|
Treatment
A diagnosis of HCV doesn't necessarily mean you need
treatment. The National Institutes of Health recommends
treatment for HCV if you have:
-
A positive test result indicating hepatitis C virus
circulating in your bloodstream
-
A biopsy that indicates significant liver damage
-
Elevated levels of a liver enzyme called alanine
aminotransferase (ALT) in your blood
-
Even so, doctors continue to debate who needs treatment. If
you have only slight liver abnormalities, your doctor may
decide against medical treatment because your long-term risk
of developing a serious disease is slight, and the side
effects of treatment can be severe.
On the other hand, because there's no foolproof way to know
whether you'll develop liver disease later on, your doctor may
recommend fighting the virus. Improved treatment methods and a
higher success rate in fighting hepatitis sometimes tip the
argument in favor of more aggressive approaches.
Drug therapies
The standard of care for hepatitis C treatment is weekly
injections of a drug called pegylated interferon alfa combined
with twice-daily oral doses of ribavirin (Rebetol) - a
broad-spectrum antiviral agent. Two pegylated interferon
medications are available, peginterferon alfa-2b (Peg-Intron)
and peginterferon alfa-2a (Pegasys).
The goal of HCV treatment is to clear the virus from your
bloodstream. Combined pegylated interferon and ribavirin clear
HCV infection in up to half of people with genotype 1 - the
most common genotype found in the U.S. - and in up to 80
percent of those with genotypes 2 and 3.
If you have genotype 1 HCV, your doctor may recommend a course
of relatively high-dose medications for 48 weeks. If you have
genotype 2 or genotype 3, a 24-week course of medications at a
lower dose may be adequate.
If one course of combined pegylated interferon and ribavirin
doesn't clear HCV from your bloodstream, your doctor may
recommend a second course of combination therapy. If your
viral load declined during the first round of medications, a
second round may clear the virus completely. Even if there was
no change in your viral load during the first course of
treatment, a second course may help reduce the damage HCV does
to your liver.
Side effects of medications
Side effects from interferon include severe flu-like symptoms,
irritability, depression, concentration and memory problems
and insomnia. Ribavirin can cause a low red blood cell count
(anemia), gout and birth defects. Both drugs can cause skin
irritation and extreme fatigue.
small number of people taking combined pegylated interferon
and ribavirin may experience psychosis or suicidal behavior.
For this reason, treatment with interferon isn't recommended
if you have a history of uncontrolled major depression. You're
also not a good candidate for this treatment if you have
untreated thyroid disease, low blood cell counts or autoimmune
disease, or if you drink alcohol or use drugs and are
unwilling to stop or seek help with stopping.
Side effects from combined pegylated interferon and ribavirin
are generally most severe during the first weeks of treatment,
and may be improved with pain relief medications and
antidepressants. However, some people taking interferon need
their dosage reduced because of severe side effects, and
others must stop treatment altogether.
Liver transplantation
The best treatment for people with end-stage liver disease is
liver transplantation. However, the number of people awaiting
transplants far exceeds the number of donated organs. But
several new developments in transplantation may make it
possible for more people to receive the organs they
desperately need.
These developments include the donation of liver segments from
living relatives, splitting one donated liver between two
recipients, new organ allocation policies and, especially, new
approaches to liver transplants for people with HCV.
Until recently, HCV-infected livers were routinely discarded.
But studies show that people already infected with HCV who
receive livers from HCV-positive donors can do as well as if
they had received a liver not infected with the virus. This
may mean that many more livers will become available for
people with hepatitis C.
Liver transplantation does not cure HCV. The majority of
people with hepatitis C who receive liver transplants
experience a recurrence of the virus. Those with HCV who
receive liver transplants also are at greater risk of
developing cirrhosis within five years than are people with
HCV who don't receive a transplant. Treatment with HCV-fighting
medications may help prevent a recurrence of infection or
treat recurrent illness that develops after a liver
transplant.
|