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PART
IX - DEALING WITH INTERFERON THERAPY
“’Tis better to suffer the
slings and arrows of outrageous interferon, than to be sawed in half for
a transplant.” - Cindy Torchin
cindyt@cpcug.org
Taking care of yourself
during your interferon therapy is important. It can lessen some of the
physical side effects you may experience.
A few simple tips can make
a big difference in how you feel, and knowing some ways to take care of
yourself can give your emotions a boost at a time when you may be
feeling that much of what’s happening to you is out of your control.
This feeling can be easier
to deal with when you discover how much you can contribute to your own
well-being. Remember though, that self-help is never a substitute for
professional medical care. Be sure to ask your doctor and nurse any
questions you may have about your medication, and tell them about any
side effects you may experience.
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IX.1.0
GENERAL TIPS FROM SCHERING
To help relieve some of the
side effects of Intron A (interferon alfa-2b, recombinant) for Injection
therapy, follow this simple A-B-C approach:
·
A nalgesics such as
acetaminophen or ibuprofen can be used to prevent or partially aleviate
the fever and headache.
·
B edtime
administration of Intron A therapy will allow you to sleep through the
“flu like” symptoms of therapy.
·
C onserve your
energy; try to get plenty of rest.
·
D rink plenty of
fluids; keep yourself well hydrated before and during therapy.
·
E at balanced
meals; make sure your are getting an adequate amount of calories in you
diet.
·
F ocus on the
positive; maintain a healthy mental outlook.
The most common side
effects associated with Intron A therapy are mild to moderate flu-like
symptoms, which usually diminish after the first few weeks of therapy.
These may include fever, headache, fatigue, weakness, chills, and muscle
and joint pain.
Other frequently occurring
symptoms are nausea, loss of appetite, diarrhea, and hair loss. They are
common at the start of therapy and should not alarm you. If you have any
questions about your side effects or medication, make sure to call your
doctor.
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IX.2.0 HOW DOES
INTERFERON WORK?
Alpha interferon works
differently in the various diseases it is used to fight. In hepatitis C
the virus invades and destroys liver cells; interferon lowers the virus
population to a level where it no longer causes injury. Interferon helps
by stimulating immune cells that in turn repel the invasion. Some
hepatitis patients don’t respond to interferon at all; others do, but
some of them relapse when they stop taking it.
---
IX.2.1
WHAT WILL
INTERFERON ACHIEVE:
Even when the interferon
does not cure the disease, it can help to put the virus into remission
for awhile, giving your liver a much needed break, and helping you to
live longer and more comfortably.
A study presented at the
AASLD 50th Annual Meeting (Nov 1999) showed that even
non-responders to interferon treatment have positive results.
Interferon has been shown to halt and even reverse fibrosis in
non-responders, and to slow down the rate of progression by reducing the
rate of inflammation, and lowering the viral load.
---
IX.2.2
CLINICAL TRIALS:
Your doctor may also
suggest that you join a clinical trial for new treatments, or you may
want to bring up this option with your doctor. Clinical trials are
carefully designed research studies that test promising new HCV
treatments. Patients who take part in research may be the first to
benefit from improved treatment methods. These patients also can make an
important contribution to medical care because the results of the
studies may help many people. Patients participate in clinical trials
only if they choose to and are free to leave at any time.
---
IX.2.3
WILL I BE ABLE TO CONTINUE WORKING WHILE I’M TAKING INTERFERON:
Most people are able to
continue working while they are being treated with interferon. It may be
possible to schedule your shots late in the day or right before the
weekend, (or whenever you determine your worst side effects - if any -
occur) so they interfere with work as little as possible.
If your interferon
treatment makes you very tired, you might want to think about adjusting
your work schedule for a while. Speak frankly with your employer about
your needs and wishes at this time. You may be able to agree on a
part-time schedule, or perhaps you can do some of your work at home.
Under Federal and state laws, some employers may actually be required to
allow you to work a flexible schedule to meet your treatment needs.
IX.2.4
HOW WILL I KNOW IF THE INTERFERON IS WORKING?
Your doctor and nurse will
use several methods to measure how well your treatments are working. You
will have frequent physical exams and blood tests. Don’t hesitate to ask
the doctor about the test results and what they show about your
progress.
