Q My son, aged 38, was diagnosed with hepatitis C about five years ago. He tried Chinese herbs and acupuncture for some months, but with little success. He was offered the then experimental chemotherapy treatment of ribavirin and interferon, which he was on for about nine months.
According to the hospital, the chemotherapy worked. Their tests showed that his liver function was normal, and the virus could no longer be detected.
However, two years on from the end of the chemotherapy, he appears to be only a little better; he has flu-like symptoms, can't keep food down, and is very tired and depressed. His doctors can't explain why he should still be feeling so ill when their tests say he's 'cured'. - JB, via e-mail
A Hepatitis C is one of five different viruses that can attack and damage the liver. It is believed to be the most virulent liver virus of all as it can cause irreversible and potentially fatal liver scarring. Transmitted largely via the blood, it is becoming increasingly more common, with some doctors even warning of an epidemic.
The standard drug treatment used to be with interferon, an artificial version of a protein that is part of the body's natural defence against viruses. However, interferon failed to live up to its promise, so another antiviral, ribavirin, was added to the treatment. This combination (marketed as Rebetron) has been in use for about five years, and is the only conventional treatment for hepatitis C on offer.
Rebetron is more effective than interferon alone, but its success comes at a price. Side-effects are among the worst in conventional medicine. A review listing 'well-described side effects' included fatigue, flu-like symptoms, blood abnormalities (such as loss of both red and white cells) and depression (Hepatology, 2002; 36 [5 Suppl 1]: S237-44).
Indeed, interferon-induced depression may be so severe that some hepatitis patients even refuse treatment (Aliment Pharmacol Ther, 2002; 16: 1091-9).
These sound very much like your son's present symptoms and, if he were still taking Rebetron, that would explain it. But you say he stopped the treatment two years ago and yet seems to still be suffering from the apparent side-effects.
Clues may be found from three new side-effects that have recently emerged from the shadows, and all with long-term consequences. Serious lung damage has been seen with Rebetron, and found to persist long after the drug was stopped (Am J Gastroenterol, 2002; 97: 2432-40). Also, a long-term 'muscle weakness' has been reported to continue for as long as nine months after stopping treatment (J Viral Hepat, 2002; 9: 75-9).
Finally - and more directly relevant to your son's case - there is also significant damage to the thyroid. A fistful of studies find that Rebetron can cause an underactive or overactive thyroid in about 12 per cent of patients (J Intern Med, 2002; 251: 400-6).
Most important of all, as one study discovered, was that 'the development of hypothyroidism [in Rebetron patients] is significantly associated with the long-term remission of [chronic hepatitis C]' (Eur J Endocrinol, 2002; 146: 743-9). So, the cost of a Rebetron hepatitis 'cure' is a long-term dysfunctional thyroid.
Thyroid hormones are the body's energy boosters, so a deficiency due to an underactive thyroid will cause generalised tiredness, lethargy and cramps - which might explain at least some of your son's symptoms. As more patients are treated with Rebetron, it may well be eventually revealed that his other symptoms are also the long-term result of the chemotherapy.
Rebetron may be one of those drugs where the treatment is worse than the disease. This might be acceptable if it actually worked, but the medical literature suggests a poor track record, with failure in more than 50 per cent of cases. 'With our current best therapies, the majority of patients still do not achieve the benefits of a sustained response', US doctors recently admitted (J Gastroenterol Hepatol, 2002; 17: 431-41).
Are there any alternatives? Liquorice root, an old Japanese folk remedy with the active ingredient glycyrrhizin, has been tested and found to be of some benefit in hepatitis C (Eur J Gastroenterol Hepatol, 1999; 11: 1077-83). Also, in addition to Chinese herbs, the European herb milk thistle is often given for liver problems. Its active ingredient, silymarin, is currently being tested specifically in hepatitis C.
Some patients with hepatitis C find that St John's wort and ginger can alleviate the side-effects of conventional treatment (Am Clin Lab, 2002; 21: 19-21).