By Susan Okie
Washington Post Staff Writer
Tuesday, October 2, 2001; Page A01
Almost all cases of chronic liver disease caused by the hepatitis C virus -- the most common reason for liver transplants -- probably could be prevented if people were given the antiviral drug interferon soon after becoming infected, a new study suggests.
About 4 million Americans and about 170 million people worldwide are estimated to be infected with hepatitis C, which causes long-lasting infection in about 70 percent of those who acquire the virus. The German study found that 42 out of 43 newly infected patients who received six months' treatment with interferon alfa-2b became virus-free and remained so after therapy ended.
Although previous reports had suggested that prompt interferon treatment could cure early hepatitis C infection, the study led by Michael P. Manns of the University of Hannover appears to be the largest and has the highest success rate of any to date. The New England Journal of Medicine released the study before its Nov. 14 publication because it may represent an important advance over current, less effective treatments for chronic hepatitis C.
But experts cautioned that putting its lessons into practice will be difficult because fewer than 20 percent of people who acquire the virus develop symptoms of the infection.
"These findings are persuasive," said Raymond T. Chung, medical director of the liver transplant service at Boston's Massachusetts General Hospital. "I think one of the more important implications . . . is that we have to be more vigilant for the discovery" of new cases of hepatitis C infection.
About 6,500 people in the United States become infected with the virus each year, according to the federal Centers for Disease Control and Prevention. About one-quarter of those who remain chronically infected develop cirrhosis. Long-lasting hepatitis C infection causes about half of all U.S. cases of chronic liver disease and kills between 8,000 and 10,000 Americans annually.
Most people infected with the virus acquired it from transfusions before a blood test for the virus was licensed in 1990. But the virus can also be spread among drug users by contaminated needles, and health workers sometimes become infected by accidental needle sticks. Contaminated medical or dental instruments (or needles used in tattooing and body piercing) have been implicated in some cases. It can also be transmitted sexually, or by an infected pregnant woman to her infant.
The success of antiviral drugs in eliminating chronic infection is lower than the 98 percent cure rate for recent infection achieved in Manns's study. At least half of chronic hepatitis C infections can be cured by a year's treatment with a two-drug combination of peginterferon alfa (a long-acting interferon) and ribavirin, said Jay Hoofnagle of the National Institute of Diabetes, Digestive and Kidney Diseases.
In the new study, funded in part by the drug's manufacturer, researchers identified 44 hepatitis C patients with known recent exposure to the virus or evidence of recent infection based on laboratory tests. They received injections of interferon alfa-2b daily for four weeks, then three times a week for another 20 weeks. They underwent tests 24 weeks after treatment ended to determine whether the virus was present in their blood. Forty-three received the full treatment; one stopped after 12 weeks because of side effects.
The hepatitis C virus was undetectable in 42 of 43 patients who completed monitoring. Even the patient who stopped treatment early had no detectable virus, Manns said. One person, who also had multiple sclerosis, was briefly treated with a steroid drug during the study for a flare-up of that disorder. Hepatitis C virus was detected in her blood 35 days after the antiviral therapy ended, but disappeared when she was given interferon alfa-2a (a slightly different interferon drug) plus ribavirin, Manns said.
Interferon treatment can cause side effects such as muscle and joint aches, headache and fever, said Mitchell L. Shiffman, chief of hepatology at Virginia Commonwealth University Health System. Some patients also experience depression or a reduction in white blood cells or platelets (cells important in blood-clotting).
Experts said identifying people with new hepatitis C infections is difficult and expensive, since multiple laboratory tests are often needed. Six months' treatment with interferon alfa-2b costs about $6,000, Manns said. A year of combination therapy for chronic infection costs about $24,000, according to Shiffman.
People who develop flu-like symptoms such as fatigue, joint or muscle aches and fever should see a doctor if the illness lasts longer than a week, especially if it also features upper abdominal pain or jaundice, experts suggested. Blood tests to assess liver function can help to detect hepatitis, and additional tests can distinguish hepatitis C from other causes of liver inflammation.