While tests and exams can
tell a lot about how the interferon is working, side effects tell very
little. Sometimes people think that if they don’t have side effects, the
drugs aren’t working or that if they do have side effects, the drugs are
working well.
But side effects vary so
much from person to person, that having them or not having them usually
isn’t a sign of whether the treatment is effective. If you do have side
effects, there is much you can do to help relieve them. The next section
of the FAQ describes some of the most common side effects the people may
experience while taking interferon, and gives you some hints for coping
with them.
If you are reading this
section before you begin taking interferon, you may feel overwhelmed by
the wide range of side effects it describes. But remember: Every person
doesn’t get every side effect, and some people get few, if any. In
addition, the severity of side effects varies greatly from person to
person. Whether you have a particular side effect, and how severe it
will be, depends on your own particular dosage and injection schedule,
and how your body reacts. Be sure to talk to your doctor and nurse about
which side effects are most likely to occur for you, how long they might
last, how serious they might be, and when you should seek medical
attention for them.
---
IX.3.0
SIDE EFFECTS
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IX.3.0a
NAUSEA
Nausea and vomiting can
often be controlled or at least lessened. If you experience this side
effect, your doctor can choose from a wide and ever-growing range of
drugs that help curb nausea and vomiting. Different drugs work for
different people, and it may be necessary to use more than one drug to
get relief.
Don’t give up. Continue to
work with your doctor and nurse to find the drug or drugs that work best
for you.
You can also try the
following ideas:
·
Avoid big meals so
your stomach won’t feel too full. Eat small meals throughout the day.
·
Drink liquids at
least an hour before or after mealtime, instead of with your meals.
·
Eat and drink
slowly.
·
Stay away from
sweet, fried, or fatty foods.
·
Eat foods cold or at
room temperature so you won’t be bothered by strong smells.
·
Chew your food well
for easier digestion.
·
If nausea is a
problem in the morning, try eating dry foods like cereal, toast, or
crackers before getting up.
·
Drink cool, clear,
unsweetened fruit juices, such as apple or grape juice, or light-colored
sodas, such as ginger ale, that have lost their fizz.
·
Suck on ice cubes,
mints, or tart candies.
·
Try to avoid odors
that bother you, such as cooking smells, smoke, or perfume.
·
Prepare and freeze
meals in advance for days when you don’t feel like cooking.
·
Rest in a chair
after eating, but don’t lie flat for at least 2 hours.
·
Wear loose-fitting
clothes.
·
Breathe deeply and
slowly when you feel nauseated.
·
Distract yourself by
chatting with friends or family members, listening to music, or watching
a movie or TV show.
·
Popsicles
·
Sea Bands are
elastic bands worn around the wrist, with a small built-in “bump” which
presses against an accupressure point on your wrist. Many people find
these to be extremely helpful for both nausea and dizziness. Sea Bands
can be found in most Sporting Goods departments, or fishing supply
stores.
·
Peppermint tea works
wonders for nausea, as does a small (very small) drop of
peppermint essential oil on the tip of your tongue.
·
Many people find
chewing on candied ginger helpful. You can find candied ginger available
in the spice department, or in the Oriental foods section of your
grocery store. Or you can put a pinch of dried ginger in powder on the
tip of the tongue or chew a piece of the root. Or drink a tea: boil one
cup of water with a slice of fresh ginger root (or 1/2 teaspoon of dried
ginger powder) for 10 minutes. Strain it and add a few drops of lemon.
---
IX.3.0b
HAIR LOSS
Some people experience hair
loss as a side effect of interferon, but it doesn’t always happen. It
may range from a slight to moderate amount of hair loss, but I have
never seen anyone become completely bald from the dosages given for
hepatitis.
The hair grows back after
the treatments are over. When your hair does begin to grow back in, it
may come in thicker, curlier, or straighter than it did before your
interferon therapy.
Hair loss can occur on all
parts of the body, not just the head. Facial hair, arm and leg hair,
underarm hair, and pubic hair may all be affected.
