Dr. Cecil's website

[Guest guest]

Good Morning, this lovely Saturday,

Have you checked out Dr. Cecil's website. I think it's got a wealth of information and seems pretty well-balanced and full of interesting info about Hep C.

http://www.hepatitisdoctor.com/

He is a Louisville, Kentucky doctor practicing currently and treats hep C.

He maintains a large and informative site, as has done so for years.

Here is what he says on his home page (and you should visit the site, it's got tons of great links):

Welcome to patients with chronic viral hepatitis B or C and to their loved ones. We can cure about halfof the patients with chronic hepatitis C, including some with advanced cirrhosis and liver failure. If you are cured, your viral level falls to undetectable during treatment and stays undetectable the rest of

your life, even after you stop the medications. Some patients who are clinically cured of HCV may still

have tiny amounts of HCV , but the implications of this are not yet clear. If your HCV-RNA level becomes

detectable (> 2 IU/ml) in your blood, you were not cured. If your HCV-RNA is undetectable 6 months

after your last injection of interferon, you have a 97-99% chance of permanent cure.

I add information to this web site as often as I can, and I want to make it the best possible resource for

patients whom are often incorrectly told that they cannot be helped. The opinions expressed here are

entirely my own, and are based on my experience in treating more than 3,000 patients with hepatitis C.

I am especially interested in developing the best treatment for patients with advanced hepatitis C

cirrhosis. We can avoid the need for transplantation for some of these patients. We can prevent

recurrent HCV in some who must be transplanted if we cure the HCV. The liver and the bone marrow

are the only two organs that can regenerate. Most patients with cirrhosis who are cured of HCV can

expect their liver damage to improve with time. We have many patients with F4 fibrosis (cirrhosis) who

now have F2 fibrosis since being cured of their hepatitis C. One patient with F3 fibrosis now has F0 fibrosis.

I am a board certified in internal medicine and gastroenterology/hepatology. In addition, I completed

2 years of residency in pathology at Duke University Medical Center. I have been a physician for 28 years.

I spend about 95% of my time treating patients with chronic viral hepatitis C. I am very excited that we

are able to cure this infection in about half of patients. Take away the virus, and the liver has an

amazing ability to heal and restore health. Even patients with liver failure improve once the virus

is permanently eradicated. If you have previously failed or could not tolerate standard antiviral

therapy, you should consider individualized therapy. Email Dr Cecil

My Louisville, KY office: 4130 Dutchmans Lane, Louisville KY 40207 Click here for mapCall 502-894-9950 if you want to schedule an appointment

My approach is individualized therapy of each patient. I offer initially small weekly doses of Pegasys or

PegIntron to minimize the side effects of treatment to patients who are afraid that they will not be able

to work while on antiviral therapy. Since the concentration of the virus falls exponentially, the first shot

of interferon kills the most virus. Starting with a low dose at first makes it

possible for patients to stick with treatment instead of giving up with the first shot. Starting with a

normal dose is fine, but causes severe fever, chills and body aches in many patients. I raise the

interferon dose over a month to a normal dose. I measure the percent fall in HCV-RNA after a month of

treatment, and calculate the minimal length of treatment. If the viral level is not falling quickly

enough, (more than 90% per month), the treatment must be changed to obtain success. The simplest

change is to raise the dose of interferon, usually to 150-200% of the normal dose, for example 270 or 360

mcg Pegasys per week. If higher doses of interferon do not work, switching to a different type of

interferon will sometimes cause a response. Some patients who do not respond to one type are able to

respond to another. We use Pegasys first. If there is no response, Infergen 15 mcg daily produces a

response in 20% and if that is ineffective, PegIntron will obtain a response in another 5-10% of patients.

Other physicians may start with PegIntron, and most doctors do not go to the trouble of using more than

one or two types of interferon before giving up.

Ribavirin does not add much to the fall in the viral level. It is the interferon that is the muscle drug.

Ribavirin does not transform a nonresponder into a responder. What ribavirin does wonderfully is

greatly reduce the chance of viral breakthrough (HCV-RNA falls with treatment, but then rises even

though treatment is continuing) or relapse in patients who respond to interferon. A relapser is a patient

who became undetectable for HCV-RNA on her previous treatment, but the virus came back when the

treatment ended. A relapser is a proven responder and will almost always respond again when retreated.

Relapsers have to be treated longer and sometimes stronger to prevent a second or third relapse.

Cirrhotic genotype 1 patients are classic relapsers. The doctors treat for 48 weeks and half of the

responding cirrhotic patients relapse. It is very frustrating for patient and physician to relapse.

relapse. I shoot for 2 years of treatment for cirrhotic patients. By treating longer, the immune system

has more time to remove 100.000% of the virus from pockets of scar tissue in the cirrhotic liver.

800 mg of ribavirin daily is optimal for easy to treat genotype 2 or 3 infected patients. In fact, 400 mg

daily was as good as 800 mg daily in an European study of genotype 2 or 3 patients presented at DDW

Chicago May 2005. Genotype 1 patients do better with 1,000 or 1,200 mg of ribavirin daily. The Roche

brand of ribavirin (Copegus) competes with Rebetol. Three Rivers pharmacy sells generic ribavirin called

Ribasphere. This is lowering the cost of treatment for patients. Competition is a wonderful economic

force. The lower the cost of treatment the easier it is for HCV infected patients to get treated and cured.

It is interesting that the total number of Americans being treated now each year for HCV is actually

falling. Only about 15% of infected patients have been treated. Where are the other 85%? We have

more tools now than ever before, but many patients are either undiagnosed or have chosen to avoid

treatment. I have new patients every week with cirrhosis who did not know they were infected with

HCV. We need to educate the American population about this silent killer. The CDC now recommends

that all Americans be tested for HIV. The CDC should also recommend that all American middle aged

persons be tested for HCV. Their data indicates that 7.1% of men and 2.3% of women between 45 and

49 are infected. Identify infected persons and offer treatment is the logical strategy. We can lower the

death rate from HCV if we are aggressive in identifying infected patients.

About half of Americans with HCV have genotype one and high viral load. Standard treatments only

work in about 30% of this large group. The success rate of treatment is especially poor in African

American patients. Many patients fail standard treatments and individualized treatment can help some.

Trying different medications at different doses helps some get cured. The prediction from the Manns

study in 2001 that higher doses (>10.6 mcg/kg) of ribavirin would give 48% sustained viral response rates

in genotype one patients was refuted by the huge sen trial reported at AASLD, November 2005 in

San Francisco. Only 34% of genotype one patients given 1,000 to 1,400 mg ribavirin daily achieved

sustained response compared to 29% with the 800 mg ribavirin daily. Very heavy patients and African

American patients were the subgroups that particularly benefited from the higher doses of ribavirin.

I am an advocate for patients infected with HCV. The medical insurance companies place too many

obstacles to block patients from going on or staying on the medications. I have seen many curable

patients fail because of this. Medicaid cancels Rx Even though treatment is now less expensive and more

effective, the insurance companies are shifting more of the cost of treatment to patients. Stage 3 and

stage 4 HCV liver disease is life threatening and should be covered like cancer treatment, coronary artery

bypass surgery and kidney dialysis. HCV cirrhosis is just as deadly as these other life-threatening diseases.

Insurance companies should not discriminate against treatment of HCV, just as they are forbidden to

discriminate against treatment of HIV/AIDS.

I can give information, but cannot practice medicine over the internet. Patients with HCV should

consult a knowledgeable medical provider who treats large numbers of HCV infected patients

Bennet Cecil, MD INC

02/13/2006 10:23 PM