WebMD Medical News
Louise Chang, MD
May 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 livertransplants 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.”
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
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
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.”
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
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
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.”
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
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
“New drugs may allow us to use existing treatments at lower doses or for
shorter periods,” he says. “The future looks bright.”
SOURCES: Digestive Disease Week, Washington, May 21, 2007. Mitchell
Shiffman, MD, professor, Virginia Commonwealth University School of Medicine;
chief of hepatology and medical director, Liver Transplant program, VCU Medical
Center. John Vierling, MD, professor of medicine and surgery, Baylor College of
Medicine, Houston; immediate past president, American Association for the Study
of Liver Diseases. Bruce Bacon, MD, director of the hepatology division, Saint
Louis University School of Medicine.
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