Hair loss usually doesn’t
happen right away; more often, it begins after a few weeks. At that
point, hair may fall out gradually or breaks at or near the skin, and
the scalp may become tender. Any hair that is still growing may become
dull and dry.
To care for your scalp and
hair:
·
Use mild shampoos.
·
Use soft hair
brushes.
·
Use low heat when
drying your hair.
·
Don’t use brush
rollers to set your hair.
·
Don’t dye your hair
or get a permanent.
·
Have your hair cut
short. A shorter style will make your hair look thicker and fuller. It
will also make hair loss easier to manage if it occurs.
There is a special type of
shampoo and conditioner designed specifically for people undergoing
chemotherapy. Many people have reported good results using it while
taking interferon. The brand name is “Nioxin” and it is sold only in
salons.
---
IX.3.0c
FATIGUE
Fatigue is a common symptom
of hepatitis, and it can become worse while you are taking interferon.
Here are some things you can do to help yourself feel better:
1. Get plenty of rest.
Sleep more at night and take naps during the day if you can. Try to
schedule regular rest periods each day.
2. Limit your activities:
Do only the things that are most important to you.
3. Delegate tasks. Don’t
be afraid to get help when you need it. Ask family and friends to pitch
in with things like child care, shopping, housework, or driving.
4. Eat well, and be sure
to include plenty of healthy foods.
5. When sitting or lying
down, get up slowly. This will help prevent dizziness.
6. Don’t stand when you
can sit.
7. Plan your activities
and assemble everything before you start.
8. Reschedule daily tasks
so you do some only 3 or 4 times a week so you have time to rest each
day.
9. Use a cart, wagon or
basket to carry things from one part of the house to the other to
eliminate retracing your steps.
10. Sit on a stool in the
bathroom while shaving or applying makeup. Prop elbows up on counter if
you can.
11. Use warm, not hot water
for baths or showers. Hot water increases muscle fatigue.
12. If your fatigue is
severe, think about asking your doctor for a handicap sticker for your
car.
13. Shop when you are at
your peak energy.
14. When shopping alone,
ask a grocery clerk to carry out groceries.
15. If you arrive home from
grocery shopping tired, put away only the perishables. A family member
of friend can do the rest.
16. Shop by phone whenever
possible.
17. Avoid peak
shopping/traffic hours.
---
IX.3.0d
MOUTH PROBLEMS
If mouth dryness bothers
you or makes it hard for you to eat, try these tips:
·
Ask your doctor if
you should use an artificial saliva product to moisten your mouth.
·
Drink plenty of
liquids.
·
Suck on ice chips,
popsicles, or sugarless hard candy. You can also chew sugarless gum.
·
Moisten dry foods
with butter, margarine, gravy, sauces, or broth.
·
Dunk crisp, dry
foods in mild liquids.
·
Use lip balm if your
lips become dry.
avoid food with a
lot of condiments (chiles, salt, acidity).
·
If possible, see
your dentist before you begin taking interferon to have your teeth
cleaned and to take care of any problems such as cavities, abscesses,
gum disease, or poorly fitting dentures.
·
Brush your teeth
after every meal. Use a soft toothbrush and a gentle touch; brushing too
hard can damage soft mouth tissues.
·
If your gums are too
sensitive for even a soft toothbrush, use a cotton swab or gauze. Use a
nonabrasive toothpaste or a paste of baking soda and water.
·
Rinse your
toothbrush well after each use and store it in a dry place.
---
IX.3.0e
INFECTIONS
Interferon can decrease
your white blood cell count (these are the cells that fight infections).
Your doctor will check your blood cell count often while you are taking
interferon, and if your white cell count falls too low, your doctor may
lower the dosage of interferon for a while to give your body a chance to
rebuild its defenses.
When your white count is
lower than normal, it is very important to try to prevent infections by
taking the following steps:
·
Wash your hands
often during the day. Be sure to wash them extra well before you eat and
before and after you use the bathroom.
·
Clean your rectal
area gently but thoroughly after each bowel movement. Ask your doctor or
nurse for advice if the area becomes irritated or if you have
hemorrhoids.
·
Stay away from
people who have diseases you can catch, such as a cold, the flu,
measles, or chickenpox. Also try to avoid crowds.
