Hepatitis C is a contagious liver disease which is spread by contact with blood that is contaminated with the hepatitis C virus. Most cases of acute hepatitis C or HCV advance to chronic HCV. This increases the risk of developing advanced liver disease which is the leading cause of liver cancer. People with HCV are grouped into genotypes, which are subgroups of the virus and are determined by duration of infection, age, viral load, and degree of liver inflammation and tissue scarring. The current standard treatment for HCV is pegylated interferon (PEG-IFN) in combination with ribavirin (RBV). This treatment is effective in about 40 to 50 percent of people with genotype-1 and 80 percent of individuals classified as genotype-2 and 3. In the United States, most people with HCV are genotype-1. An article in the May 2010 issue of Current Opinions in Gastroenterology announces the current trial of new medication which promise higher cure rates for HCV genotype-1 patients.
The introduction of a first generation protease inhibitor is hoped to have a higher response rate in new HCV patients as well as HCV patients who have received prior treatment. This new type of medication, STAT-C, or specifically targeted antiviral therapy, would be added to the combination therapy of PEG-IFN and RBV. STAT-C targets the enzymes which cause the replication of the hepatitis C virus. The hope is for higher cure rates and reduced time of treatment. There is concern regarding relapse rates and side effects. In clinical trials, the relapse rate was the lowest for patients who received 24 weeks of treatment with the three drugs followed by 24 weeks of treatment with the current standard treatment.
Additional clinical trials are investigating the combination of oral antiviral drugs, protease inhibitors, and polymerase inhibitors. The aim is to develop an effective interferon free regime. About 50 to 60 percent of HIV-infected individuals cannot tolerate interferon.
Approval of the first generation protease inhibitor and testing of interferon free treatments is expected in 2011.
Sources: Current Opinion in Gastroenterology, May 2010- volume 26- issue 3
www.medscape.com
Maryann Gromisch is a registered nurse with clinical experiences in medical,surgical, and critical care nursing. She has experience assisting a gastroenterologist in a private practice setting.
