Treatment For Hepatitis C
Current Treatment
Deciding to start or continue treatment for hepatitis C is complicated - even more complicated than with HIV. Many people with HCV will never need treatment and will experience minimal health consequences as a result of their infection. People with advancing disease, however, must consider the benefits and consequences of beginning a treatment regimen that is not always successful.
Current treatment is a combination of alfa-interferon and ribavirin, taken for six months to one year.- • People with genotype 1 usually undergo treatment for one year, while people with genotypes 2 or 3 typically need treatment for six months.
- • Some physicians are treating people with HIV/HCV co-infection for 18 months.
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Alfa-Interferon
- • Is a protein that interferes with a virus' ability to infect cells.
- • Early versions of alfa-interferon had to be injected subcutaneously (under the skin) three times a week.
- • The most recently approved treatment for HCV, pegylated interferon, reduces the frequency of injection to only once a week.
- • There are currently two brands of pegylated interferon available: PEG-Intron and Pegasys.
Ribavirin
- • Is an antiviral capsule or tablet taken orally twice a day.
- • For reasons that are not well understood, ribavirin makes interferon work better than if the interferon is used alone.
- • Ribavirin used alone has no effect on HCV.
- • There are currently two brands of ribavirin available: Copegus and Rebetol.
- • Generic ribavirin will likely be available in the near future.
The primary goals of HCV treatment are eradication of virus and a healthier liver:
- • Liver health (histological improvement) is measured by normalized liver enzymes, lower or undetectable viral load, and possibly a follow-up liver biopsy.
- • Treatment success is measured by a sustained virological response, which is an undetectable viral load six months after completing treatment.
- • Combination therapy of pegylated interferon and ribavirin achieves a sustained response in approximately 50-60% of people overall.
- • People with genotype 1 typically have a sustained response of 42-46% with combination therapy.
- • People with genotype 2 or 3 respond more favorably, with 76-82% achieving a sustained response.
- • Even without a sustained response or significantly lower viral load, treatment may give the liver a much-needed break and decrease the degree of liver damage.
| "Even without a sustained response or significantly lower viral load, treatment may give the liver a much-needed break and decrease the degree of liver damage." |
Factors that may influence a successful response to treatment:
Most predictive:
- • having genotype 2 or 3
- • having a low HCV viral load when starting treatment
Somewhat predictive:
- • age under 40
- • pre-menopausal female
- • little fibrosis (scar tissue)
- • no cirrhosis
- • low body mass index (BMI)
Treatment Side Effects
The side effects of interferon and ribavirin can be severe. In clinical trials of interferon plus ribavirin, 10-20% of participants dropped out because of side effects or adverse events. Side effects are usually worse during the first few weeks, though each person experiences them very differently. Possible side effects include:
- • fatigue
- • joint pain
- • muscle pain
- • fever and/or chills
- • nausea
- • headaches
- • weight loss
- • mild hair loss low white blood cells and platelets
- • rapid heart beat
- • irritability
- • depression
- • suicidal thoughts
- • severe anemia
- • birth defects
Some people experiencing side effects find relief by:
- • Using ibuprofen or acetaminophen to help with flu-like symptoms.
- • Getting treated with injections of erythropoetin (Epogen or Procrit) to stimulate the production of more red blood cells to combat anemia.
- • Getting treated with injections of Neupogen to stimulate production of white blood cells.
- • Starting antidepressants prior to beginning HCV treatment.
- • Arranging the timing of interferon shots to allow for rest afterwards (nighttime dosing may allow a person to sleep through some of the side effects).
Treatment for Injection Drugs Users
The National Institutes of Health (NIH) Consensus Statement on the Management of Hepatitis C: 2002
In June of 2002, a panel of experts in the field of hepatitis prevention, care, and treatment developed a consensus statement that addressed several key questions:
- • What is the natural history of hepatitis C?
- • What is the most appropriate approach to diagnose and monitor patients?
- • What is the most effective therapy for hepatitis C?
- • Which patients with hepatitis C should be treated?
- • What recommendations can be made to patients to prevent transmission of hepatitis C?
- • What are the most important areas for future research?
While many important recommendations were developed, none have the potential for greater positive impact than the recommendation that active injection drug use in and of itself not be used to exclude people from HCV treatment. Prior to this statement, people who injected drugs were often denied access to treatment.
The needs of people who are actively using drugs while receiving treatment are complex but can be addressed with consistent education and support. Alcohol use, however, adversely affects response to treatment, and alcohol abstinence is strongly recommended before and during treatment.
For people with a history of injection drug use, the process of injecting interferon can be difficult while in recovery. Some people prefer to have their healthcare providers inject interferon for them. In addition, interferon side effects can feel similar to drug withdrawal. People with a substance use history need to be prepared for these possibilities and have a support system in place (such as a support group or sponsor) to help them sort through their feelings and impulses.
"The side effects from the interferon injections are similar to those of heroin withdrawal…the fever, the hot/itchy skin, and aching muscles and joints. For me, an attitude of gratitude has helped me immensely. I remind myself that I am taking treatment so I can have a normal life. I go to meetings."
-Ted, hepatitis C-positive person in recovery |
Support During Treatment
Making the decision to start antiviral therapy is a very personal one.
- • Establishing a support network before beginning treatment is important. This is true with HCV treatment even more than with HIV treatment.
- • The side effects of HCV treatment can be extremely debilitating (especially in the beginning), and some peopl will need help with everyday tasks such as shopping, food preparation, cleaning, or childcare.
- • Psychological support is equally important. The irritability, depression, and suicidal ideation that may accompany treatment often come on slowly, are difficult to identify, and can be unbearable for the person experiencing them.
| "All substances, including herbs, can have dangerous side effects and impact the dosing of other drugs." |
Complementary and Alternative Therapies
Complementary therapies are used together with conventional medicine to treat many illnesses, including HCV and the side effects of treatment. Alternative therapies are used instead of conventional medical treatment.
- • Complementary and alternative therapies attempt to use the body's natural self-healing abilities to bring the body back into balance.
- • These therapies can include acupuncture, massage, yoga, Tai Chi, meditation, and Chinese herbal medicine.
- • No complementary or alternative therapies have been scientifically proven to cure or even ease symptoms of HCV.
- • All substances, including herbs, can have dangerous side effects and impact the dosing of other drugs.
- • Talk with your doctor or pharmacist before using any complementary or alternative therapies - including over-the-counter ones.
Herbs and herbal products with the most information, as well as most widely used, include:
- • milk thistle (silymarin)
- • astragalus
- • dandelion
- • bupleurum
- • garlic
- • licorice root
- • artichoke
- • thioctic (alpha-lipoic) acid
- • gingko biloba
