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Exhaustion During Hepatitis C Treatment

Nicole Cutler L.Ac. December 22, 2010

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An extreme degree of fatigue, exhaustion is common during HCV treatment – and it may also hinder the treatment outcome.

Fatigue is the number one complaint of those living with the Hepatitis C virus. The likelihood of being fatigued with Hepatitis C appears to be even higher during antiviral treatment. When tiredness becomes severe enough to where it interferes with the ability to function normally, exhaustion sets in. Unrelenting exhaustion is a major problem during Hepatitis C treatment and, if a solution is not found promptly, therapy could be stopped prematurely.

When treating the most common strain of Hepatitis C in the U.S. with antiviral therapy, there is an estimated 50 percent chance of success. Unfortunately, those whose exhaustion has prevented them from completing antiviral treatment (at the suggested dosage for the entire duration) have a much slimmer possibility of eliminating the Hepatitis C virus.

Hepatitis C is often referred to as the “silent killer.” This moniker was earned, because those infected rarely have symptoms until the virus damages a significant portion of their liver. However, fatigue is a frequent exception to Hepatitis C being asymptomatic. In fact, fatigue is:

  • The most frequent extra-hepatic (outside of the liver) manifestation of those with Hepatitis C.
  • Reported in up to 67 percent of those with Hepatitis C.
  • Present in 70-100 percent of patients treated with interferon-based therapy (the current, standard, Hepatitis C antiviral treatment).

Clinicians have found that if fatigue is present prior to starting therapy, interferon treatment can exacerbate it to the point of exhaustion. As the severity of fatigue grows, so too does the chance of Hepatitis C treatment being discontinued.

When exhaustion is evaluated during interferon therapy, a wide range of conditions must be ruled out. A handful of those, include:

  • Insomnia
  • Anemia
  • Excess iron
  • Dehydration
  • Depression
  • A thyroid imbalance
  • Hormone imbalance
  • Diabetes
  • Severe pain
  • Allergies

Upon working with a clinician to determine the best way to regain energy levels, it is important for the patient to deliver an accurate description of exactly how tired he or she is. This is because there is no objective test to measure tiredness, so clinicians must rely on their patients’ subjective reports to determine the severity of their fatigue. Especially important when exhaustion has been reached, such communication is essential to expedite finding its resolution. After ruling out fatigue-causing factors that lie outside of the domain of the Hepatitis C virus and the medication used to treat it, there is a wide range of approaches to help reduce fatigue. Some of the top non-pharmacological strategies to ease exhaustion, include:

  • Bedtime administration of interferon
  • Reduction of interferon dose (although this also may reduce the medication’s effectiveness)
  • Improving nutritional intake
  • Replacing fluids and electrolytes
  • Alternating periods of rest and activity
  • Treating with Traditional Chinese Medicine (primarily acupuncture and herbal therapy)
  • Engaging in regular aerobic exercise
  • Scheduling strenuous activities during peak times of energy

Most individuals can find some degree of exhaustion relief by combining these strategies. In addition, some doctors may prescribe exhaustion-alleviating drugs. While this could enable certain individuals to complete a course of Hepatitis C interferon therapy, all medications have side effects. Several examples of drugs considered for this purpose are:

  • Anti-depressants – Research indicates that anti-depressants may be useful in reducing fatigue, especially when it manifests with depression.
  • Methylphenidate – Known widely by its brand name Ritalin, methylphenidate is a central nervous system stimulant that may ease interferon-related fatigue. However, methylphenidate will exacerbate many underlying substance use disorders.
  • Modafinil – Also a central nervous system stimulant, Modafinil is another pharmacological option for easing interferon-related fatigue.

As anyone who has experienced exhaustion before will attest, this extreme degree of fatigue is debilitating. Luckily, there are many ways to ease fatigue. Especially for those fighting Hepatitis C with antiviral therapy, reducing fatigue severity is paramount to completing treatment. Therefore, alleviating fatigue before and during interferon therapy serves to increase the odds at beating Hepatitis C.

References:

http://www.hcvadvocate.org/hcsp/articles/hauser-1.html, Hepatitis C and Fatigue, Peter Hauser, MD, Retrieved June 9, 2010, Hepatitis C Support Project, 2010.

http://www.hcvadvocate.org/news/newsLetter/2010/advocate0610.html#3, Healthwise: Making Friends with Fatigue, Lucinda K. Porter, RN, Retrieved June 9, 2010, The Hepatitis C Support Project, 2010.

http://www.mentalhealth.com/drug/p30-r03.html, Methylphenidate, Retrieved June 11, 2010, Phillip W. Long, MD, 2010.

http://www.springerlink.com/content/3502632747149t5p/, Modafinil’s Use in Combating Interferon-Induced Fatigue, Kari A. Martin, et al, Digestive Diseases and Sciences, February 2007.

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