Hepatitis C (cont.)

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What about liver transplantation for hepatitis C infection?

HCV is the leading reason for liver transplantation in the U.S., accounting for 40% to 45% of transplants. HCV routinely recurs after transplantation and infects the new liver. Approximately 25% of these patients with recurrent hepatitis will develop cirrhosis within five years of transplantation. Despite these findings of recurrence, the five-year survival rate for patients with HCV is comparable to that of patients who are transplanted for other types of liver disease.

Treatment for recurrent hepatitis after transplantation is not a simple issue. Most transplant centers delay therapy until recurrent disease is confirmed. Treatment of recurrent hepatitis is complicated with interferon, an important drug for treatment, is an immune modulator (modifier) that may promote rejection of the transplanted liver. Furthermore, interferon and ribavirin may not be well tolerated by patients who just underwent transplantation and are taking many different kinds of medications.

What is the current research and what is in the future for hepatitis C?

As our awareness of HCV infection increases, more and more patients are being diagnosed with this condition. Current research includes diagnosis, natural history, treatment, and vaccine development.

  • Diagnosis: More accurate tests are being developed to detect even smaller amounts of the virus.
  • Natural history: There is much we do not know about the natural history of chronic HCV. Why do some people clear the virus spontaneously? What makes some people develop cirrhosis when others appear to have little liver damage? What predicts response to treatment or re-treatment?
  • Treatment: New formulations of interferon are being developed in the hopes of improving response rates. In addition, newer oral agents are in early stages of testing that have SVRs upwards of 85%, and can eliminate the need for injectable interferons.
  • Vaccine development: Scientists have not been able to develop an effective vaccine against HCV. This is partly due to the ability of the HCV to change (mutate) and evade the body's immune responses.

REFERENCES:

Marc G Ghany et al. Diagnosis, management and treatment of Hepatitis C: and update, AASLD practice guidelines. Hepatology April 2009

Wilkins T, Malcolm JK, Raina D, Schade RR. Hepatitis C: diagnosis and treatment. Am Fam Physician. 2010 Jun 1;81(11):1351-7.

WHO.int. Hepatitis C.


Medically Reviewed by a Doctor on 2/2/2014

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