SLU Doctors at Forefront on Hepatitis C Research

Experts at the Centers for Disease Control and Prevention estimate that the current 9,000 annual U.S. deaths attributed to hepatitis C (HCV) could triple within the next 10 years. As the most common chronic blood-borne infection in the United States, HCV soon will kill more people each year than AIDS.

Bruce R. Bacon, M.D., director of the division of gastroenterology and hepatology, and Adrian M. Di Bisceglie, M.D., of the division of gastroenterology and hepatology, are internationally recognized leaders in liver disease research. Di Bisceglie is a principal investigator in the largest and longest study of chronic hepatitis C to date _ a $28 million, eight-year clinical trial financed by the National Institutes of Health. Saint Louis University's portion of the grant is $2.4 million.

The nationwide study expects to enroll 800 to 1,000 patients at nine clinical trial sites, including 80 to 100 patients at Saint Louis University. Though DiBisceglie has some patients identified for this study, additional patients will be sought.

Other members of the Saint Louis University team involved in the study are Bacon, Brent Tetri, M.D., from the division of gastroenterology and hepatology, and Elizabeth Brunt, M.D., from the department of pathology.

Hepatitis C is the leading indication for liver transplantation in the United States and can lead to cirrhosis, liver cancer and death. Twenty to 30 percent of those patients with chronic HCV develop cirrhosis, and it is now believed that HCV may cause more cases of cirrhosis than excessive alcohol use.

The good news is that the rate of new infections now is reduced greatly. But an estimated 70 percent of the almost 4 million people in the United States with HCV who were infected -- often exposed 10 to 30 years ago -- are unaware of their condition. The disease usually causes no symptoms until serious liver damage sets in.

The symptoms themselves make HCV harder to diagnose because they can resemble the flu or a variety of other conditions. If symptoms are present, they include fatigue, nausea and liver pain.

"About 60 percent of the patients we diagnose with hepatitis C can determine how they contracted it," Di Bisceglie said. "For the remaining 40 percent, the cause may not be as obvious. Anyone who may be at risk should get tested immediately for hepatitis C."

"The general public's awareness level regarding hepatitis C is low, but improving," Bacon said. "I've had several patients tell me recently they were motivated to get tested when they learned through various media sources that they may be at risk. However, we still havea long way to go in educating the public about this disease."

Di Bisceglie and Bacon agree on the biggest misconceptions about HCV -- how it is spread and its levels of severity. "People are sometimes confused about the various types of hepatitis and how the different forms are contracted," Di Bisceglie said. "It's essential people know that hepatitis A is transmitted by food, food handlers and being around someone who is infected with it, whereas hepatitis C requires blood-to-blood contact to put someone at risk."

And reactions to being diagnosed with HCV run the gamut. "Someone who currently feels well may think it's nothing to be worried about, and another person may think it's a death sentence," Di Bisceglie said. "The truth is somewhere in between. Hepatitis C does not progress in everyone, and if it does, it progresses very slowly. It's not something to be panicked about, but to pay attention to."

About 70 to 80 percent of the people with HCV develop chronic HCV, meaning they have not been able to clear the infection. Severity of liver damage varies, from no damage at all to enough to require a transplant. "We see both ends of the spectrum in the same day," Di Bisceglie said.

"And people need to know that there are treatments that are effective for about 40 percent of the patients," Bacon said. Therapy with interferon, a substance naturally produced in the body to fight infection and tumors, by itself or in combination with ribavirin, can help many people with chronic HCV.

The study will target patients for whom interferon and ribavirin treatments haven't succeeded. "The goal of the study is to slow down the disease and prevent cirrhosis of the liver and transplants," DiBisceglie said.

Top