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The New Treatment of Hepatitis C. Illustrate your essay with specific examples.

Abstract:

Over the past three decades Hepatitis C has become one the most prevalent causes of liver disease in the world. It now affects over 180 million people worldwide (3% of the population), with over 30,000 new cases being diagnosed in the US alone every year. Though treatments for hepatitis C exist, only 50% of those treated show any response resulting in an urgent need for new therapies. This review will aim to cover the current treatment options available and the most relevant clinical and pre-clinical trials for the treatment of hepatitis C.

1. Introduction:

More than 180 million individuals across the globe are infected with the hepatitis C virus (HCV) (Waters et al., 2006). Infection can lead to fatal liver diseases; cirrhosis and primary liver cancers known as hepatocarcinomas (Waters et al., 2006). Indeed, HCV is considered by the World Health Organisation to be a silent but nevertheless deadly epidemic. The Centre for Disease Control (CDC) has declared that 20-30% of individuals with chronic hepatitis C will eventually develop potentially fatal symptoms (Webster et al., 2009). When compared to Human Immunodeficiency Virus (HIV), the most well known and well publicised viral infection, HCV is found to be more prevalent. For each individual infected with HIV, there are more than four infected with HCV (Webster et al., 2009). In addition, the number of HCV cases in the developing world is rapidly increasing with 6% of the population of central Africa infected (Madhava et al., 2002). The scale of the level of hepatitis infection worldwide has lead to many avenues of research being pursued. However, though therapies currently exist for the treatment of HCV, their efficacy is low; effective in only 50% of subjects (Waters et al., 2006). This has driven the development of more efficacious and less toxic treatments.

Though new strategies for the treatment of HCV show significant promise for the future, it should also be noted that in those responsive to combination therapies, 99% of patients had no detectable virus up to a decade later (Adamek et al., 2007; Lau et al., 1998). Thus the current combination therapy represents a cure for the 50% of HCV infected individuals who respond.

7. Conclusions:

The wealth of research continuing into the treatment of HCV brings significant hope that an effective treatment for this virulent and widespread virus may be found in the near future. Inhibitors of viral replication, virus attachment and virus release are all currently undergoing clinical trials and are likely to provide the next round of HCV therapeutics. The geographical diversity of the different genotypes and the significant influence of genotype on therapy responsiveness mean that trials conducted on one continent or even in different countries of regions within a continent are not comparable. Therefore it is likely that a worldwide single dosing strategy will not be appropriate for all patients. Differences in genotype and individual responsiveness may warrant local modifications in interferon dosing. Improvements in the dosing, dose regime and support infrastructure of patients receiving pegylated interferon and ribavirin could also significantly improve response rates. However, further studies are required to gain a better understanding of the mechanisms of IFN and ribavirin activity in order to substantially improve their actions. Recent innovation in the development of a cell-culture system that allows complete HCV replication may provide further information on the antiviral mechanisms of IFN activity and increase the ease with which new antiviral agents can be assessed. Crucially, novel antivirals may act synergistically with current therapies by reducing the ability of HCV to replicate and by increasing its susceptibility to IFN, reducing the level of non-responders. In summation, these rapidly increasing combinations of therapeutics hold the promise of greatly improved rates of response in the treatment of hepatitis C.

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