Hepatitis C is a viral condition that kills as many as 10,000 people in the United States every year. Insidiously, its initial symptoms are mild and flu-like–loss of appetite and muscle aches–and can take weeks to appear. As time goes on, however, in some cases, the virus hardens and scars the liver (cirrhosis) or leads to liver cancer. That’s why early detection is so important. But now there is another reason: A study has shown that early treatment, within 90 days of exposure, is almost 100% effective at eliminating the virus from the body.
Performed in Germany between 1988 and 2001, the study involved treating 44 patients (25 women and 19 men, average age 36) with acute hepatitis C with a substance called interferon alfa-2b. The treatment was intensive–an injection of 5 million units of interferon for 4 weeks and then injections three times a week for another 20 weeks. Treatment was started within 3 months.
By the end of the study, 43 patients had stayed the course, and one had dropped out because of interferon’s side effects. Another needed supplementary treatment with another hepatitis C drug called ribavarin. Of the 42 who completed the course of treatment, all had undetectable levels of virus in their systems at the end. The scientists concluded that interferon alfa-2b prevents chronic hepatitis C infection and its possible fatal outcome.
By contrast, although there was no “control group” taking a sugar pill in this study, in a similar group of untreated subjects studied in Italy during the same period, 70% went on to develop chronic hepatitis C.
“The problem with this is that you need to treat patients within 90 days,” says Charles Lieber, MD, a liver specialist and professor of medicine and pathology at the Mount Sinai School of Medicine. Lieber is also director of the Alcohol Research and Treatment Center at the Bronx VA Medical Center. Lieber says doctors normally don’t even see cases of hepatitis C until 10 or 20 years after the disease is contracted. “The symptoms are minor and often overlooked,” he says.
Lieber says the new approach is probably appropriate for people who know they have been exposed. “You need to get contaminated with someone else’s blood to get hep C,” he explains. “Excessive alcohol use can also make you more vulnerable, not only because of [carelessness that could expose you to] the other factors, but because alcohol seems to enhance acquisition of the virus in and of itself.”
The usual treatment for chronic hepatitis C, once it’s discovered, is also interferon–a form called pegylated interferon, which is wedded to a carbohydrate molecule that makes it disappear less rapidly from the blood. Another drug, called ribavarin, is also given with the interferon.
The problem is that interferon itself has many possible side effects. “A lot,” Lieber says: “Depression, skin disorders, automimmune problems, anemia.” Sometimes, he says, the cure may be worse than the disease, and it only works in half the [chronic] cases, anyway. “This is where medical judgment comes in,” he says, referring to chronic, long-standing hepatitis C. “Sometimes it may be better to do nothing.”
It’s a whole different story, though, if you catch the virus early, within the 90-day window studied in Germany. “The benefit of getting treated early and being sure of getting rid of the virus is tremendous,” Lieber says. This is why the New England Journal of Medicine, scheduled to publish the study in November, moved up the release–so potential patients can benefit.
Should You Be Tested?
The cost of a hepatitis C test varies widely. “You don’t really need to get it,” Lieber says. “You can just get a normal liver enzyme test and see if those [the liver enzyme levels] are in line first.” He recommends you get a test if you think you have been exposed to the blood of a person at risk for the disease. (As many as 4 million people in the United States have it.) In the study, people acquired the disease as a result of sharing infected drug needles, accidental needlesticks, medical procedures, sexual contact, and several unknown ways, perhaps something as innocent as getting a tattoo from an artist who forgot to sterilize the instruments.
Article By: Jean Lawrence, Medical Writer
Publication Date: October 2001