| Subject: Treatment of acute cases of hepatitis C: Marketing or science? |
Author:
Teresa Hanbey
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Date Posted: Tue, October 02 2001, 8:13:25 PDT
Treatment of acute cases of hepatitis C: Marketing or science?
There are a number of articles and press releases cropping up regarding researchers from Germany's Medical University of Hannover who concluded that people treated within the first three to six months of infection successfully cleared the virus and did not develop chronic infection. Their study ( of 44 subjects )will appear in the Nov. 15 issue of The New England Journal of Medicine.
There are some points to keep in mind as you read the articles and press releases, many of which contain language like "harmful" (the disease, not the treatment, of course), "deadly infection," "killer:"
1) Lifestyle changes. A person diagnosed this early in the disease should opt never to use alcohol again. This has been the agent most often linked in studies to damage of the liver in combination with hepatitis C. Second, smoking has beeen linked in studies with progression to cirrhosis. Third, exposure to toxicities in the air and water have been suspected of having a negative effect on progression of disease in those with hepatitis C.
2) A person diagnosed this early in disease (or, on biopsy, early in progression) should be monitored until there is evidence that the disease is progressing at all. Only 2% of cases have resulted in death from hepatitis C. Presumably, the disease would progress even more slowly in those who do not use alcohol or smoke. If true, disease may never progress to a point requiring treatment in an entire lifetime. By the time those who would progress do progress, we will likely have vastly improved options for treatment.
3) Treatments have risks, as well as potential benefits. Not every patient should be treated in any case, as suggested here. By virtue of being a study at all, these patients were highly selected to avoid severe side effects. In studies, only 6-7% of ALL patients (not just those suitable for treatment) actually benefitted from treatment. We do not yet know the effects on the brain, heart, lung and other systems of the body. We DO have evidence that the treatment impacts fertility. So, are we going to give it to every young woman who tests positive?
4) Under these recommendations, healthcare workers would potentially be treated multiple times for a disease which might never have presented any problems if left alone. Some would spontaneously clear the virus (about 15%), anyway, if given some time. We still are not sure what multiple treatment protocols might offer in terms of long term problems to patients, particlulary those whose situation may be made worse, rather than better from premature decisions to treat the infection before it is known whether it will progress to liver disease at all.
5) We do not yet know much about the acute phase. It is still a theory in terms of science. It is possible this disease has no acute phase and is transmitted in a "chronic" form. Until we have studies demonstrating this, one way or the other, we might be looking at the limitations of the testing and not at the characteristics of the virus.
Now, having said all that, early detection is absolutely critical to the outcome of the disease. So is making appropriate choices regarding self care and monitoring the disease over time.
For those who demonstrate faster progressions through monitoring, treatments soon to be available, ot which will be developed over the next few years, might show improvement in liver histology or offer eradication without the current side efffects, discomforts and disruption to patients lives.
I hope this leads doctors to test more often on more people. I hope we can finally look at this as a disease worthy of screening without undue attention to whether a risk factor is identified or not. I fear it will lead to lots of people put needlessly on a treatment that will result in long term problems for a disease that was never likely to be life threatening in the first place.
It is an important distinction to remember that diagnosing a 30 year old infection is far different to diagnosing a recent infection. They present very different options for patients. It is the early diagnosis that is critical to outcome, not early treatment.
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