning they had no evidence of the virus in their blood six months aftertreatment.
All but eight of the patients were still free of the virus an average offour years after treatment. Some patients were followed for as long as sevenyears.
Two of the eight patients showed evidence of a second HCV infection, and itwas not clear if the remaining five relapsed or were reinfected.
Virginia Commonwealth University Medical Center chief of hepatology MitchellShiffman, MD, presented the follow-up data Monday in Washington at DigestiveDisease Week, an annual meeting of liver and gastric disease specialists fromaround the world.
“When we achieve sustained virologic responses, less than 1% of patientswill get the virus back,” he tells WebMD. “We know the virus will not come backin 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 notrespond to treatment or have incomplete responses, according to Shiffman.
He adds that roughly 70% of infected Americans have genotype 1, a genetictype of the disease that tends to be less responsive to treatment than othergenotypes.
Bruce Bacon, MD, of St. Louis University, tells WebMD that specialists knowmuch more now than they did a few years ago about individualizing interferontreatment.
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 longas 1.5 years for very slow responders.
Bacon, who directs the division of hepatology at Saint Louis UniversitySchool of Medicine, says many patients — and even their primary carephysicians — still do not understand that HCV infection can be cured.
“The overwhelming perception is that this is a disease that can becontrolled, but not cured,” he says. “That is why infected people are oftenhesitant to even consider treatment.”
Better Treatments to Come
The message, the experts agree, is that a cure is possible, even for peoplewho already have liver damage and for those with conditions like HIVco-infection.
They also agree that highly anticipated new treatments could improve curerates 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 largelymanageable disease, can improve treatment outcomes for a larger number ofpatients.
“New drugs may allow us to use existing treatments at lower doses or forshorter periods,” he says. “The future looks bright.”