WIDER HEPATITIS THERAPY URGED

WASHINGTON - Drug users, children and AIDS patients should not be
excluded from treatment for hepatitis C, a blood-borne virus that has
infected an estimated 4 million Americans and is a leading cause of
liver cancer, a federal advisory panel says.

A 12-member committee of experts selected by the National Institutes
of Health said Wednesday that treatment for hepatitis C has improved
in recent years and that groups that previously were excluded from
therapies should now receive treatment.

The committee made the recommendation in a report that reviewed the
current medical consensus on the diagnosis and treatment of hepatitis
C. Such reports influence the way doctors treat patients in the United
States.

About 4 million Americans are infected with hepatitis C, making it the
most common blood-borne infection in America. The virus is spread most
frequently through the shared needles of drug users, but it can also
be spread by high-risk sex and transplantation of infected organs, and
an infected woman can give it to her infant.

Blood transfusions were once a common source of the infection, but
blood screening tests started in the early 1990s have almost
eliminated that risk. However, patients infected before the tests
began may be diagnosed in coming years as they develop symptoms.

About 85 percent of people infected with hepatitis C develop chronic
disease; the other 15 percent are able to eliminate the virus. Chronic
disease over a 10- to 20-year period can lead to cirrhosis, liver
failure and cancer. It is estimated 3 percent to 20 percent of
chronically infected patients will develop cirrhosis, making hepatitis
C the leading cause of liver transplants.

Dr. James Boyle, a liver expert from the Yale University School of
Medicine and chairman of the panel, said clinical studies that led to
development of drugs to treat hepatitis C excluded children, drug
users, the elderly, people infected with HIV, alcoholics and those
with depression.

As a result, he said, there was no clinical evidence that people in
these groups responded to the hepatitis C therapies and doctors tended
to not treat such patients.

"We now know that these patients can respond to the standard treatment
so we are recommending that they receive it," he said.

New tests can now detect hepatitis C infection at a high degree of
accuracy and can be suitable for screening virtually all at-risk
patients, the panel said.

To treat the virus, a combination of drugs that includes interferon
and ribavirin has been shown to be the most effective, the panel found.

Patients who do not respond after a year of this therapy, however,
"present a significant problem," the committee said. A large drug
trial is under way to determine if maintenance therapy with interferon
alone can prevent progression of cirrhosis or development of liver
cancer among chronically infected patients.