UCLA Campus    |   UCLA Health    |   School of Medicine Translate:
UCLA Health It Begins With U

Clinical Updates

Print
Email

Clinical Updates

 
Hepatology

Hepatitis C care can prevent serious liver disease

05/01/2006

The number of patients presenting with cirrhosis, liver cancer and liver failure related to hepatitis C has increased dramatically over the past decade. Hepatitis C is a blood-borne virus that is most frequently transmitted through shared injectable needles. Because it typically takes many years for hepatitis C to lead to these serious liver conditions – about 20 percent of hepatitis C patients will develop cirrhosis in about 20 years – an increase in these conditions is being seen decades after infection.

Other risk factors for hepatitis C infection include blood transfusion prior to the implementation of routine screening for the virus, accidental needle-stick injuries among healthcare workers, and cocaine use.

Detecting and treating hepatitis C

Most hepatitis C patients lack symptoms before the disease causes permanent liver damage. When symptoms occur, they include fatigue and depressed mood along with flu-like symptoms. Hepatitis C can be detected using simple blood tests (hepatitis C antibody and hepatitis C RNA tests) that can indicate infection. However, the hepatitis C RNA load does not predict liver disease severity. A liver biopsy is the best way to determine the extent of the disease, and helps the physician decide whether treatment should be started and help determine the patient’s prognosis. A genotype test can distinguish among the six hepatitis genotypes, and can be useful in predicting how well a patient will respond to medication and how long to continue medication therapy.

Hepatitis C progresses at different rates in different people — one patient can have the disease for three to five decades without apparent damage, while another can show signs of cirrhosis in less than 10 years. Factors associated with more quickly progressing cases of hepatitis C include gender – men do worse than women – alcohol consumption and co-infection with HIV.

Hepatitis C treatment aims to eradicate the virus and reduce the risk of liver disease progression and complications. The ultimate goal is to help the patient live longer and enjoy better health. Current standard therapy combines pegylated interferon injections given once a week and ribavirin pills taken twice a day. This therapy usually applies when significant liver damage from hepatitis C is suspected from a liver biopsy, blood test results or radiological studies. The medications are given for six to 12 months. Potential adverse effects include psychiatric symptoms (depression and insomnia), flu-like symptoms, suppression of white blood cells and platelets in bone marrow, and birth defects. The combination therapy reduces the virus beyond detectable levels in approximately 50 percent of patients. The success of the treatment depends on a number of factors including the viral genotype.

New data and new strategies

Emerging new research data may be changing how hepatitis C is treated for the first time in many years. Patients in whom the hepatitis virus becomes undetectable after the first four weeks of treatment can be considered for shorter courses of therapy. This helps to minimize the adverse side effects of the interferon and ribavirin therapy.

An area of research generating great interest is the development of disease-specific agents that could be used in addition to interferon/ribavirin therapy for hepatitis C. By targeting enzymes specific to the virus, researchers hope to directly attack the virus, preventing it from replicating. Researchers expect that this will yield an improved response rate over interferon and ribavirin alone. Clinical trials using these new agents are planned to begin next year.

Another trial set to begin soon at UCLA will test a new medication that may reverse liver fibrosis. Fibrosis, or scar tissue caused by hepatitis C, has traditionally been thought to be irreversible.

Hepatitis C is the leading indication for liver transplantation in the U.S. One of the most significant problems in treating hepatitis C with transplantation is that the disease often returns to infect the new liver. UCLA is very actively involved in clinical trials of hepatitis C treatment after liver transplantation.

The role of education

Patient education is vitally important to help people deal with hepatitis C. Every year, UCLA holds two free patient education seminars – one in English and one in Spanish – to discuss how the liver works, what happens when the liver is damaged, and what therapies, including liver transplantation, are available. Call to find when these seminars are scheduled to take place.

Contact information

For more information, or for an appointment or consultation, call (310) 794-7788.

Program physicians

Sammy Saab, M.D., M.P.H.

Steven Han, M.D.

Francisco Durazo, M.D.





Add a comment


Please note that we are unable to respond to medical questions through the comments feature below. For information about health care, or if you need help in choosing a UCLA physician, please contact UCLA Physician Referral Service (PRS) at 1-800-UCLA-MD1 (1-800-825-2631) and ask to speak with a referral nurse. Thank you!


comments powered by Disqus