Hepatitis C and its significance

Hepatitis C affects approximately 4 million or 2% of Americans, and more than 100 million persons worldwide. Chronic hepatitis C can progress to cirrhosis and liver cancer. Endstage liver disease and liver cancer due to hepatitis C account for 30%-50% of adult liver transplantations in western countries. Most people with chronic hepatitis C do not have symptoms and are not diagnosed until they have advanced liver disease. There is as yet no vaccine for hepatitis C.

Current treatment for hepatitis C

Currently, the only treatment is combination therapy with pegylated interferon and ribavirin. This treatment can lead to virus clearance in roughly 50% of patients. However, the treatment is expensive and associated with many side effects. Only a small percent of hepatitis C patients are treated because of lack of access to medical care or presence of other medical conditions that preclude them from treatment. Of those who are started on treatment, 15%-30% are unable to complete the course of treatment due to inability to tolerate the side effects. Thus, there is a need to develop more effective and better tolerated treatments. There is also an urgent need to develop treatments that would be effective for those who have failed to respond to currently available treatments.

University of Michigan Hepatitis Program

The Viral Hepatitis program is the center piece of the University of Michigan Hepatology Program. This program is led by Drs. Anna Lok, Hari Conjeevaram and Robert Fontana, national and international leaders in the field. The program integrates state-of-the-art care with cutting edge research.

The clinical program evaluates approximately 2000 new patients with viral hepatitis and provides antiviral treatment to more than 250 patients each year. This program is supported by 2 physician assistants: Kelly Oberhelman and Tracy Licari, who ensure that all the patients receiving antiviral treatment are closely monitored and optimally managed.
In addition to providing standard of care, patients referred to our Viral Hepatitis program are also evaluated for entry into clinical trials. These clinical trials provide access to investigational treatment that frequently prove to be superior to existing treatment. In addition, the clinical trials often provide free medications to patients who otherwise cannot afford the treatment. During the last 10 years, we have participated in more than 20 industry-sponsored clinical trials and have provided care to more than 500 patients.
 

In the past two years, we participated in two trials on the safety and efficacy of viramidine in combination with pegylated interferon, and a 16 vs. 24 week course of pegylated interferon and ribavirin for patients with genotype 2/3 infection. We are currently involved in studies on novel treatments to block hepatitis C virus replication and fibrosis (scarring) of the liver.

Our Program is also a participating site in two key NIH trials on hepatitis C: HALT-C and VIRAHEP-C. The HALT-C trial aims to determine if long-term maintenance therapy with low dose pegylated interferon can decrease the rate of progression to cirrhosis, liver failure and liver cancer. The VIRAHEP-C trial aims to unravel the mechanisms (genetics, immune response and viral factors) that account for the poorer response of African Americans to interferon-based therapies. Data from these trials will revolutionize our management of the "difficult-to-treat" hepatitis C patients.

Our Program is also active in hepatitis B research. The University of Michigan Viral Hepatitis Program is one of the top programs in the country, with more than $1million/year grant funding from the NIH and more than 20 peer-reviewed scientific publications each year.

Anna S. Lok, MD
Dr. Lok is Professor of Internal Medicine and Director of Clinical Hepatology. She is a world renowned investigator in viral hepatitis. She has lectured all over the world and has published more than 200 scientific papers. She is currently an Associate Editor of HEPATOLOGY, the official journal of the American Association for the Study of Liver Diseases. She is also a member of the National Board of Directors of the American Liver Foundation. Dr. Lok is listed in "Who's Who" and "Best Doctors" of America. She has trained more than 20 young doctors in the care of patients with liver diseases and in research on viral hepatitis. She also participates in community education and recently won an "Award for Outstanding Contribution to Health" from the Community Health Charities.

Hari Conjeevaram, MD
Dr. Conjeevaram is an Assistant Professor of Internal Medicine. He has made significant contributions to viral hepatitis and fatty liver disease research. He is the principal investigator at Michigan in the VIRAHEP C study. Dr. Conjeevaram has received numerous teaching awards. He also devotes time and energy to community health providing service to free clinics for the indigent patients, and relief efforts to Katrina and Tsunami victims.

Robert Fontana, MD
Dr. Fontana is an Associate Professor of Internal Medicine and Medical Director of the Liver Transplant Program. He has made important contributions to research into viral hepatitis, drug induced liver disease, and acute liver failure. He has lectured in many parts of the world and has published around 100 scientific papers.

Allocation of donations

Donations that exceed $50,000 will be earmarked for research on hepatitis C. Research topics may include optimizing treatment response in clinical practice (for example, research into methods to reduce side effects and to improve dose adherence), or evaluation of new treatment strategies (for example, research on impact of weight reduction or treatment of associated metabolic conditions such as insulin resistance on rate of viral decline during antiviral therapy). Donations below $50,000 will be used for education of hepatitis C patients on their disease and its management.