Combo Treatment Best for Hepatitis C

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Combo Treatment Best for Hepatitis C, Panel Says

Thu Jun 13,10:39 AM ET

By Joyce Frieden



BETHESDA, Maryland (Reuters Health) - Combining two therapies remains the best way to treat hepatitis C infection, according to a draft consensus panel statement released Wednesday during a conference at the National Institutes of Health ( news - web sites).



  

The combination includes interferon, a protein that blocks virus reproduction, and the antiviral medication ribavirin.



The hepatitis C virus, which is spread by contact with infected blood, causes inflammation of the liver. Although many hepatitis C patients remain symptom-free for years, a few develop cirrhosis of the liver, a condition that often requires a liver transplant.



Unlike hepatitis A and hepatitis B, hepatitis C can only be transmitted by exposure to infected blood. An estimated 4 million Americans are infected with the hepatitis C virus.



A combination of polyethylene glycol (PEG) interferon and ribavirin works well in about half of the patients with the most common form of the virus. However, it causes severe side effects in some patients, including flu-like symptoms, blood abnormalities and depression, so patients must be educated about these issues, the panel said.



Despite the success of this combination, hepatitis C researchers need to find out more about what treatments work best on different types of hepatitis C patients, the panel said.



"Most clinical trials have excluded [certain patient groups] like children, the elderly, patients with co-infections, and patients with advanced liver cirrhosis," said panel chairman Dr. James L. Boyer, director of the Liver Center at the Yale University School of Medicine in New Haven, Connecticut. "But we now know these patients respond to treatment," even if they don't respond as well as patients with less complicated cases.



The 12-member independent panel recommended increasing hepatitis C screening tests for patients in high-risk groups--injection drug users, HIV ( news - web sites) patients, health care workers and people who had had blood transfusions prior to the mid-1990s, when a reliable blood test for the virus was developed and blood banks began using it.



The panel did not recommend that everyone be screened for the virus; this would be ineffective since the virus occurs in only about 1% of the population, Boyer said.



Another problem with universal screening, said one expert who attended the conference but did not serve on the panel, is that it would yield many false positives.



"Instead, physicians should screen people by asking them about their risk factors," said Dr. Michael Rigsby, national program director for HIV and hepatitis C at the Department of Veterans Affairs ( news - web sites) in West Haven, Connecticut.



The panel's other recommendations included:



-- Establishing a network to better coordinate hepatitis C research.



-- Educating the public--including children in grades K-12--about how hepatitis C is spread in order help identify patients and prevent disease transmission.