Drug Criteria & Outcomes
Hepatitis primer: A, B, C
Take a moment to review this information on hepatitis A, B, and C, provided by the Center for Disease Control in Atlanta and the Hepatitis Foundation International in Cedar Grove, NJ.
• Hepatitis A is a liver disease caused by the hepatitis A virus (HAV). Hepatitis A can affect anyone. In the United States, hepatitis A can occur in situations ranging from isolated cases of disease to widespread epidemics.
Good personal hygiene and proper sanitation can help prevent hepatitis A. Vaccines also are available for long-term prevention of hepatitis A virus infection in people 2 years of age and older. Immune globulin is available for short-term prevention of hepatitis A virus infection in all ages.
There is no specific treatment for hepatitis A. However, the infection will clear up on its own in a few weeks or months with no serious aftereffects. Once recovered, an individual is then immune. About 1 in 100 people with HAV suffer from a sudden and severe infection (fulminant) that may require a liver transplant.
• Hepatitis B virus (HBV) is a serious disease that attacks the liver. The virus can cause life-long infection, cirrhosis (scarring) of the liver, liver cancer, liver failure, and death.
Two medications treat chronic HBV: Interferon (IFN) and lamivudine. Treatment facts include:
Fewer than 50% of chronic HBV patients are candidates for interferon therapy. Initially, 40% of HBV patients who are treated with IFN will respond; however, some will relapse when the treatment is stopped. Overall, about 35% of the eligible patients will benefit. IFN treatments may have a number of side effects, including: flu-like symptoms, headache, nausea, vomiting, loss of appetite, depression, diarrhea, fatigue, and thinning of hair. Interferon may lower the production of white blood cells and platelets by depressing the bone marrow. Thus, blood tests are needed to monitor blood cells, platelets, and liver enzymes.
The response to oral lamivudine, given for at least one year, may be somewhat lower.
There is no treatment for acute hepatitis B.
• Hepatitis C is a liver disease caused by the hepatitis C virus (HCV), which is found in the blood of people who have the disease. HCV is spread by contact with an infected person’s blood.
Three types of interferon and a combination of interferon and ribavirin are used to treat hepatitis C. Blood tests and liver biopsy findings may determine the need for treatment. Here are other facts:
Interferon must be given by injection, and may have a number of side effects, including flu-like symptoms: headaches, fever, fatigue, loss of appetite, nausea, vomiting, and thinning of hair.
Ribavirin, given by mouth, can have additional side effects including depression, severe anemia, and especially, birth defects. Women or the male partners of women, who are pregnant or who are planning pregnancy, should not take ribavirin. Pregnancy should not be attempted until six months after treatment is ended. Ribavirin also may interfere with the production of red blood cells and platelets by depressing bone marrow. Patients should be monitored frequently.
Although 50-60% of patients initially respond to treatment, sustained response occurs in up to 40%.
Treatment of children with HCV is under investigation. Researchers are re-examining when treatment should begin, how long it should continue, and its effectiveness.
Currently, almost one-half of all liver transplants in the United States are performed for end-stage hepatitis C. However, reinfection of the transplanted liver by the virus usually occurs and may require a second transplant.
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