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Hepatitis C clinical update |
Since being identified in 1989, hepatitis C (HCV) infection rates have reached epidemic levels in Australia, with the Northern Rivers area having one of the highest numbers of people infected with HCV in regional Australia. It is estimated more than 210,000 people in Australia have HCV. Currently there are 44 new infections daily in Australia, which equates to around one new infection every 32 minutes. HCV is a major public health problem.
In response to these staggering figures, new developments have occurred with respect to HCV treatments. Until recently, combination therapy consisting of interferon and ribavirin has been the most effective treatment. Overall, this therapy has achieved sustained viral response (SVR) rates of between 4-50%, meaning a loss of measurable virus in the blood and normalisation of LFTs that lasts at least six months after treatment.
The most effective treatment for HCV currently is a combination therapy of pegylated interferon and ribavirin. A polyethylene glycol PEG molecule has been attached to the interferon, resulting in a larger water soluble substance that has a longer half life and improved pharmacokinetics than that of regular interferon. As a result, injections of interferon are only required weekly, lessening the peak and trough effects of regular interferon therapy.
The side effects of pegylated interferon remain similar to those of regular interferon, ie. flu-like symptoms, fatigue and depression being the most severe. As a result, those starting on treatment still require continual support and close assessment throughout their treatment period. The length of treatment is either 24 or 48 weeks, depending on HCV genotype.
Pegylated interferons offer a higher chance of SVR making the options of treatment far more attractive to those with HCV. Overall, 60-70% of those with genotype 2 or 3 can achieve a SVR and those with genotype 1 a 50% change of SVR.
The health care needs of people with HCV can be complex. Chronic problems such as excessive alcohol intake, injecting drug use, diet and lifestyle can complicate their situations.
Discrimination can also play a large part in their acceptance and continued attitude to their diagnosis and illness. It is therefore important for all those involved in their care and treatment to be able to provide accurate and up to date information on HCV and management options.
Rebecca Wishart is a registered nurse, Hepatitis C Clinic, St Vincent’s Hospital.
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