June 13, 2002 WASHINGTON (AP) -- Drug users, children and AIDS patients should not be excluded from treatment for hepatitis C, a blood-borne virus that has infected an estimated 4 million Americans and is a leading cause of liver cancer, a federal advisory panel says.
A 12-member committee of experts selected by the National Institutes of Health said Wednesday that treatment for hepatitis C has improved in recent years and that groups that previously were excluded from therapies should now receive treatment.
The committee made the recommendation in a report that reviewed the current medical consensus on the diagnosis and treatment of hepatitis C. Such reports influence the way doctors treat patients in the United States.
About 4 million Americans are infected with hepatitis C, making it the most common blood-borne infection in America. The virus is spread most frequently through the shared needles of drug users, but it can also be spread by high-risk sex and transplantation of infected organs, and an infected woman can give it to her infant.
Blood transfusions were once a common source of the infection, but blood screening tests started in the early 1990s have almost eliminated that risk. However, many patients infected before the tests began may be diagnosed in coming years as they develop symptoms.
About 85 percent of people infected with hepatitis C develop chronic disease; the other 15 percent are able to eliminate the virus. Chronic disease over a 10- to 20-year period can lead to cirrhosis, liver failure and cancer. It is estimated that 3 percent to 20 percent of chronically infected patients will develop cirrhosis, making hepatitis C is the leading cause of liver transplants.
Dr. James Boyle, a liver expert from the Yale University School of Medicine and chairman of the panel, said clinical studies that led to development of drugs to treat hepatitis C excluded children, drug users, the elderly, people infected with HIV, alcoholics and those with depression.
As a result, he said, there was no clinical evidence that people in these groups responded to the hepatitis C therapies and doctors tended to not treat such patients.
"We now know that these patients can respond to the standard treatment so we are recommending that they receive it," said Boyle.
New tests can now detect hepatitis C infection at a high degree of accuracy and can be suitable for screening virtually all at-risk patients, the panel said.
To treat the virus, a combination of drugs that includes interferon and ribavirin has been shown to be the most effective, the panel found.
Patients who do not respond after a year of this therapy, however, "present a significant problem," the committee said. The group report said a large drug trial is underway to determine if long-term maintenance therapy with interferon alone can prevent progression of cirrhosis or development of liver cancer among chronically infected patients.
Copyright 2002 The Associated Press. All rights reserved.
