Early treatment for hepatitis C offers a good chance of a cure

Apr 22 2009

Australian researchers say as many as 70% of hepatitis C carriers can possibly be cured of the disease with early treatment - this is excellent news as hepatitis C, if left untreated can lead to serious liver disease.

Although the hepatitis C virus (HCV) damages the liver, most people with the disease have no symptoms and when symptoms do appear, sometimes decades later, they are often mild and vague and come and go - unfortunately, by this stage the damage may be very serious.

Symptoms if they do appear are often flu-like and last a few weeks or months - they include nausea, vomiting, diarrhea, loss of appetite and fatigue, pain over the liver (on the right side of the abdomen, just under the rib cage), jaundice - where the skin and the whites of the eyes turn yellow, dark-colour urine (like cola or tea) and stools which become pale in colour (greyish or clay coloured).

Chronic hepatitis C can lead to cirrhosis of the liver, a condition usually associated with alcoholism where healthy liver tissue is replaced by fibrous tissue, followed by scarlike hardening and the liver gradually begins to fail, or lose its ability to carry out its normal functions and eventually, symptoms develop.

These symptoms include fluid retention causing swelling of the belly, legs, or whole body, jaundice, fatigue, disturbed sleep, itchy skin, loss of appetite, weight loss, wasting, vomiting with blood in the vomit and mental disturbances such as confusion, lethargy, extreme sleepiness, or hallucinations.

HCV is not related to the other viruses that cause hepatitis, however like the other hepatitis viruses, it is contagious and is transmitted mainly by contact with blood or blood products - the most common mode of transmission is the sharing of contaminated needles among IV drug users.

Transfusion with infected blood or blood products, hemodialysis, or transplantation of organs from infected donors was once a common method of transmission but is now rare as tests now ensure that they are not contaminated.

Less common causes of HCV transmission include from mother to infant at the time of childbirth, through sexual intercourse with an infected person, having multiple sex partners and accidental needle sticks with HCV-contaminated blood.

Hepatitis C is not contracted by living with, being near, or touching someone with the disease but can be passed on by sharing a razor, nail clippers, or other such items with an infected person - in about 10% of people with acute hepatitis C and in about 30% of people with chronic hepatitis C, the source of transmission is unknown.

Treatment includes rest, drinking plenty of fluids to prevent dehydration, a total avoidance of all alcohol and any medicines and substances that can cause harm to the liver such as acetaminophen (Tylenol) and other preparations that contain acetaminophen.

At least 75% of people infected with HCV develop chronic hepatitis, and 30% of these people go on to develop cirrhosis - Hepatitis Australia says more than 200,000 Australians have chronic hepatitis C and more than 278,000 are exposed to the virus, primarily through use of needles with traces of infected blood, but less than 2% of infected people receive treatment.

Chronic liver disease because of hepatitis C causes 10,000 deaths each year in the United States can lead to liver failure and liver cancer - if damage is severe, liver transplantation is the only treatment.

A doctor may prescribe IV fluids for dehydration and drugs to control nausea and vomiting.

The most successful treatment to date in dealing with chronic hepatitis C is called pegylated interferon alpha which is often combined with an antiviral drug called ribavirin (Virazole) and the decision to embark on medication to treat hepatitis C is usually made by a liver specialist (hepatologist), based on the results of lab tests of liver function, on results of tests for HCV and liver biopsy, and on the person's age and general medical condition.

According to Professor Stuart Roberts, director of gastroenterology and hepatology at The Alfred hospital in Melbourne, who led the research, without treatment people would eventually develop serious liver disease and a cure will prevent the development of liver disease.

Professor Roberts says hepatitis C is the main reason for liver transplants in Australia, and the results from a new study shows as many as 70% if sufferers can be cured - the study also showed that the standard combination drug treatment was as effective as a stronger regimen, which caused more serious side effects, in treating HCV.

The Australian-led clinical trial the CHARIOT study involved 702 Australian patients at 33 hospitals across the country and another 194 from New Zealand, Canada, Thailand, Argentina and Mexico - all were suffering from the most difficult type of hepatitis C to treat, hepatitis C genotype 1 - they were treated with a combination of interferon and the antiviral drug ribavarin.

Associate Professor Simone Strasser from the Royal Prince Alfred Hospital in Sydney, says the study was very important because it identified a group of patients who responded much better than expectations, and much better than other studies.

Dr Strasser says they found that patients who had minimal damage on their liver had very high chance of clearing the virus and a seven in 10 chance of actually clearing the infection and this significantly changes the thinking about when is the best time to start treatment.

The researchers say the study shows that early treatment of HCV, before it has caused significant damage to the liver, offers a very high chance of eradicating the virus permanently.

Hepatitis Australia says the results are a breakthrough for sufferers and could also have economic implications as the number of people with advanced liver disease has increased from nearly 36,000 to 47,000 in the last five years and people with Hepatitis C or anyone with risk factors should see a doctor as soon as possible.

Professor Roberts says because the disease often has no symptoms anyone who engaged in risky behaviour or had been treated with blood products prior to 1990 should be tested - he says the CHARIOT research shows that early treatment with a combination of interferon, to slow viral replication, and the antiviral drug ribavarin, was effective and produced a good outcome.

Professor Roberts will present the findings next Saturday at the congress of the European Association for the Study of the Liver, in Copenhagen.

The research is published in the journal Hepatology.