New Era in Hepatitis C Treatment
What is hepatitis?
Hepatitis means inflammation of the liver. There are numerous causes of hepatitis, including viruses, alcohol, certain medications, autoimmune disorders and inherited disorders. There are a number of viruses that can cause inflammation in the liver, and there are at least six that preferentially infect the liver. Through the years, these viruses have been given letters and include hepatitis A, B, C, D, E and G. All of these viruses can be transmitted from person to person, although the route of infection varies depending on the virus. Very often patients recover completely after a bout of acute viral hepatitis, but sometimes the virus can become chronic. In some cases, the chronic hepatitis can lead to extensive scarring of the liver, a condition called cirrhosis.
What is hepatitis C?
Hepatitis C is a virus that infects the liver. It was known to exist for many decades and seemed to be associated with blood transfusions. Before the virus was identified in 1989, it was known as non-A, non-B hepatitis. Since a blood test for hepatitis C has been available since 1990, much has been discovered about the virus. There are four million Americans (1.5 percent) that currently are infected with hepatitis C. There are 30,000 new cases of hepatitis C in the United States each year. Hepatitis C accounts for approximately 20 percent of all new cases of hepatitis. It is the leading reason for liver transplantation in the United States.
What is the natural history of hepatitis C?
About 85 percent of patients who become infected with hepatitis C develop chronic hepatitis. The disease is characterized by very slow progression; and after two decades of infection, only about 20 percent of those with the disease develop cirrhosis. There also is a small risk of developing liver cancer, especially if cirrhosis is present.
How is hepatitis C acquired?
Hepatitis C is mainly transmitted by parenteral means (by way of infected needles or blood, not by contaminated food). It is commonly seen in people who have a history of intravenous drug abuse. It occasionally occurs in health care workers who have a needle stick from a patient who has hepatitis C. Since 1990, all blood that is transfused in the United States is checked for hepatitis C and is not used if it is positive. Currently, the estimated risk of transmitting hepatitis C with a blood transfusion is somewhere between 1 and 10,000 and 1 and 100,000. Hepatitis C is also probably transmitted by sexual contact, although it is much less likely to be transmitted than other viruses such as hepatitis B or HIV, the virus that causes AIDS.
What are the symptoms of hepatitis C?
Many patients have no symptoms and are unaware that they are infected with the hepatitis C virus. Non-specific symptoms such as fatigue or joint pain may occur. When the disease has progressed to cirrhosis of the liver, symptoms may include rapid weight gain, fatigue, yellowing of skin (jaundice), dark urine, black or bloody stools and easy bruising or bleeding. These symptoms also are associated with virtually all types of hepatitis-induced cirrhosis.
What treatment is available for hepatitis C?
The FDA-approved forms of treatment for hepatitis C include interferon, peginterferon (long-acting interferon), interferon and ribavirin, and peginterferon and ribavirin. Interferon is given by injection, and treatment usually is six to 12 months. Ribavirin is given orally (by mouth). The sustained response to treatment is as high as 80 percent. Interferon and ribavirin have side effects. When treatment is first begun, patients often experience fever, chills and malaise. These symptoms usually go away after two to three doses. After several weeks or months, other symptoms may occur such as fatigue and depression. These medications also may cause bone marrow suppression, and frequent blood tests are required to monitor for this side effect.
What new treatments are available for hepatitis C?
There are multiple drugs currently in development to treat chronic Hepatitis C. The most promising drugs are called protease and polymerase inhibitors. These drugs are only available in clinical trials.