May 22, 2002 -- For years, many doctors have been reluctant to give aggressive treatment to people with hepatitis Candcirrhosis of the liver. Conventional wisdom said that the damage is done; treatment probably won't help much. But research presented at the Digestive Disease Week conference in San Francisco indicates that conventional wisdom was wrong.
Doctors in Switzerland gave 88 patients with cirrhosis and hepatitis C the newer combination therapy -- a long-lasting interferon called PEGylated interferon taken with ribavirin. At 24 weeks into the study, close to 90% of the patients had no hepatitis C virus detectable in their body.
"This treatment could cure a substantial portion of patients, even at the stage of cirrhosis," said researcher Eberhard L. Renner, MD, head of hepatology at University Hospital in Zurich, Switzerland.
Some patients will undoubtedly relapse once treatment ends, Renner said. Still, he expects cirrhosis patients to enjoy the same permanent success rate -- 50% -- as studies have found in patients with hepatitis C who do not have cirrhosis.
The combination treatment is costly -- about $2,000 a month -- and must be given by injection. Moreover, not all insurance companies will cover the cost. But the new research indicates that PEGylated interferon with ribavirin is becoming the standard of care, even for those with advanced liver disease.
In other hepatitis C research presented at the conference:
- Amantadine, an antiviral medicine originally used to treat the flu, cleared hepatitis C in 27% of patients in a study conducted by researchers at Pennsylvania State College, Hershey Medical Center. Although amantadine is not as effective as PEGylated interferon with ribavirin, it's an alternative for those patients who do not respond to interferon, said researcher Jill P. Smith, MD.
- It does appear possible to transmit hepatitis C by sharing toothbrushes. German researchers measured virus in the saliva and on the toothbrush of 30 patients with chronic hepatitis C. They found virus on the brush and in the rinse. Thus, although studies haven't found high rates of household transmission, the risk is clearly present, they concluded.
- Overweight patients with hepatitis C are more likely to develop liver fibrosis than other patients. In separate studies in Minnesota and in France, researchers found that overweight patients were more likely to develop worsening liver disease and cirrhosis. Researchers do not yet know if losing weight will lower the risk of developing cirrhosis.