A new report shows that patients with hepatitis C infection can not only be successfully treated by the best available drug therapies, but they also can be cured.
Up to seven years after treatment, 99 percent of close to 1,000 successfully treated patients showed no evidence of hepatitis C virus (HCV) infection.
Hepatitis C is caused by the hepatitis C virus, which is transmitted from contact with infected blood. HCV infection is the leading cause of cirrhosis, liver cancer, and liver transplants in the United States. Roughly 4 million Americans are infected, but only about a quarter of them know they have the virus, hepatitis treatment expert John Vierling, MD, says.
“We have to start identifying infected people earlier so they can be treated earlier,” he says. “It is true that about half of patients can be cured with the treatments available now.”
‘Virus Won’t Come Back’
Those treatments include a long-acting version of the drug interferon, known as pegylated interferon, and the antiviral drug ribavirin.
The long-term follow-up study included 997 patients who achieved sustained virologic responses with pegylated interferon with or without ribavirin, meaning they had no evidence of the virus in their blood six months after treatment.
All but eight of the patients were still free of the virus an average of four years after treatment. Some patients were followed for as long as seven years.
Two of the eight patients showed evidence of a second HCV infection, and it was not clear if the remaining five relapsed or were reinfected.
Virginia Commonwealth University Medical Center chief of hepatology Mitchell Shiffman, MD, presented the follow-up data Monday in Washington at Digestive Disease Week, an annual meeting of liver and gastric disease specialists from around the world.
“When we achieve sustained virologic responses, less than 1 percent of patients will get the virus back,” he says. “We know the virus will not come back in a year or two or three. These patients are cured.”
Not All Respond
But between 45 percent and 50 percent of patients treated in the United States do not respond to treatment or have incomplete responses, according to Shiffman.
He adds that roughly 70 percent of infected Americans have genotype 1, a genetic type of the disease that tends to be less responsive to treatment than other genotypes.
Bruce Bacon, MD, of St. Louis University, says that specialists know much more now than they did a few years ago about individualizing interferon treatment.
Patients who respond very quickly may not need to be treated for as long, while those who respond slowly may need a longer course of treatment — as long as 1.5 years for very slow responders.
Bacon, who directs the division of hepatology at St. Louis University School of Medicine, says many patients — and even their primary care physicians — still do not understand that HCV infection can be cured.
“The overwhelming perception is that this is a disease that can be controlled, but not cured,” he says. “That is why infected people are often hesitant to even consider treatment.”
Better Treatments to Come
The message, the experts agree, is that a cure is possible, even for people who already have liver damage and for those with conditions like HIV co-infection.
They also agree that highly anticipated new treatments could improve cure rates in the years to come.
Phase II trials of highly specific drugs that target HCV are now under way, and Bacon says they could be approved within two to three years.
Vierling says he has high hopes that a multidrug approach to HCV treatment, similar to the approach that has turned HIV from a uniformly deadly to largely manageable disease, can improve treatment outcomes for a larger number of patients.
“New drugs may allow us to use existing treatments at lower doses or for shorter periods,” he says. “The future looks bright.”
Primary Medical Reviewer: Louise Chang, MD
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