·
Don’t cut or tear
the cuticles of your nails. Use cuticle cream and remover instead.
·
Be careful not to
cut or nick yourself when using scissors, needles, or knives.
·
Use an electric
shaver instead of a razor to prevent breaks or cuts in your skin.
·
Use a soft
toothbrush that won’t hurt your gums.
·
Don’t squeeze or
scratch pimples.
·
Take a warm (not
hot) bath, shower, or sponge bath every day.
·
Pat your skin dry
using a light touch. Don’t rub.
·
Use lotion or oil to
soften and heal your skin if it becomes dry and cracked.
·
Clean cuts and
scrapes right away with warm water, soap, and an antiseptic.
·
Wear protective
gloves when gardening or cleaning up after animals.
·
Do not get any
immunization shots without checking first with your doctor to see if
it’s all right.
Even if you take extra
care, you may still get an infection. Be alert to the signs that you
might have an infection and check your body regularly for its signs,
paying special attention to your eyes, nose, mouth, and genital and
rectal areas. The symptoms of infection include:
·
Fever over 100
degrees F.
·
Chills.
·
Sweating.
·
Loose bowels
·
A burning feeling
when you urinate.
·
A severe cough or
sore throat.
·
Unusual vaginal
discharge or itching.
·
Redness or swelling,
especially around a wound, sore, pimple, or boil.
Report any signs of
infection to your doctor right away.
---
IX.4.0
IMPORTANCE OF WATER
It is extremely important
to drink all of the water that you can stand (and then drink some more)
when you are taking interferon. It not only dramatically decreases the
severity of side-effects, but there is also a danger of serious kidney
infections if you do not drink enough. Milk/soda/coffee/tea don’t count.
You need genuine water.
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IX.5.0
STORAGE
According to a Schering
representative: Intron is stable undiluted for 7 days at room temp and
30 months in the refrigerator.
Reconstituted Intron is
stable for 1 month in the refrigerator and never at room temp.
---
IX.5.0a
TRAVELING WITH INTERFERON
When flying with
interferon, it won’t be affected by going through the x-ray machine. If
you are worried about it, you can always just stick it in your pocket
and walk through the metal detector. Since the horror of September 11th,
it might be advisable to carry your prescription with you, as proof as
to why you are carrying syringes.
In order to keep the
interferon cool, you can pack it in a Thermos bottle, or freeze a blue
ice pack and put it into a soft thermal lunch bag, and wrap the
interferon in newspaper so that it doesn’t sit directly on the ice. This
should last you for a few days. Do Not put ice in a glass
Thermos. It can break the glass (personal experience). If possible get
a stainless steel Thermos. I don’t know if they’re as good, but they
don’t break.
When in a hotel you can
just fill the ice bucket and then put a glass with the interferon
bottles on top so if the ice melts the interferon will not get wet.
---
IX.6.0
TIMING OF INJECTIONS
Schering (the manufacturers
of Intron-a) recommend giving yourself the injections in the evening so
that you can sleep through the worst of the side effects.
A better idea is to keep
track of when your worst side effects occur, and then time your shots so
that they occur when you are asleep. For some people, this may even mean
giving yourself the injections in the morning.
---
IX.7.0
INJECTION HINTS
First, wash your hands
before beginning.
Take the box to where you
inject, open up the box and take the vial out.
Clean the injection site
with an alcohol wipe.
Wipe the vial top with an
alcohol wipe also.
Now its time to find out
where you are going to make a hole. The nursing term is “clean to
dirty.” You put the pad at the spot where you are going to inject and
using a circular motion clean from that point out a few inches.
Fill the syringe. Pull the
top off the syringe. Pull the cover off the needle. Holding the vial in
one hand, have the syringe in the other and brace both hands together.
The reason is to not miss the center of the vial and nick or blunt the
needle.
(This part applies only to
the powdered form of interferon. You can skip this paragraph if you’re
using the new pre-mixed, already in the syringe stuff.) Turn the vial
upside down and draw in the IF. If its real cold, or the syringe is a
29g or smaller getting the stuff in can be a problem. Let it calm down
and push out the air. (vial and syringe still upside down) Then draw to
the full dose, occasionally pushing out air bubbles. I draw a little
more past the fill level, so if its a 3mil dose instead of the .5cc I go
to a couple of small marks beyond .5. Flick the syringe near the vial
with your finger, this makes air bubbles gather and go out the needle.
