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DRIVING down the number of circulating copies
of the hepatitis C virus to undetectable levels in the earliest stages
of infection makes it highly likely that the patient will eventually be
cured - even among patients who are also infected with HIV.
The
findings, the interim results from an Australian study presented to a
recent international conference in Italy, suggest that rapid
virological response - or RVR, the term used to indicate successful
suppression of viral load within four weeks of starting treatment - is
just as good a predictor of eventual cure among patients suffering
acute hepatitis C infection as it is already known to be among
chronically infected individuals.
In addition, the trial - which is still continuing - suggests new
treatment options for difficult-to-treat groups such as people with HIV
and injecting drug users. Unlike most hepatitis C treatment studies,
this research included significant numbers of HIV patients and
injecting drug users, and the findings showed RVR was just as good at
predicting eventual cure in these as in other patients.
The Australian Trial in Acute Hepatitis C, known by its acronym
ATAHC, was funded by the US National Institutes of Health. The interim
findings were presented as a poster at the recent annual scientific
meeting of the European Association for the Study of the Liver in
Milan, where it was voted into the top 10 per cent of the more than 800
poster presentations at the meeting.
An estimated 264,000 Australians have been exposed to hepatitis C, a
blood-borne virus that attacks the liver and left untreated can lead to
liver inflammation, cirrhosis and eventually cancer.
Although 25 per cent of people clear the virus naturally, the
prognosis for the remaining 75 per cent is more difficult as most will
usually experience symptoms such as debilitating fatigue, pain and
nausea.
While cure is possible with drug therapy, the drugs are quite toxic
and hard to tolerate. Treatment also lasts a year and only works in
fewer than 50 per cent of cases. Co-infection with HIV makes it even
harder to eradicate hepatitis C.
Sydney-based hepatitis expert Greg Dore, a co-author of the study
and who attended the Milan conference, said the message from the ATAHC
findings was that if doctors could drive viral levels down to
undetectable levels early "you can get incredibly good response rates".
While 107 patients in the study elected to have treatment for acute
hepatitis C, 84 patients continued to the point where they had data on
their progress after four weeks of treatment. Among the 26 patients
infected with HIV as well as hepatitis C, RVR, or complete viral
suppression, was observed in 10 people (45 per cent), and in 28 out of
the 58 patients infected with hepatitis C alone (48 per cent).
Those
with high hepatitis C viral loads at the start of treatment, with more
than 400,000 international units per millilitre of blood, were less
likely to achieve RVR.
Finally, 53 patients were assessed for
both RVR and for sustained virological response, or SVR, a longer-term
measure that is often taken to mean the patient has been cured. All the
participants who achieved RVR went on to achieve SVR, and even 59 per
cent of those who did not achieve RVR went on to be cured later.
The
study's authors concluded that patients treated for acute hepatitis C
infection and who achieved RVR "are highly likely to achieve SVR,
irrespective of HIV status".
"This is the largest study ever
of an injecting drug-user population with early infection," said
professor Dore, who is head of the viral hepatitis clinical research
program at the Sydney-based National Centre in HIV Epidemiology and
Clinical Research.
"We have shown that it is feasible to treat
this group, many of whom have been recent injecting drug users, and get
remarkably good outcomes.
"What we are looking at now is to
apply to the NIH for another five years' funding, to look at the
different strategies to optimise treatment outcomes in this group."
Dore's
colleague doctor Gail Matthews said the high proportion of HIV-positive
cases in the study participants, about one-third, "probably reflects a
current increase in acute HCV in this population - predominantly
acquired through sexual transmission and mirroring what is being
reported from many centres in Europe".
"This has potential implications for public health messages in this group," she said.
Adam
Cresswell's trip to the EASL conference in Milan was organised as part
of the prize for winning the Professor Geoff Farrell Medal, a
journalism award organised by Hepatitis Australia for writing about
hepatitis C. Funding for the award was provided by the drug company
Schering-Plough.
http://www.theaustralian.news.com.au/story/0,25197,23743186-23289,00.html
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