What is the Conventional Medical Treatment for Hepatitis C?
Not all people who have been diagnosed with Hepatitis C need treatment, especially in the case of acute Hepatitis. Medication may be prescribed, however, bed rest, drinking plenty of fluids, avoidance of alcohol and eating a healthy diet will be recommended by the doctor. It is important to work closely with one’s doctor and follow up with tests to make sure the virus has cleared the body.
Some people won’t be treated because they don’t know they have the Hepatitis C virus.
Individuals who have been diagnosed with chronic Hepatitis C will probably be treated with interferon combination therapy or interferon monotherapy. The monotherapy only consists of interferon, while combination therapy combines interferon with ribavarin. Combination therapy is the treatment of choice. However, some people will still receive monotherapy due to intolerance to ribavirin.
The type of treatment as well as the length of treatment for Hepatitis C depends on the genotype of the virus. Working closely with one’s physician, using an open line of communication will help in determining the best course of action.
People with genotype 1 have a lower rate of response to combination therapy (most studies have shown that treatment with combination therapy works for up to 50% of people with genotype 1), whereas people with genotypes 2 and 3 have a high rate of response to combination therapy (around 80%).
Current treatment options for Hepatitis C include various types of interferon - either genetically engineered or a synthetic replica of the body’s natural protein produced and secreted by special immune cells which act as an antiviral, immune-regulating chemical.
Once in the bloodstream, interferon interferes with the Hepatitis C virus’ ability to replicate. In addition, interferon appears to build up the immune system’s disease fighting T helper-1 cells so that they are strong enough to kill off the Hepatitis C viruses.
Types of interferon used in the treatment of Hepatitis C include:
- Alpha Interferon – the standard treatment for management of acute and chronic Hepatitis C
- Consensus Interferon – a synthetic form of interferon
- Pegylated Interferon – a long-acting, time-release form of interferon
Side effects from interferon can be unpleasant and sometimes serious, leading to dose reduction or discontinuation of treatment. All side effects should be reported to one’s doctor right away for management of symptoms and to prevent serious complications from occurring.
Not all people experience the same side effects, nor are all side effects necessarily severe. Some people experience few or no side effects at all. Having a good support system in place prior to starting treatment will help in managing side effects whether few or many. Family, friends, and support groups can be helpful to most people during difficult times while undergoing Hepatitis C treatment.
Side effects from interferon may include:
- Persistent flu-like symptoms (including body aches and headaches)
- Loss of appetite
- Mental and psychiatric symptoms, including depression, irritability, anxiety, mania and trouble concentrating
- Bone marrow suppression
- Mouth sores
- Changes in the way food and beverages taste
- Skin rashes and itching
- Dry, brittle nails
- Injection site reactions (pain, irritation, swelling or infection)
- Hair loss
- Vision or eye problems (rare but can be serious)
- Libido changes (decreased interest in sex)
- Menstrual and menopausal changes
Ribavirin, an antiviral drug that suppresses the Hepatitis C virus is commonly used in conjunction with interferon to treat Hepatitis C. When used alone, Ribavirin promptly brings down liver enzymes but the results don’t last long and liver enzymes go back up. The best success for sustained results has been shown when treatment consists of pegylated interferon/peginterferon (a time-released, longer acting interferon), and Ribavirin combined. Similar to interferon side effects, Ribavirin has been known to cause anemia, thyroid disease, hypertension and depression. Pregnant women and anyone with cardiovascular disease should not take Ribavirin. Ribavirin can cause birth defects so it is important for both men and women to use an effective form of contraception.
On May 13, 2011, the U.S. Food and Drug Administration approved two prescription medications Victrelis™ (boceprevir) and Incivek™ (telaprevir) for use in combination with peginterferon alfa and ribavirin to treat chronic Hepatitis C genotype 1 infection in those who have not been treated before or who have failed previous Hepatitis C treatment.
There are contraindications with regard to both Victrelis™ and Incivek™ which should be discussed thoroughly with one’s doctor as should all treatment options.
It is important to note that not all people are candidates for antiviral drug treatment. Antiviral drug treatment for Hepatitis C may not be recommended for the following:
- People who use intravenous drugs
- People who drink alcohol
- People who have advanced cirrhosis of the liver
- People who have received a kidney or heart transplant, since treatment will increase risk of rejection of the organ
- People with liver cancer
- Men and women who are planning to conceive a child and women who are pregnant
- People who are severely depressed and/or have mental health issues because antiviral medications used to treat Hepatitis C can make those issues worse
- People who have an autoimmune disease such as rheumatoid arthritis, lupus, or psoriasis
- People with advanced heart disease or diabetes
- People with normal aminotransferase levels (ALT less than 30 independent units per milliliter)
Finally, if the liver is severely damaged, a liver transplant may be recommended. End-stage liver disease (cirrhosis) due to chronic Hepatitis C viral infection is the number one reason for liver transplantation in the United States. During the transplant procedure, the diseased liver will be replaced with a healthy liver from an organ donor or from a live donor who donates a portion of their healthy liver. However, contrary to popular misconception, a liver transplant is not a cure for Hepatitis C. Unfortunately, the Hepatitis C virus recurs in the new liver in almost all cases, with fibrosis (scarring of the liver) or cirrhosis occurring in 10% to 30% of patients in as little as 5 years after the transplant.
