Hepatitis C (cont.)
Mary D. Nettleman, MD, MS, MACP
Mary D. Nettleman, MD, MS, MACP is the Chair of the Department of Medicine at Michigan State University. She is a graduate of Vanderbilt Medical School, and completed her residency in Internal Medicine and a fellowship in Infectious Diseases at Indiana University.
Jay W. Marks, MD
Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
In this Article
- Hepatitis C infection (HCV, hep C) facts
- What is hepatitis C infection?
- What is the nature (biology) of the hepatitis C virus?
- How does liver damage occur in hepatitis C infection?
- How is hepatitis C virus spread, is it contagious, and how can transmission be prevented?
- What are the symptoms of hepatitis C infection?
- What conditions outside the liver are associated with hepatitis C infection?
- What is the usual progression of chronic hepatitis C infection?
- Who is at high risk and should be tested for hepatitis C infection?
- What are the diagnostic tests for hepatitis C virus and how are they used to diagnose hepatitis C infection?
- What is the role of a liver biopsy in the management of chronic hepatitis C infection?
- What is the treatment for hepatitis C infection?
- Who should receive antiviral therapy for hepatitis C infection?
- What are the different patterns of response to antiviral treatment?
- What are the goals of therapy for hepatitis C infection?
- What are the therapy options for previously untreated patients with chronic hepatitis C infection?
- How are relapses and nonresponders treated?
- Should individuals with acute hepatitis C infection be treated?
- What are the side effects of treatment for hepatitis C infection?
- What about liver transplantation for hepatitis C infection?
- What is the current research and what is in the future for hepatitis C infection?
- Find a local Gastroenterologist in your town
What about liver transplantation for hepatitis C infection?
HCV is the leading reason for liver transplantation in the U.S., accounting for 40% to 45% of transplants. HCV routinely recurs after transplantation and infects the new liver. Approximately 25% of these patients with recurrent hepatitis will develop cirrhosis within five years of transplantation. Despite these findings of recurrence, the five-year survival rate for patients with HCV is comparable to that of patients who are transplanted for other types of liver disease.
Treatment for recurrent hepatitis after transplantation is not a simple issue. Most transplant centers delay therapy until recurrent disease is confirmed. Treatment of recurrent hepatitis is complicated with interferon, an important drug for treatment, is an immune modulator (modifier) that may promote rejection of the transplanted liver. Furthermore, interferon and ribavirin may not be well tolerated by patients who just underwent transplantation and are taking many different kinds of medications.
What is the current research and what is in the future for hepatitis C?
As our awareness of HCV infection increases, more and more patients are being diagnosed with this condition. Current research includes diagnosis, natural history, treatment, and vaccine development.
- Diagnosis: More accurate tests are being developed to detect even smaller amounts of the virus.
- Natural history: There is much we do not know about the natural history of chronic HCV. Why do some people clear the virus spontaneously? What makes some people develop cirrhosis when others appear to have little liver damage? What predicts response to treatment or re-treatment?
- Treatment: New formulations of interferon are being developed in the hopes of improving response rates. In addition, newer oral agents are in early stages of testing that have SVRs upwards of 85%, and can eliminate the need for injectable interferons.
- Vaccine development: Scientists have not been able to develop an effective vaccine against HCV. This is partly due to the ability of the HCV to change (mutate) and evade the body's immune responses.
For Further Information
The NIH maintains a summary of recent information on Hepatitis C, which can be found at: http://digestive.niddk.nih.gov/ddiseases/pubs/chronichepc/
The Centers for Disease Control and Prevention (CDC) also provides information for patients and clinicians at: http://www.cdc.gov/hepatitis/HCV/
REFERENCES:
Marc G Ghany et al. Diagnosis, management and treatment of Hepatitis C: and update, AASLD practice guidelines. Hepatology April 2009
Wilkins T, Malcolm JK, Raina D, Schade RR. Hepatitis C: diagnosis and treatment. Am Fam Physician. 2010 Jun 1;81(11):1351-7.
WHO.int. Hepatitis C.
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