Hepatitis C: Curable or Incurable Disease?
Recent data from a Phase II trial claims that twice daily dosing of telaprevir cured Hepatitis C in over 80 participants.
Since its identification in the 1980s, Hepatitis C has been established as a major worldwide health problem. The gravity of this disease is especially poignant, because an estimated 85 percent of those infected go on to develop a chronic infection. While researchers are continually developing, testing and refining the available treatments for Hepatitis C, there is still considerable confusion over our ability to “cure” Hepatitis C.
As of Fall 2009, the current standard treatment for Hepatitis C is antiviral combination therapy consisting of pegylated interferon and ribavirin. Approximately half of those who are eligible for this treatment are able to achieve a sustained viral response. According to Schering Corporation, a sustained viral response is the inability to detect Hepatitis C genetic material for at least six months after Hepatitis C therapy is completed.
Because it is the best measure we currently have for evaluating the elimination of Hepatitis C, many physicians believe attaining a sustained viral response is the same as a cure. Others exhibit more caution in proclaiming their patients are cured.
Evidence for a Cure
In order for a sustained viral response to be called a cure, the inability to detect Hepatitis C six months after treatment completion must be permanent. Unfortunately, only time and repeated testing can confirm the permanence of viral absence.
Hope for pegylated interferon and ribavirin therapy representing a Hepatitis C cure took root in the Spring of 2007. In a study led by Mitchell Shiffman, M.D., professor in the Virginia Commonwealth University (VCU) School of Medicine, and chief of Hepatology and medical director of the Liver Transplant Program at the VCU Medical Center, nearly 1,000 patients were followed for up to seven years after they achieved a sustained viral response. Their results were the most encouraging thus far that Hepatitis C is curable.
According to Shiffman, “The use of peg-interferon alone, or in combination with ribavirin, points to a cure for Hepatitis C. This paper strongly suggests, for the first time, that Hepatitis C is a curable disease. After treatment, 99.6 % of the patients remained virus undetectable for over five years.” In Schiffman’s study, eight patients who achieved sustained viral response tested positive for Hepatitis C at an average of two years following treatment completion. However, it is unknown why this occurred.
Reason for Caution
The primary reason that some physicians avoid using the term “cure” in relation to sustained viral response with Hepatitis C, is the possibility of giving false hope.
Our ability to detect the Hepatitis C virus is not absolute. While Hepatitis C tests examine the blood for viral particles, they are not sophisticated enough to be able to test for signs of the virus in other organs, the lymphatic system or other parts of the body where the virus is believed to hide. Thus, it is difficult to know if Hepatitis C is truly eradicated or if a microscopic virion has found a good hiding place.
This doubt exists because there have been cases where people have achieved sustained viral response only to test positive for Hepatitis C years later. In such instances, it is unknown if these people experienced a relapse of the virus or if they were re-infected. People who believe they are cured might assume they can resume liver damaging habits and that they can no longer transmit Hepatitis C. If their liver infection does return, believing they were cured of Hepatitis C could lead to a medical lawsuit. This also explains why anyone who has ever tested positive for Hepatitis C is not permitted to donate blood.
Based on a study published in the April 2008 edition of the Journal of Clinical Gastroenterology, investigators from Georgetown University looked at how many physicians used the term “cure” in their discussions with Hepatitis C patients. They found the following:
- 63 percent of physicians used the word “cure” in 38 percent of visits involving response discussions.
- “Cure” most frequently meant “absolute cure” and occurred more commonly in visits conducted before therapy initiation, and with patients having favorable genotypes.
- Physicians hedged the meaning of “cure” in 29 percent of visits.
- These statistics demonstrate that some doctors discuss hope for a cure with their patients, while others are still hesitant to use this terminology.
Defining whether or not Hepatitis C is a curable disease depends on your perspective. If there is fear of false hope, it is premature to consider Hepatitis C curable. However, based on the best measure we currently have to assess the presence of this infection, there is a 50/50 chance of curing Hepatitis C. Obviously, this debate has not yet been settled. Nonetheless, more and more people are achieving a sustained viral response and remaining free of the virus for increasingly longer periods of time. As this trend continues and improvements in testing are made, more doctors will be convinced that curing Hepatitis C has become a reality.
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