Report Questions Early Treatment of Hepatitis C

People with hepatitis C whose livers remain healthy may be better off not undergoing drug treatment, which can produce severe side effects and does not always work, researchers said on Tuesday. The recommended 48-week course of treatment for the blood-borne virus -- injections of interferon and oral ingestion of ribavirin -- is effective in, at most, 60 percent of patients and has potentially severe side effects such as nausea, fatigue, depression and, in some cases, suicidal impulses.

The treatment, which costs in excess of $20,000, has been shown to lengthen the lives of hepatitis C patients who have existing liver damage. But a majority of hepatitis C patients do not develop liver damage before dying of other causes, so the drug treatment may not be cost-effective or helpful for them, according to the report from the Harvard School of Public Health's Center for Risk Analysis.

Most of the 25,000 new U.S. cases of hepatitis C annually are infected through sharing needles or from receiving blood from an infected donor. But four out of five have no symptoms, and many of them are unaware they have it.

The disease's progression varies considerably and milder cases, especially among women, may never progress to cirrhosis. The report's analysis showed that the probability of infected men developing cirrhosis over a 30-year period was between 13 percent and 46 percent, and among women the probability was between 1 percent and 29 percent.

"There has been a huge effort over the last few years to identify people infected with [hepatitis C], but this wider group of patients will likely include those who are least likely to develop advanced liver disease," said Sue Goldie, coauthor of the report. "For patients at low risk of progressing, the overall health gain from treatment may be minimal given the potential for toxic side effects," she said.

The full report, "Cost-Effectiveness of Treatment for Chronic Hepatitis C Infection in an Evolving Patient Population," is published in the July 9 issue of the Journal of the American Medical Association (2003;290(2):228-237).

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