"I tell my patients who achieve a sustained virologic response to go home and get on with their lives," said Mark Swain, professor of medicine at the University of Calgary in Canada, who presented results of an international trial at the opening session of the 42nd European Association for the Study of the Liver in Barcelona, Spain. "I tell them that there is less than a 0.5 percent chance that the disease will ever return."

In fact, of 997 patients who were able to achieve the complete response, only 8 came down with the disease again, Swain said.

"This is a very important message. We can cure people with this disease," Xavier Forns, senior specialist in liver diseases at the Hospital Clinic in Barcelona and a member of the program committee for the conference, told United Press International.

"We made this paper 'Abstract 1' because we thought this was a significant finding that is important to our patients and to the clinicians."

Swain identified the 997 patients from 9 clinical trials that tested drugs either in monotherapy or in combination therapy. All these patients had a sustained virologic response when treated with pegylated interferon alfa-2a (PEGASYS) as monotherapy or in combination with ribavirin (COPEGUS). The criteria for a sustained virologic response means that after taking drugs for either six months or 24 months, tests could not detect virus in the bloodstream. If six months after stopping the drugs there was still no detectable virus, the patient was said to have achieved a sustained virologic response.

Swain said that such patients should also be told that can be considered cured.

The study included three trials in which patients were treated with monotherapy and six trials in which the combination treatment was employed. Swain said the combination therapy is now considered standard of care and as many as 66 percent of patients infected with hepatitis C who faithfully take their antiviral medication -- usually for 48 weeks -- are able to achieve the sustained virologic response.

"Although the benefits of viral eradication have been well established, the overall durability of a sustained virologic response is less well known," Swain explained.

Of the patients who did achieve a sustained virologic response, 163 patients who only had hepatitis C infections were treated with peginterferon alfa-2a monotherapy; 741 patients were treated with peginterferon alfa-2a monotherapy plus ribavirin combination therapy; 93 patients co-infected with human immunodeficiency virus (HIV) and hepatitis C were treated with either monotherapy or combination therapy.

"We found that a sustained virologic response is a sustained virologic response whether it occurs in an immunosuppressed patient due to disease such as HIV, or who has undergone transplantation and requires immunosuppressive drugs," Swain said. There was no falloff in response. Of the eight people who relapsed or were re-infected, just one patient in the combined hepatitis C-HIV group was listed as a relapse. He also noted that only one of the eight cases involved a patient who had taken a full course of treatment.

Swain said that, due to the way the studies were conducted, it will be impossible to determine if the patients indeed relapsed or were re-infected. In only one case did a patient's records contain viable virus for a DNA comparison to be made. In that case, the patient appeared to become re-infected with a different strain of hepatitis C. "We are never going to know the answer to whether these are relapses or re-infections," he said.

Forns told UPI that hepatitis can be contracted through injected drug use, sexual contact and hospital-acquired infections. He said that patients need to be aware, however, that a cure does not mean that re-infection can't occur if they continue to have risky activities.

Related Links
European Association for the Study of the Liver
Hospital and Medical News at InternDaily.com
The science and news of Epidemics on Earth
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