Turning the Corner in Hepatitis C Treatment (cont.)

"My patients are very interested in alternative treatments like milk thistle, and I am absolutely convinced by the amount of evidence that milk thistle is safe," says Berk. "However, I'm not convinced that milk thistle is really effective."

Thomas agrees. "I generally say milk thistle is okay to my patients," says Thomas. "But only after we've gone over any other medications they're taking that might cause interactions with milk thistle."

Those interactions can be dangerous. Berk and Thomas both stress that other herbal remedies and supplements may be much less safe.

"People need to think of herbal remedies as drugs, which is what they really are," says Thomas. "There have been some people who died from liver failure as a result of some of these alternative medicines."

Anyone with hepatitis C absolutely must talk to his or her doctor before taking any herbal remedies or supplements.

New Drugs for Hepatitis C

While combination therapy with pegylated interferon and ribavirin has made a difference, new treatments are still needed for hepatitis C. In coming years, slightly different versions of interferon may become available, as well as a new drug similar to ribavirin. Researchers are also looking into the possibility of inhaled -- rather than injected -- interferon. Doctors hope that these new medications might make hepatitis C treatment more effective with fewer side effects.

However, doctors are much more excited about the next generation of medicines.

"In the next ten years, we'll hopefully be moving away from interferon and ribavirin to more specific drugs that attack the virus itself," says Worman.

Interferon and ribavirin both have general antiviral properties, but researchers are now working on various drugs that will specifically target the hepatitis C virus, interfering with the way it replicates itself. These drugs will be similar to the drugs used to fight HIV, such as protease inhibitors.

Early studies of these new drugs have been mixed. Researchers had to stop testing one promising antiviral drug when it turned out to harm the heart.

However, experts had much more success with another drug manufactured by Vertex Pharmaceuticals. Of eight people treated with the ideal dose of the drug for 14 days, half had a 25,000-fold drop in their hepatitis C levels. The disease was undetectable in two patients. Considering that standard treatment takes months to achieve similar results, the effects were striking.

However, much more research needs to be done. Even if further studies prove that the new drug works and is safe, it will be many years before it becomes available. One of the risks to this antiviral approach is that, potentially, the virus could become resistant to these drugs over time. This is what happened with HIV.

"We could run into drug resistance," admits Worman. "But hopefully, we'll come up with multiple drugs that attack different targets. We could use them in combination, or use one to replace another that fails."

Many other companies besides Vertex are working on similar drugs. But while targeted therapy is exciting, it's not going to be available soon. For the next several years at least, treatment will still be pegylated interferon and ribavirin, says Worman. "Or maybe some slightly better versions of those drugs," he adds.

Other Advances

Researchers are working on other ways to improve the lives of people with hepatitis C. While the liver biopsy remains the best test to evaluate the disease, it has drawbacks: namely, no one likes to be poked with a big needle. Researchers hope to develop blood tests that could test for cirrhosis and spare people the discomfort and mild risks of biopsies.

"I'm really hopeful about blood tests that might replace biopsies," says Thomas. "That research has some of the greatest promise in near to mid-future."

Researchers are also working on therapeutic vaccines. These wouldn't prevent the disease, but could be given to a person who's already infected to help fight the virus.

"There are some drug companies that are putting a lot of resources into hepatitis C vaccines and there are some promising leads," says Berk. But, he cautions that we're still years away from using any of them.

Hope for the Future

While it may be discouraging to learn that the next generation of hepatitis C treatments is still a few years away, it's important to keep things in perspective. Hepatitis C progresses slowly. Most people infected today may be able to take advantage of these drugs when they're available.

For the time being, experts encourage people with hepatitis C to be optimistic.

"If you're someone who doesn't need treatment right now, try to relax about it," says Thomas. If you do need treatment, try to be comforted by the fact that we can cure this disease [over] 50% of the time."

Berk agrees. "As much as we want better therapies, the success we've had so far is pretty amazing," says Berk. "We can now take a serious, chronic viral illness and cure it [over] half of the time. There aren't many other examples of that."

Medically updated June 2005.

Originally published March 2004.

SOURCES: Paul Berk, MD, Professor of Medicine and Emeritus Chief of the Division of Liver Disease, Mount Sinai School of Medicine, New York City; Chairman of the Board of the American Liver Foundation. Alan Franciscus, Executive Director, Hepatitis C Support Project and Editor-in-Chief of HCV Advocate, San Francisco. Thelma King Thiel, Chair and CEO of the Hepatitis Foundation International. David Thomas, MD Professor of Medicine, Johns Hopkins School of Medicine, Baltimore, MD. Howard J. Worman, MD, Associate Professor of Medicine and Anatomy and Cell Biology, College of Physicians and Surgeons, Columbia University, New York City. The American Gastroenterological Association web site. The Centers for Disease Control web site. The Hepatitis Foundation International web site. The HCV Advocate web site. Medscape Conference Coverage, based on selected sessions at the 54th Annual Meeting of the American Association of the Study of Liver Diseases. November, 2003. The National Center for Complementary and Alternative Medicine (National Institutes of Health) web site. The National Digestive Diseases Information Clearinghouse (National Institutes of Health) web site. The National Institute of Allergic and Infectious Diseases (National Institutes of Health) web site. The Organ Procurement and Transplantation Network web site. WebMD Medical Reference in Collaboration with Healthwise: "Health Guide A-Z: Hepatitis C." WebMD Medical Reference: "Newly Diagnosed: Hepatitis C." WebMD Scientific American Medicine. Gastroenterology: VI. Acute Hepatitis. 1-10. WebMD Scientific American Medicine. Gastroenterology: VII. Chronic Hepatitis. 1-9. WebMD Medical News. "Hepatitis C Drug Rocks Virus in Early Test." American Academy of Family Physician's FamilyDoctor web site. Wedemeyer, H. Management of Hepatitis C -- Addressing the Issues Beyond the Guidelines. May 12, 2005, Medscape web site. Heathcote, J. Journal of Viral Hepatitis, 2005; vol 12: pp 223-235. Papatheodoridis, G. Journal of Viral Hepatitis, 2005; vol 11: pp 287-296. Pawlotsky, JM. Seminars in Liver Disease, 2005; vol 25: pp 72-83.

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Last Editorial Review: 6/30/2005 8:45:49 PM