MUHC Hepatitis C Program: High chance of cure for infected individuals


Thanks to the Hepatitis C Program at the MUHC, victims of this life-threatening disease have access to treatment that in many cases will completely eradicate the Hepatitis C virus (HCV). The treatments involve the weekly injection of a potent form of interferon for a period of 12 to 48 weeks and the use of an oral medication called ribavirin. There are six different types of HCV; types 2 and 3 are most responsive to the treatments.

Both medications are associated with many side effects, such as prolonged flu-like symptoms, muscle aches, fatigue, general malaise, poor appetite, and moderate to severe depression. The drugs can also reduce blood cell counts and can affect the function of other organs, such as the thyroid gland. Therefore, patients must be properly supported by health care professionals throughout the treatment period.

The anti Hepatitis C drugs cannot safely be prescribed from a doctor's office without extensive prior investigations, patient education and close follow-up. "This type of treatment is so complex that it can be more effectively delivered through a tertiary care institution like the MUHC — one that provides patients with access to proper nursing resources and other specialized MUHC hospital facilities, such as radiology for liver biopsies and state-of-the-art laboratories to monitor the response to treatment and the onset of serious side effects," explains Dr. Richard Lalonde, Chief of Infectious Diseases of the MUHC. The capacity to treat Hepatitis C within the MUHC has until recently been limited because of limited medical expertise and the absence of nursing resources but now, as Lalonde explains: "We have been able to employ a full-time nurse dedicated to the treatment program and as a result the Infectious Diseases specialists at the RVH site have acquired the expertise to successfully treat and cure patients infected with this virus — in fact, we will see about 250 patients per year in this program." The Infectious Diseases physicians in collaboration with the Hepatology service — in particular Dr. Marc Deschênes — make this program unique because it coordinates input from these two key medical specialities.

"This disease has a wide spectrum of symptoms," says Lalonde. "Some people have it and seem completely healthy while others are dying of advanced liver cirrhosis which requires a liver transplant — a life-saving procedure but with life-long consequences for the quality of life of the patient and a major cost to the health care system." The treatments are costly, but a study done by the MUHC technology assessment unit (TAU) in 2002 showed that these treatments will actually save money by preventing the evolution to end-stage liver disease.

"I want to announce to the medical community that we have created this new service and that patients may be referred to the Infectious Diseases Clinic of the MUHC with only a very brief waiting period (a few weeks at the most as opposed to the previous several months waiting time).

"Hepatitis C is a major public health problem involving significant costs to the health care system. I hope that the government, through its Service de Lutte aux Infections Transmissibles Sexuellement et par le Sang (SLITSS), will make this new treatment a priority," adds Dr. Lalonde.

Hepatitis C

Hepatitis C virus (HCV) now seems to be the major cause of advanced liver disease in Canada and the major indicator for liver transplantation. Two hundred fifty thousand Canadians — 40,000 in Quebec — are infected with the virus (discovered in 1989), many without even knowing it. Once infected, 75% will remain infected for the rest of their life. Over a period of several decades, some of those who are chronically infected will develop cirrhosis of the liver or liver cancer, both of which are irreversible and frequently fatal. Symptoms of the disease include mild to severe fatigue, muscle aches, loss of appetite, arthritis or other autoimmune disorders and, in the more advanced stages, jaundice, abdominal swelling and stomach hemorrhages. The disease is contracted through untested blood products (such as transfusions), needle sharing by IV drug users, health care workers who suffered needle-stick injuries, and many immigrants from the Middle East and North Africa who, between 1950 and 1970, contracted the virus from unsafe therapeutic injections such as needle re-use in vaccine campaigns in their home countries. HCV is occasionally transmitted by sexual intercourse; infected mothers can also pass the virus on to their babies and tattoos have occasionally also transmitted it.

About the McGill University Health Centre (MUHC)

The McGill University Health Centre (MUHC) is a comprehensive academic health institution with an international reputation for excellence in clinical programs, research and teaching. The MUHC is a merger of five teaching hospitals affiliated with the Faculty of Medicine at McGill University — the Montreal Children's, Montreal General, Royal Victoria, and Montreal Neurological Hospitals, as well as the Montreal Chest Institute. Building on the tradition of medical leadership of the founding hospitals, the goal of the MUHC is to provide patient care based on the most advanced knowledge in the health care field, and to contribute to the development of new knowledge.

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