Further studies are needed to develop better strategies to prevent recurrence of infection after a liver transplant as well as better treatment protocols after reinfection of the liver has occurred.
Centers for Disease Control and Prevention “Hepatitis C, FAQs for Health Professionals” http://www.cdc.gov/hepatitis/HCV/HCVfaq.htm#section1 Retrieved October 28, 2011
HCV Advocate “A Guide to Hepatitis C Treatment Side Effect Management” http://www.hcvadvocate.org/hepatitis/factsheets_pdf/Treatment_Side_effect_Guide.pdf Retrieved October 28, 2011
Hepatitis-Central.com “Hepatitis C Progress Hampered by Re-Infection and Superinfection” http://www.hepatitis-central.com/mt/archives/2009/05/hepatitis_c_pro_1.html Retrieved October 28, 2011
HIVand Hepatitis.com “Telaprevir Plus Standard Therapy Can Produce Hepatitis C Cure in Less Time” http://www.hivandhepatitis.com/hepatitis-c/hepatitis-c-topics/hcv-treatment/3235-telaprevir-plus-standard-therapy-can-produce-hepatitis-c-cure-in-less-time Retrieved October 28, 2011
Journal of General Virology “Hepatitis C virus superinfection of liver grafts: a detailed analysis of early exclusion of non-dominant virus strains” http://vir.sgmjournals.org/content/91/5/1183.short Retrieved October 28, 2011
Massage Today “What is Massage?” http://www.massagetoday.com/aboutmt/ Retrieved October 28, 2011
Mayo Clinic “Hepatitis C” http://www.mayoclinic.com/health/hepatitis-c/DS00097 Retrieved October 28, 2011
National Institutes of Diabetes and Digestive and Kidney Diseases “What I Need to Know About Hepatitis C” http://digestive.niddk.nih.gov/ddiseases/pubs/hepc_ez/ Retrieved October 28, 2011
Official Journal of the International Aids Society “Sexually Transmitted Hepatitis C Virus Superinfection in HIV/Hepatitis C Virus co-infected men Who Have Sex With Men” http://journals.lww.com/aidsonline/fulltext/2008/03120/sexually_transmitted_hepatitis_c_virus.16.aspx Retrieved October 28, 2011
U.S. National Library of Medicine National Institutes of Health “Hepatoprotective Properties of Silymarin” http://www.ncbi.nlm.nih.gov/pubmed/21560654 Retrieved October 28, 2011
U.S. National Library of Medicine National Institutes of Health “Milk Thistle in Liver Diseases: Past, Present, Future” http://www.ncbi.nlm.nih.gov/pubmed?term=Milk%20thistle%20in%20liver%20diseases%20past%2C%20present%20and%20future Retrieved October 28, 2011
U.S. National Library of Medicine National Institutes of Health “Multiple effects of silymarin on the hepatitis C virus lifecycle” http://www.ncbi.nlm.nih.gov/pubmed?term=multiple%20effects%20of%20silymarin%20on%20the%20hepatitis%20c%20virus%20lifecycle Retrieved October 28, 2011
U.S. National Library of Medicine National Institutes of Health “Silybin and the Liver: from basic research to clinical practice” http://www.ncbi.nlm.nih.gov/pubmed?term=Silybin%20and%20the%20liver%3A%20from%20basic%20research%20to%20clinical%20practice Retrieved October 28, 2011
Vertex Pharmaceuticals "Medication Guide - Incivek™" http://pi.vrtx.com/files/usmedguide_telaprevir.pdf. Retrieved October 23, 2011.
Merck "Medication Guide - Victrelis™" http://www.merck.com/product/usa/pi_circulars/v/victrelis/victrelis_mg.pdf. Retrieved October 18, 2011.
WebMD “Hepatitis Health Center, Hepatitis C” http://www.webmd.com/hepatitis/hepc-guide/default.htm Retrieved October 28, 2011
World Health Organization “Hepatitis C” http://www.who.int/mediacentre/factsheets/fs164/en/ Retrieved October 28, 2011
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