Take the needle out of the
vial.
Holding the syringe upside
down, and push the plunger to the correct level (e.g., .5cc). This gets
rid of any air in the needle.
With one hand pinch the
skin/fat layer at the injection site.
As fast as possible push
the needle into the layer with the syringe almost parallel to the skin
(hold the syringe similar to the way in which you hold a pencil). The
faster the needle goes in the less pain there is.
Very slightly pull back on
the plunger to check for blood. If the syringe fills with blood, it
means you’ve hit a vein and need to start the procedure over again.
If there is no blood in the
syringe, you can then push the plunger.
Pull the syringe straight
back. You get less bleeding if you don’t play twister. Drop the syringe
in the sharps container.
Syringes: I’ve found that
the .5cc ½ inch 29 (or 28) gauge insulin syringe to be the best. Gauges
that are numbers like 24 or 22 are bigger and hurt more.
Things that happen after
injection:
Sometimes there will be a
tiny bit of blood after an injection.
This just means you’ve
probably popped some capillaries or punctured a small vein. It’s nothing
to worry about; just cover it up with a bandage and let it clot.
The day after a shot, a red
area is quite normal. They can range from dime size to silver dollar
size and may feel hot and tender.
A small area is fine, but
if it gets much bigger and hotter, or you see something that looks
infected, contact your doctor.
Bruising is also very
common after shots.
Sites: Most people use
their thighs for injections. Some people find the lower abdominal area
(*not* around the belly button) to be the least painful spot for
injections.
Sharps containers: You
should be provided with one, either from where you get your interferon
(pharmacy or home delivery) or your doctor’s office. If you have a
problem getting one, puncture-proof soda bottles can be used to
temporarily hold the used syringes until you can take them to your
doctor’s office and ask them what to do with them. If you do this enough
times, eventually, someone might get the idea you need a real sharps
container. If you have children and/or cats, keep your sharps container
locked up. The hole is inviting to small hands and paws.
Some find it helpful to
numb the injection site beforehand. An icepack (or a bag of frozen peas)
placed on the injection site a few minutes ahead of time will make the
shot relatively painless.
To help prevent bruising,
some people recommend using only half of the diluent provided (this
applies to the powdered formulation only, and not to the new pre-mixed
syringes).
---
IX.7.0a
INJECT-EASE:
If you are having a problem
giving yourself a shot, ask your pharmacist for a B-D Automatic
Injector, Inject-Ease.
They cost about $25.00, and
are well worth every penny. You simply load the syringe into the
automatic injector, place it on the injection site, and push a button.
It is virtually painless, and also makes it much easier to choose a site
to inject, thereby giving you more sites per thigh.
---
IX.7.0b
BRUISING AND DILUENT AMOUNTS
If you are experiencing a
lot of bruising after your injections, you may find that it helps to
reduce the amount of diluent used when mixing the powdered form of
interferon. Schering always overfills their diluent bottles or syringes.
When using the powdered form of Intron-A, you only have to use enough
diluent to dissolve the powder. 0.4 to 0.5cc is a comfortable volume for
subcutaneous injection. The only time you need to absolutely use a known
volume is when you use a 3mu vial for multiple doses and you have to
know how much you put in so you know how many mu per cc and what the
volume will be for fewer than 3mu a dose.
---
IX.7.0c
NEEDLE SIZE
Many “Interferon Rangers”
recommend not using the syringe that comes with your interferon
prescription, for the actual injection. Use that one to mix the
interferon powder, and buy a box of ½ cc Microfine IV 29 gauge syringes
to use for the injection. The needle that comes with your interferon is
a fairly large gauge and inserting it through the rubber stopper of the
interferon vial dulls it a little. Using a smaller gauge needle will
make the injection more comfortable, and using a separate needle to mix
the diluent with the powder will keep your injection needle sharper.
---
IX.8.0
HELP! I THINK I HIT A VEIN!
