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« Exclusion of African Americans from Schering Hepatitis C Protease Inhibitor Study | Main | Using HIV Testing Sites to Offer Hepatitis C Testing »

May 01, 2006

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Hepster

What most of these tests always seem to leave out is that for most of the fraction of people that are cured by interferon it is simply cured long enough to register on Schering Test Results. The bulk of the cured relapse within 6 months and get to enjoy severe side effects like brain damage for the rest of their lives.

Daniel Raymond

I'd like to offer a clarification about relapse rates: for people on hepatitis C treatment, an undetectable viral load at the end of their course of treatment (usually 48 weeks) is called an End of Treatment Response (ETR). That's good news, but it doesn't mean that you're cured -- as Hepster notes, a proportion of people experience a viral "relapse" after treatment. This means that the hepatitis C virus returns to detectable levels after the person finishes their course of medication. That's why people have to get their viral load measured six months after stopping their medications: if it's still undetectable, that's considered a sustained virologic response (SVR).

Not everyone whose virus becomes undetectable by the end of treatment will ultimately have an SVR, but the majority will. I looked back at 3 pivotal clinical trials that resulted in the FDA approvals of pegylated interferon, to see what the breakdown was:

Fried et al. (NEJM 2002): ETR - 69%; SVR - 56%
Hadziyannis et al. (AnnIntMed 2004): ETR - 69%; SVR - 52%
Manns et al. (Lancet 2001): ETR - 65%; SVR - 54%

Based on these numbers, people who have an ETR (undetectable at the end of treatment) have a 75-83% chance of an SVR (still undetectable six months later). In other words, the majority of people with an ETR stay undetectable.

For a detailed discussion of these studies, see Treatment Action Group's comprehensive report, especially the chapter on treatment:
http://aidsinfonyc.org/tag/coinf/hcv2004/chap5.html

Virtually everyone who achieves an SVR will remain undetectable on standard viral load tests. A recent study reported at a major liver disease conference looked at nearly 1,000 people who had achieved an SVR (undetectable 6 months after treatment) and found that 99% remained undetectable after several years of follow up (averaging over 4 years). The hepatitis C virus became detectable again in only 8 out of the 997 people studied.

For a report on this study, see NATAP's write up here:
http://www.natap.org/2007/EASL/EASL_34.htm

So people are increasingly comfortable calling an SVR a cure, with a minimal risk of relapse.

As Hepster notes, some side effects do persist after the end of treatment -- I've heard people refer to an interferon "hangover" from lingering depression, though the people that I've talked to generally say that it clears up after a few months off of treatment. I've also heard about rare cases of people developing permanent side effects -- including a couple people who developed diabetes on treatment.

To the best of my knowledge, permanent/life-long side effects from hepatitis C treatment are extremely rare -- and not unique to interferon: medications for many other conditions and diseases can also pose a risk for long-term damage. But a lot of people have a rough time on hepatitis C treatment. I always encourage people who are considering treatment to carefully consider the risk of side effects, talk with their doctor about how they'd manage or prevent the more common ones, and talk to other people who've gone through treatment about what worked for them.

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