Hepatitis C
Treatment Overview
Being diagnosed with hepatitis C can change your life. You may feel angry or depressed about having to live with a long-term (chronic), serious disease. You may have a hard time knowing how to tell other people that you have the virus. It can be helpful to talk with a social worker or counselor about what having the disease means to you. You also may want to find a support group for people with hepatitis C. If you do not have a support group in your area, there are several on the Internet.
You may or may not receive treatment for hepatitis C, depending on how damaged your liver is, other health conditions you have, how much virus you have in your body, and what type (genotype) of hepatitis C you have. Treatment is not always an option, because the medicines used to treat hepatitis C have serious side effects, are expensive, and do not work for everyone.
The goal of treatment for hepatitis C is to eliminate the virus from your body early, to prevent serious liver problems. The length of treatment for hepatitis C depends on whether you have a short-term (acute) infection or a long-term (chronic) infection. It may also depend on the type of hepatitis C virus causing the infection and how well the medicine seems to be working.
Treatment of short-term (acute) hepatitis C
Most people with acute hepatitis C do not get treated, because they do not know they have the virus.
If a person knows that he or she may have been exposed to the virus—such as a health care worker who is stuck by a needle—acute hepatitis C can be identified early. Most people who are known to have an acute hepatitis C infection get treated with medicine. In these cases, treatment for acute hepatitis C may help prevent long-term (chronic) infection, although there is still some debate over when to begin treatment and how long to treat acute hepatitis C.3, 4
Treatment of long-term (chronic) hepatitis C
It is common for people to live with hepatitis C for years without knowing they have it, simply because they do not have symptoms. Most people diagnosed with hepatitis C find out that they already have long-term, chronic infection. If your blood tests and liver biopsy show that you have chronic infection but no damage to your liver, you may not need treatment. If you do have some liver damage, you may be treated with a combination of medicines that fight the viral infection.
Whether or not you take medicines to treat hepatitis C, you will need to have routine blood tests to help your doctor know how well your liver is working.
If you decide not to be treated with medicines, your doctor will want to monitor you closely and may want to do a liver biopsy every 4 or 5 years to check for damage in your liver.
Some people who originally decide not to have treatment for hepatitis C later decide they want to try antiviral medicines.
Antiviral medicines for hepatitis C may not be recommended if you:
- Drink alcohol or use IV drugs. (Although you cannot take antiviral medicines if you use IV drugs, you can take antiviral medicines if you are using methadone.)
- Have advanced cirrhosis.
- Have severe depression or other mental health problems. The antiviral medicines used to treat hepatitis C can make mental health problems worse.
- Are pregnant or might become pregnant. Two forms of birth control must be used during treatment and for 6 months after treatment, because the medicines used to treat hepatitis C can harm a fetus.
- Have an autoimmune disease such as lupus, rheumatoid arthritis, or psoriasis, or certain medical problems such as advanced diabetes, heart disease, or seizures.
The U.S. National Institutes of Health has made recommendations on who should receive antiviral treatment for hepatitis C.5 For example, treatment is recommended for people who are at least 18 years old, have detectable levels of the virus in their blood, and have significant liver damage confirmed by a liver biopsy.
Only a few clinical trials have tested antiviral medicines in children. The results suggest that they work about as well in children as in adults. Combination therapy using interferon and ribavirin is now approved by the U.S. Food and Drug Administration (FDA) for use in children ages 3 to 17 years.
Antiviral medicines to treat hepatitis C include:
- Peginterferon and other interferons, which are similar to a protein your body makes to fight off infection.
- Combination antiviral therapy with interferons and ribavirin, which increases your chances of getting rid of the virus in your body.
Peginterferon—a newer, longer-acting form of interferon—combined with ribavirin is now considered better than standard interferon combined with ribavirin. Peginterferon is given as a weekly shot, and ribavirin is taken as a pill 2 times a day.
The length of your treatment depends on what hepatitis C genotype you have. Genotype 1 generally is treated for 1 year and genotypes 2 and 3 generally are treated for 6 months. The amount of virus in your body (viral load) will be checked while you are being treated. If you have genotype 1 and your viral load does not improve after 3 months of treatment, your treatment may be stopped.
Even if medicines are recommended for you, they may not work or they may not work long-term. Chronic hepatitis C infection is cured or controlled in about half of people who are treated with a combination of peginterferon and ribavirin.6 Studies have shown that treatment works for up to 50% of people with genotype 1 and up to 80% of people with genotype 2 or 3.7
Sometimes, treatment does not permanently lower the amount of virus in your blood. But some studies have shown that treatment may still reduce scarring in your liver, which can lower your chances of developing cirrhosis and liver cancer.5, 2
Medicines for hepatitis C are expensive and can cause many serious side effects, such as constant fatigue, headaches, fever, nausea, depression, and thyroid problems.
It is important to weigh the benefits of medicines for hepatitis C against the drawbacks. You most likely do not need to make a quick decision about treatment, because hepatitis C progresses very slowly. Talking with your doctor can help you decide whether medicines are right for you. For more information, see:
Treatment of relapse or nonresponse
Sometimes, you can take more medicine if your first round of treatment did not work very well. The decision to try treatment again is based on how well you tolerated the first treatment, how well the first round of treatment worked, the dose of the first treatment, and the genotype of your virus. Talk to your doctor about whether you might try medicines again.
Treatment if the condition gets worse
Severe liver damage caused by chronic hepatitis C usually takes 20 or more years to develop. If you have hepatitis C, there are certain factors that may help you predict your risk of severe liver damage.
If your hepatitis C continues to get worse, it can cause your liver to stop working, a condition called end-stage liver failure. In this case, a liver transplant may be the only way to extend your life. But if you are using alcohol, are sharing needles to inject drugs, or have severe depression or certain other mental illnesses, liver transplant may not be an option.
End-of-life issues
Most people with chronic hepatitis C will not die from the disease. But between 1% and 5% of people with severe liver damage from chronic hepatitis C will die due to hepatitis C.8 Even if a liver transplant is done as a last possible treatment, there can be complications that lead to death. For more information about death and dying, see the topic Care at the End of Life.
What To Think About
If you have chronic hepatitis C, you can help keep the disease from getting worse. You can do this by not drinking alcohol, not sharing needles for drug use, eating well, and not taking any herbal supplement unless your doctor tells you it is okay.
There is no vaccine for hepatitis C, but there are vaccines for hepatitis A and hepatitis B. Your doctor may recommend that you have these vaccines to help protect you from more liver problems.
The U.S. National Institutes of Health has made recommendations on who should receive antiviral treatment for hepatitis C.5 For example, treatment is recommended for people who are at least 18 years old, have detectable levels of the virus in their blood, and have significant liver damage confirmed by a liver biopsy. If you do not meet these criteria, your decision to try antiviral treatment is more complicated.
Antiviral therapy is expensive, and the medicines can cause many serious side effects, including constant fatigue, nausea, headaches, depression, and thyroid problems.
Researchers are working to develop other treatments, including gene therapy and medicines that help control the immune system. A new medicine called viramidine is also being studied as a substitute for ribavirin. Viramidine may cause less anemia than ribavirin causes.9
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| Author: | Maria G. Essig, MS, ELS | Last Updated: August 27, 2007 |
| Medical Review: | Kathleen Romito, MD - Family Medicine W. Thomas London, MD - Hepatology | |
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