When giving yourself an
injection, it’s recommended that you pull back slightly on the plunger,
to check for blood, before actually injecting. But, occasionally people
forget, and it’s almost a sure thing that at least once you will pull
the needle out and find blood and bruises. Unless you are injecting into
your neck and hit the jugular you have no problem! And even then, with
the size of needles we use, it would be real hard to have a bleeding
problem. The skin is “rich” with blood supply, so its just a matter of
time before you “nail” something that bleeds or shows up as a bruise
(not just the normal interferon reaction).
Normally, if you hit an
actual vein, there will be no doubt in your mind, as the blood tends to
come up into the needle very quickly. If you see that happen before you
actually inject, just start over again with a fresh dose. If you only
see bruising or a small drop or two of blood, chances are that you only
went through some capillaries and it’s nothing to worry about.
The only important thing to
do if you are bleeding after an injection is to cover it with a
band-aid. Even for long-term interferon users there is enough clotting
factor to stop the bleeding in a few minutes. The band-aid is to stop
making a mess. Interferon is given intramuscularly and intravenously for
other conditions, so even if you are “lucky” enough to find a real vein
or vessel the interferon won’t hurt you.
Some people say it is not
necessary to discard the dose. The caution against injecting the
interferon intravenously is because interferon is very irritating and
can cause a slight phlebitis (inflammation of the vein). Also it will be
painful once the reaction starts, with swelling and redness. If that
ever happens to you first apply cold compresses to keep the swelling
down and take your favorite painkiller. If after 24 hours the swelling
becomes worse, along with increased pain and redness, apply warm
compresses and call your doctor or go to the emergency room.
---
IX.9.0
WHAT TO DO WHEN YOU CAN’T AFFORD THE INTERFERON
Schering-Plough, the
manufacturers of Intron-A recombinant alpha-interferon 2b, have a cost
sharing program called “Commitment to Care” designed to help those in
need of interferon therapy who are unable to afford it. The program is
based on a sliding-scale based on your income, with the cost to you
ranging from free in some cases, to whatever their scale says you can
afford. They will first try to find programs in your State that may
help, and if none are found they will determine what you are able to pay
and absorb the rest of the cost.
In the US:
The number to call for the “Commitment to Care” program is
1-800-521-7157, ext 147.
The interview will take
approximately a half hour. Some of the questions you will be asked are:
·
name and address of
the prescribing doctor -dosage you will be using
·
when you were
diagnosed
·
your income (need to
send them tax forms or pay stub to verify)
·
number of people in
household
·
why you are unable
to pay
·
cost of your rent or
mortgage
·
any outstanding
loans
·
amount of credit
card debt
·
any savings
In Canada:
The number to call is 1-800-603-2754 extension 2121. According to Mike
Betel from HepNet:
In response to the emails
concerning anyone who was on the SAP (special access program) for
ribavirin, or anyone who has received a prescription for Rebetron from
their Physician, reimbursement assistance is available.
C.A.R.E., (The Canadian
Advisory Reimbursement Exchange) is the reimbursement assistance number
for patients who were prescribed Rebetron. There is a very easy to read
booklet available.
The new dedicated line is
1-800-603-2754 extension 2121. The people at C.A.R.E. are fully
bilingual and available from 10:00am to 6:00pm Monday to Friday Eastern
Standard Time. After hours, patients can leave their name and number,
and a medical professional will call them back the next day. Everything
is always confidential!
Concerns like these will be
answered.
I don't know who is
supposed to pay for my REBETRON
I don't think I have
coverage
I have no coverage
and I can't afford to pay for it myself
I have insurance but
I can't afford my co-pay or deductible
I have insurance but
they won't pay for REBETRON
My government plan
is too complicated for me to understand
My government plan
only pays for a portion of my REBETRON and I can't afford the rest
They tell me that my
REBETRON is not covered, what do I do now?
Also in the US:
IV ONE (800) 892-9622
Call for help with
interferon costs. This operation will accept whatever your insurance
company will pay as full payment in most cases. For dosages above 3
million units, your physician must write a special request to your
insurance company first.
They send your prescription
in pre-mixed dosage syringes, alcohol swabs, Band-Aids and a Sharp’s
biohazard container for the used syringes, each month by FedEx. They
deliver nationally, so their office location does not preclude anyone
from using their service.
