March 17, 2012

Health Watch: Developments emerge in treating hepatitis C

3:09 PM, Mar. 16, 2012

Written by Dr. Carl West

Hepatitis C is a form of chronic liver disease that results in 8,000 to 10,000 deaths in the United States each year. People suffering complications from hepatitis C can develop jaundice, internal bleeding, malnutrition, and kidney damage. Hepatitis C is the leading cause of liver failure, for which the only viable treatment is liver transplantation.

Until recently, the standard treatment for hepatitis C has been only somewhat successful, curing just under 50 percent of patients. However, in 2011 the Food and Drug Administration approved two new drugs, Victrelis and Incivek. When used in conjunction with the standard treatment, these new medications have increased the cure rate for hepatitis C to about 70 percent. In addition, there are newer drugs currently being studied that appear to offer even higher levels of cure with fewer side effects. We expect these medications to be available in about three years.

» What if I was treated for hepatitis C before and I was not cured? Following FDA approval of Victrelis and Incivek, my colleagues and I called our patients with hepatitis C who were not cured after following the standard therapy and invited them to come back in for the new treatment. We've had very good success, our patients have responded well, and our cure rate reflects the national cure rate of approximately 70 percent.

» What is the new treatment protocol? The treatment protocol for hepatitis C lasts for 24 to 48 weeks and it can have some unpleasant side effects, including fatigue, skin rash, and low white-blood-cell count. The protocol requires a weekly shot of interferon and daily pills to enhance the impact of the interferon. One of the new medications is added to this standard treatment regimen and while it may increase the side effects, it can also shorten the duration of treatment.

» How do you know the treatment has been successful? As treatment progresses, we measure the virus counts by drawing blood samples. Prior to treatment, it is not unusual for the virus count of someone with hepatitis C to measure in the millions. Our goal is for the virus count to become undetectable within a few weeks of treatment and with these new drugs we are able to accomplish this in the majority of patients. It is very gratifying to see a patient's virus count go from 10 to 20 million to virtually nothing.

» What if I have already suffered liver damage from hepatitis C? Studies have shown that if patients with liver damage undergo successful therapy for hepatitis C and the virus is eliminated, the liver can partially recover from the damage. This is an important incentive for people who have undergone the standard treatment for hepatitis C with no success.

» How do people contract hepatitis C? Hepatitis C is only acquired by blood-to-blood contact. This can happen by sharing a syringe or sharing a razor blade. Nurses and doctors are at increased risk because they can get accidentally stuck with a needle while treating a patient. Rescue personnel at the scene of a bloody accident are also at higher risk if they suffer a cut in the line of duty. Blood transfusions were not screened for hepatitis C until the 1980s, so people who received transfusions prior to that time are at higher risk.

There is a widespread misconception that once you have hepatitis C there is no cure, but this is not true. The new treatment is very promising. If you have been treated for hepatitis C in the past with no success, I urge you to try again for a cure with the new drugs now available.

Dr. Carl West is board certified in gastroenterology and internal medicine. He is on the medical staff of Cayuga Medical Center and is in practice with Gastroenterology Associates of Ithaca, where he can be reached at (607) 272-5011.


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