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Patient Dilemma: Treat Hepatitis C Now or Hold Out?

Being diagnosed with a potentially fatal disease usually triggers immediate treatment. But a growing number of people infected with hepatitis C are putting off therapy, choosing instead to roll the dice and wait for a new generation of drugs to become available.

The new drugs, which could begin hitting pharmacies in a year or two, promise to cure hepatitis C more effectively and with far fewer harsh side effects than the current regimen of medications. The disease, which attacks the liver, often progresses slowly, giving certain patients leeway in when to seek treatment. And doctors regularly monitor these patients to check if the disease has significantly worsened. Up to four million Americans are estimated to be infected with the hepatitis C virus.

But with delayed treatment come risks. Determining how far liver disease has progressed isn't an exact science, and hepatitis C may worsen more quickly than expected. There is evidence patients have a better chance of curing the disease the less time they've been infected. And there isn't any guarantee that the new generation of medications, none of which has yet been approved by federal regulators, won't suffer setbacks. Last year, for instance, Bristol-Myers Squibb Co. BMY-0.03% scrapped development of a once-promising hepatitis C treatment after serious safety issues emerged in testing.

"With certain types of patients who have mild disease, I think it's reasonable to defer treatment," says Ira M. Jacobson, a physician specializing in hepatitis C research and chief of the division of gastroenterology and hepatology at Weill Cornell Medical College in New York. He estimates at least half of his hepatitis C patients are currently being "warehoused," a term that refers to patients deferring treatment in hopes a better therapy comes along soon.

Doctors say they face an ethical dilemma in advising people whether to wait to seek treatment for hepatitis C, especially if they are dealing with patients with mid-stage liver damage. "We're constantly weighing whether to treat now to avoid problems downstream versus waiting for newer, easier and potentially better therapies a couple years from now," says Donald M. Jensen, director of the Center for Liver Diseases at the University of Chicago Medical Center.

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