15 Sep Hepatitis C Virus – A View On The New And Older Treatments
News of a new treatment for hepatitis C virus has recently become prominent (with almost unpronounceable names like grazoprevir and elbasvir). This infection certainly deserves serious attention, as it carries the possibilities of liver cirrhosis (hardening and malfunction) and liver cancer.
About a quarter of those infected have a spontaneous resolution of infection. The remainder have a chronic infection (low level, but continuing), some of whom may acquire the difficulties mentioned above.
The new treatment appears to have the potential to become the most successful yet. However it is quite expensive, as are most new pharmaceutical agents.
In medical school, this writer had a professor who said, “When something new is invented, don’t let your patient be the first in line.” He was referring to what some call “the law of unintended consequences” and suggested waiting until the effects and side effects of a new treatment are understood.
Considering the treatment previous to this new one, there was just as much hoopla initially expressed. However that previous treatment, using interferon and ribavirin, caused many discomforts and 18.5 percent of patients acquired a new autoimmune disease. That’s an illustration of the law of unintended consequences.
Further, the best results achieved with interferon and ribavirin was that about 50-60 percent of the patients eliminated the hepatitis C virus. Generally in medicine there is great satisfaction if something succeeds 50 percent of the time. However given the merely modest success rate and the unpleasant side effects, further research was pursued. While this recently announced new treatment might turn out to have a high success rate with few side effects, we may not know its consequences for a few years.
Some history about hepatitis C virus may give a better overall view of the problem and of treatment. In the 1980s the viruses causing hepatitis A and hepatitis B infection had been identified and tests invented to diagnose them.
These are viruses that preferentially infect liver cells. When that happens, the liver cells are so to speak “sick.” This has two immediate effects. One is that many jobs performed by the liver may not be done as well, and the rest of the body may suffer. The second effect is that the sick cells leak protein enzymes that are required for certain chemical reactions in liver cells.
When these enzymes leak into the bloodstream, they can be detected by testing. This provides a simple test for a disturbed liver and the initial alert to consider a hepatitis virus infection.
In the 1980s a new liver viral infection began to appear in addition to types A and B. As it tested negative for both hepatitis A and B viruses, it was named non-A non-B hepatitis. In the scientific pursuit to identify this virus, it was almost missed at first.
One examination procedure consisted of growing liver cells in laboratory dishes and infecting them with various viruses to see what would happen to the liver cells. What was first observed in liver cells infected with the virus now known as hepatitis C virus, was nothing. The virus seemed to have no effect on the health of the liver cells. Thus it was almost discarded as a possibility.
It was finally realized that when the hepatitis C infected liver cells were in a human body, the immune system attempted to eradicate the virus. Since the immune system can be fairly violent on a small scale, the liver got damaged – not from the virus, but from the immune attack.
By 2000, hepatitis C infection was prominent in the United States, but treatment was unreliable and sometimes unpleasant. The idea arose that if the immune system could be controlled to not attack the liver, then a person might live WITH hepatitis C, but without likelihood of cirrhosis, liver cancer, or the need for liver transplant. Research began on this at Tahoma Clinic, and in 2000 the writer and two other physicians published the results of a small trial using natural agents that accomplished immune control and reduced the levels of liver enzymes in the blood. The results have been quite successful and striking in 90-95 percent of those treated.
Note that this does not reduce overall immune function, just the part attacking the liver. (Milliman, Lamson, and Brignall. “Hepatitis C; a retrospective study, literature review, and naturopathic protocol.” Altern Med Rev 2000 Aug;5(4):35571) A number of refinements have been added to the original program.
The liver is one of the more amazing organs. Up to two thirds can be destroyed and it can still grow back. That’s probably the reason an alcoholic lasts so long.
Here’s a hopeful word on liver fibrosis, a term for created scar tissue. Any injury is knit back together by scar tissue. If liver injury occurs constantly, as with alcoholism and hepatitis C, a lot of the cell replacement will be with scar tissue, eventually called cirrhosis. Those cells don’t function as liver cells. However, the size and shape of a normal liver remains, but gradually there are less and less liver cells to function.
Here’s the kicker, it has been shown that the fibrosis occurring with hepatitis C can be reversed if further damage is stopped.
Returning to today and new treatment, it certainly seems best to completely remove the virus, providing that does not give unintended consequences. Certainly anyone with hepatitis C should seek treatment to reduce any tendency for progressive liver damage. If the new treatment does disagree, there is an alternative.
Davis W. Lamson, MS, ND