And the staff is available
24 hours a day to answer any questions or give you any assistance you
may need.
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IX.10.0
INTERFERON TREATMENT OF HCV WITH CIRRHOSIS
In patients with hepatitis
C who have cirrhosis, the rate of sustained response following
interferon therapy is only half that of patients without cirrhosis.
Although it has been suggested that a higher dose regime in patients
with cirrhosis may improve response, this remains largely untested. The
results of a recent Australian study where cirrhotic patients were given
an intense interferon program of 4.5 MIU daily for 24 weeks suggests
that future studies in cirrhosis should be carried out exploring higher
doses and longer durations of therapy. - “Interferon Treatment of HCV
with Cirrhosis,” Journal of Viral Hepatitis 1997 ;4:85-88
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PART
X - WHERE DO WE GO FROM HERE?
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X.1.0
LONG TERM PROGNOSIS (WILL I EVER GET CURED? AM I GOING TO DIE?)
Current studies indicate
that most (80%) people infected with hepatitis C will develop a chronic
state of infection. About 30% those with chronic infection will go on to
develop cirrhosis of the liver. The disease appears to progress slowly,
symptoms often do not appear for ten or twenty years.
After an average follow-up
of 18 years, a prospective study of patients who received blood
transfusions showed no difference in overall mortality between HCV-infected
cases and noninfected controls. Liver-related mortality, though rare,
was twice as high in the cases (3.2 percent vs. 1.5 percent). A European
study showed survival among HCV patients with compensated cirrhosis was
91 percent at 5 years and 79 percent after 10 years. Among patients
developing decompensated cirrhosis, however, 5-year survival was only 50
percent. - National Institutes of Health Statement on Hepatitis C 1997
The latest study shows that
incidences of hepatocellular cancer due to hepatitis C and deaths caused
by hepatitis C are almost double the rate given a few years ago. An
article in the July issue of Gut reveals that ‘“of the 416
patients, 60 developed HCC with a 5-year rate of 13.4%...and 83 died
(including 34 with HCC), with a 5-year death rate of 15.3%.’ According
to the authors, these results contrast with previous studies, which cite
5-year mortality rates of 9%, and HCC rates of 5% or 7%.”
The overall severity of
chronic hepatitis C is controversial. There is no question that HCV can
lead to cirrhosis and hepatocellular carcinoma (HCC) and that end-stage
chronic hepatitis C is now the leading indication for liver
transplantation. At question is how frequently and how soon these
serious consequences occur.
A controlled prospective
study (Seeff) has shown that after 20 years of follow-up, patients with
transfusion associated hepatitis C had no increase in overall mortality
and only a slight increase in liver-related mortality compared to
controls who did not develop hepatitis. Another prospective study (Koretz)
has shown that the probability of developing clinical cirrhosis or liver
related mortality was 20% and 5%, respectively after 16 years;
comparable values were 24% and 3% in the NIH series. The paradox between
the relatively benign mortality figures and the observed fatal outcomes
resides in the indolent nature of progressive HCV infection.
Progression is generally
measured in decades and most subjects acquiring infection in mid-life or
later will succumb to their underlying disease or old age before they
develop end-stage chronic hepatitis C. By inference, it appears that the
HCV mortality risk is approximately 4% in the first two decades and the
risk will increase over time in those that do not succumb to other
events. “Natural History and Clinical Aspects of HCV Infection.” H.J.
Alter. Department of Transfusion Medicine, National Institutes of
Health, Bethesda, Maryland. Cancer Biotechnology Weekly,
01-29-1996, pp 20.
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X.2.0
CURRENT RESEARCH, TESTING AND CERTIFICATION OF NEW DRUGS AND TREATMENTS
IN THE U.S. AND ABROAD
There is a great deal of
research going on, regarding the possible prevention and treatment of
hepatitis.
The following table is from
the website at
http://www.frontiernet.net/~monty/hcvpipel.html
and was last updated August
16, 2001. © Frank Montmarquet.
HEPATITIS C NEW
DRUG PIPELINE
Drugs
specific for Hepatitis C
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