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Should You See a Specialist for Hepatitis C?

April 17, 2008

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Even though you may be on a first name basis with your general practitioner, research from Germany proves that your chances for successfully eliminating the Hepatitis C virus are greater when treated by a hepatologist.

by Nicole Cutler, L.Ac.

Once diagnosed with Hepatitis C, a little research will eventually reveal that the current standard treatment is pegylated interferon with ribavirin. Despite the relatively low rate of success in eliminating the virus, many may mistakenly believe that it doesn’t matter who administers the treatment. However, new research demonstrates that it is well worth the effort to seek out a specialist for monitoring your therapy.

Successful Treatment
Known as sustained virological response (SVR), successful treatment for Hepatitis C is described as the inability to detect any of the virus in the blood six months after stopping therapy. Although it is currently the only viable option for Hepatitis C, estimates of those attaining SVR with pegylated interferon and ribavirin treatment vary widely.

Regardless of a study’s country of origin, large trials evaluating Hepatitis C treatment success have reported SVR rates ranging between 30 and 80 percent. However, close examination of people fighting Hepatitis C in the real world have led researchers to suspect that the type of doctor a patient seeks help from significantly impacts SVR likelihood.

German Study
In an attempt to realize the real world impact of the type of physician administering Hepatitis C treatment, researchers at the University of Dusseldorf conducted a landmark retrospective study. At their outpatient clinics, these German researchers analyzed the records of patients receiving at least one dose of interferon treatment for Hepatitis C over a span of seven years.

After analyzing over 300 people receiving Hepatitis C treatment for the first time, approximately two thirds consulted with an expert hepatologist on a regular basis while just over one third had their interferon treatment administered and supervised by a general practitioner. Even though the characteristics of infection were similar between those working with a hepatologist and those seeing a general practitioner, the outcomes of Hepatitis C treatment were significantly different between the two groups.

Right after interferon treatment, elimination of the Hepatitis C virus was more likely for those seeing a hepatologist:

· A viral load of zero was evident in 74 percent of those seeing a hepatologist.
· A viral load of zero was evident in 48 percent of those seeing a general practitioner.

At the six-month mark when SVR is measured, those seeing a hepatologist continued to have a definite advantage:

· SVR was attained by 66 percent of those seeing a hepatologist.
· SVR was attained by 34 percent of those seeing a general practitioner.

When broken down even more, those with genotypes 1 and 4 and those with advanced liver damage specifically benefited from expert care:

· For study participants infected with genotype 1 or 4, SVR was attained by 61 percent of those seeing a hepatologist.

· For study participants infected with genotype 1 or 4, SVR was attained by 27 percent of those seeing a general practitioner.

· For study participants with advanced liver damage, SVR was attained by 69 percent of those seeing a hepatologist.

· For study participants with advanced liver damage, SVR was attained by 25 percent of those seeing a general practitioner.

These results led the German authors to conclude “Patients with…genotypes 1 and 4 or with advanced liver damage benefit from HCV therapy supervision by a specialist, probably because of less frequent treatment interruptions or dose reductions.”

What Is An Expert?
A hepatologist is a physician who has obtained additional, specialized training in liver diseases. Initially, all hepatologists are trained in general internal medicine (adult medicine) or pediatrics (children’s medicine). Some pursue additional training in gastroenterology (which includes digestive disorders involving the esophagus, stomach, small and large intestines, pancreas, gallbladder and liver). However, to be a hepatologist, a fellowship focusing solely on the liver is typically mandated. Even though a hepatologist is the most qualified type of doctor to treat liver disease, there is currently no separate board certification examination in this highly specialized field.

The field of hepatology is a rapidly changing, emerging field. Even though the standard of care for Hepatitis C has been interferon-based treatment for many years, there are many factors involved in its administration. Hepatologists are up-to-date on the latest research and discoveries for treatment modifications, length of treatment, dosage adjustments, side effect management and all of the other details related to Hepatitis C treatment.

Although most people are comfortable with their general practitioner – and they may have been the physician who originally detected their infection – an expert may be more qualified to administer Hepatitis C treatment. Especially important for people who have genotypes 1 or 4, or who already have advanced liver disease, the chance of achieving SVR is much higher when an expert liver specialist manages treatment.

References:

http://depts.washington.edu, Sagir, A., et al., Therapy outcome in patients with chronic hepatitis C: role of therapy supervision by expert hepatologists, Journal of Viral Hepatitis, September 2007.

www.acponline.org, Hepatitis C, American College of Physicians, ACP Observer, April 2006.

www.annals.org, Update in Hepatology, Willis C. Maddrey, MD, Annals of Internal Medicine, February 2001.

www.hepatitiscounselor.com, Thoughts about Hepatitis C and Liver Disease, Hepatitiscounselor.com, 2007.

www.hepato-site.net, What is a hepatologist and why do I need one?, University of Cincinnati, 2007.

www.hivandhepatitis.com, Treatment Outcomes in HCV Patients Whose Therapy is Supervised by Expert Hepatologists, hivandhepatitis.com, October 2007.

Posted by Editors at April 17, 2008 1:50 PM