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 various combinations of medication. 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.
Some treatment options for Hepatitis C include medications with and without 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 other medications 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. 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 (FDA) 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. These two drugs are protease inhibitors. They are direct acting antiviral drugs against the Hepatitis C virus. Since then, the manufacturer of Incivek™ announced its discontinuation as of August 2014 and the manufacturer of Victrelis™ will discontinue at the end of 2015.
Toward the end of 2013 the FDA approved two new medications. Olysio® capsules are used in combination with pegintereferon alfa and ribaviron or in combination with sofosbuvir for hepatitis c genotype 1 patients. The once-daily oral prescription medication, Sovaldi™ (sofosbuvir), was also approved for use in combination with peginterferon alfa and ribavirin OR ribavirin. Its efficacy was established in patients with hepatitis c genotypes 1, 2, 3 or 4.
On October 4, 2014 a new medication called Harvoni® (ledipasvir and sofosbuvir) was approved combining sofosbuvir and ledipasvir. This single daily tablet for the treatment of HCV genotype 1 is not used in combination with interferon. Two months later, Viekira Pak™ (ombitasvir, paritaprevir and ritonavir) was approved for those with HCV genotype 1 including those patients with compensated cirrhosis.
There are contraindications with each of these medications and it is important to note that not all people are candidates for receiving them. Speak with your specialist.
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.
Mayo Clinic “Acute Liver Failure” http://www.mayoclinic.com/health/liver-failure/DS00961. Retrieved May 20, 2011
Medscape “Diagnosis and Management of Acute Liver Failure” http://www.medscape.com/viewarticle/720697_3. Retrieved May 20, 2011
Palmer, M.D., Melissa. Dr. Melissa Palmer’s Guide to Hepatitis & Liver Disease. New York: Avery Trade, 2004.
U.S. National Library of Medicine NIH National Institutes of Health “Acute liver failure caused by 'fat burners' and dietary supplements: a case report and literature review” http://www.ncbi.nlm.nih.gov/pubmed/21499580. Retrieved May 20, 2011
U.S. National Library of Medicine NIH National Institutes of Health “Influence of high body mass index on outcome in acute liver failure” http://www.ncbi.nlm.nih.gov/pubmed/16996806. Retrieved May 20, 2011< Worman, MD Howard J. The Liver Disorders and Hepatitis Sourcebook. McGraw-Hill, 2006
- What is Hepatitis C?
- What Causes Hepatitis C?
- Who is at Risk for Contracting Hepatitis C?
- What are the Signs and Symptoms of Hepatitis C?
- Are There Different Types of Hepatitis C?
- Is it Possible to Become Infected with More Than One Genotype of Hepatitis C?
- How is Hepatitis C Diagnosed?
- Is it Possible for Hepatitis C to Clear on Its Own?
- What is the Conventional Medical Treatment for Hepatitis C?
- Are There Alternative Therapies for the Treatment of Hepatitis C?
- What is the Long Term Prognosis?