Turning the Corner in Hepatitis C Treatment
Newer medications are making a difference, and better ones may be on the way.
Reviewed By Charlotte Grayson
Getting diagnosed with hepatitis C can be frightening, and it's natural to worry. You may have heard that treatment is difficult. Or you may wonder if you'll need a liver transplant someday. But while hepatitis C is undeniably a serious disease, it's not as bad as many people imagine.
"For people who have just been diagnosed, it's normal for hepatitis C to be a source of worry," says Paul Berk, MD, professor of medicine at Mt. Sinai School of Medicine and Chair of the American Liver Foundation. "But it shouldn't be a source of panic."
The facts are reassuring. Even without treatment, most people with the hepatitis C virus (HCV) live decades without having any symptoms. According to the Centers for Disease Control and Prevention (CDC), between 40-80% of all patients can now be essentially cured with current treatment regimens. Moreover, new drugs are in development that may radically improve the prognosis.
This is impressive progress for a disease that was only identified in 1989.
"If you've been newly diagnosed, you really should be optimistic," Berk tells WebMD. "This is a disease that's going to be manageable."
Understanding Hepatitis C
Almost 4 million people in the U.S. are infected with hepatitis C, according to the CDC. Most don't know they have it. Hepatitis C causes few symptoms. Indeed, many of the people who are infected have had the virus for years. They may have contracted it from a blood transfusion or organ transplant before 1992, when supplies began to be screened for the disease.
There are at least six different subtypes of the hepatitis C virus. While no one type is more dangerous than another, they do respond differently to treatment. Hepatitis C Type 1 is the most common type in the US. Unfortunately, the medications we have don't work as well with Type 1 as with other subtypes of the virus.
Current Hepatitis C Treatment
For years, the standard hepatitis C treatment was a combination of injected interferon and the oral antiviral drug ribavirin. Recently, a new form of interferon -- peginterferon, or pegylated interferon -- has become the standard of care. It's a significant step toward better treatment.
"Combination treatment with pegylated interferon and ribavirin is giving us appreciably better results than what we used to get," says Berk.
Interferon is a manufactured version of certain natural proteins that fight viruses. Peginterferon, or pegylated interferon, is modified so that it stays in the body longer than standard interferon. Because the drug stays at more constant levels in the body, patients need only one injection a week instead of three.
Hepatitis C treatment with peginterferon and ribavirin achieves a "sustained response" up to 54% of people, which means that the virus has been eliminated from their blood after stopping treatment. People with hepatitis C types 2 and 3 have sustained response rates of about 80%; people with type 1 have rates of up to 50%. As far as we know, a sustained response means that the illness is cured, says Berk.
Berk also believes that hepatitis C treatment is better now because doctors now use various hormones that can counteract drops in blood cell counts, a common side effect of treatment. In the past, these side effects might make a doctor reduce the dose, or stop treatment altogether. Now it's possible to correct the side effects and carry on.
In cases where a person can't tolerate the effects of ribavirin, it's possible to use pegylated interferon on its own. However, the treatment is less effective. Ribavirin by itself doesn't work.
The Trouble With Treatment
While hepatitis C treatment has come a long way, there are still drawbacks. For a person who's newly diagnosed, a 54% cure rate may not sound great. After all, it means that about one out of two people won't respond to treatment.
Also, hepatitis C treatment is less effective in some populations. For reasons that no one understands yet, African-Americans are less likely to benefit from treatment. And the treatments may not be safe for people with other medical conditions -- such as kidney failure, heart disease, or pregnancy. Interferon can also be expensive; according to the American Academy of Family Physicians, it can cost $6,000 per year.