2001 The Washington Post Company
Washington Post Staff Writer
Tuesday, October 2, 2001; Page A01
Almost all cases of chronic liver disease caused by the hepatitis C virus -- the most common reason for liver transplants -- probably could be prevented if people were given the antiviral drug interferon soon after becoming infected, a new study suggests.
About 4 million Americans and about 170 million people worldwide are estimated to be infected with hepatitis C, which causes long-lasting infection in about 70 percent of those who acquire the virus. The German study found that 42 out of 43 newly infected patients who received six months' treatment with interferon alfa-2b became virus-free and remained so after therapy ended.
Although previous reports had suggested that prompt interferon treatment could cure early hepatitis C infection, the study led by Michael P. Manns of the University of Hannover appears to be the largest and has the highest success rate of any to date. The New England Journal of Medicine released the study before its Nov. 14 publication because it may represent an important advance over current, less effective treatments for chronic hepatitis C.
But experts cautioned that putting its lessons into practice will be difficult because fewer than 20 percent of people who acquire the virus develop symptoms of the infection.
"These findings are persuasive," said Raymond T. Chung, medical director of the liver transplant service at Boston's Massachusetts General Hospital. "I think one of the more important implications . . . is that we have to be more vigilant for the discovery" of new cases of hepatitis C infection.
About 6,500 people in the United States become infected with the virus each year, according to the federal Centers for Disease Control and Prevention. About one-quarter of those who remain chronically infected develop cirrhosis. Long-lasting hepatitis C infection causes about half of all U.S. cases of chronic liver disease and kills between 8,000 and 10,000 Americans annually.
Most people infected with the virus acquired it from transfusions before a blood test for the virus was licensed in 1990. But the virus can also be spread among drug users by contaminated needles, and health workers sometimes become infected by accidental needle sticks. Contaminated medical or dental instruments (or needles used in tattooing and body piercing) have been implicated in some cases. It can also be transmitted sexually, or by an infected pregnant woman to her infant.
The success of antiviral drugs in eliminating chronic infection is lower than the 98 percent cure rate for recent infection achieved in Manns's study. At least half of chronic hepatitis C infections can be cured by a year's treatment with a two-drug combination of peginterferon alfa (a long-acting interferon) and ribavirin, said Jay Hoofnagle of the National Institute of Diabetes, Digestive and Kidney Diseases.
In the new study, funded in part by the drug's manufacturer, researchers identified 44 hepatitis C patients with known recent exposure to the virus or evidence of recent infection based on laboratory tests. They received injections of interferon alfa-2b daily for four weeks, then three times a week for another 20 weeks. They underwent tests 24 weeks after treatment ended to determine whether the virus was present in their blood. Forty-three received the full treatment; one stopped after 12 weeks because of side effects.
The hepatitis C virus was undetectable in 42 of 43 patients who completed monitoring. Even the patient who stopped treatment early had no detectable virus, Manns said. One person, who also had multiple sclerosis, was briefly treated with a steroid drug during the study for a flare-up of that disorder. Hepatitis C virus was detected in her blood 35 days after the antiviral therapy ended, but disappeared when she was given interferon alfa-2a (a slightly different interferon drug) plus ribavirin, Manns said.
Interferon treatment can cause side effects such as muscle and joint aches, headache and fever, said Mitchell L. Shiffman, chief of hepatology at Virginia Commonwealth University Health System. Some patients also experience depression or a reduction in white blood cells or platelets (cells important in blood-clotting).
Experts said identifying people with new hepatitis C infections is difficult and expensive, since multiple laboratory tests are often needed. Six months' treatment with interferon alfa-2b costs about $6,000, Manns said. A year of combination therapy for chronic infection costs about $24,000, according to Shiffman.
People who develop flu-like symptoms such as fatigue, joint or muscle aches and fever should see a doctor if the illness lasts longer than a week, especially if it also features upper abdominal pain or jaundice, experts suggested. Blood tests to assess liver function can help to detect hepatitis, and additional tests can distinguish hepatitis C from other causes of liver inflammation.
2001 The Washington Post Company
