Do you need to start drug therapy
immediately?

Not necessarily. Your doctor may recommend certain lifestyle changes (such as following a healthy diet and avoiding alcohol) and "watchful waiting," instead of starting drug treatment immediately.

Watchful waiting doesn't mean that you will be doing nothing. Instead, it means that you and your doctor will carefully monitor the progression of your hepatitis C, keeping treatment with currently available medications in mind as an option. Newer medications, possibly with fewer side effects, continue to be developed. Many patients with hepatitis C can wait until these better drugs are available, some of which should be on the market by 2010.

Watchful waiting and lifestyle changes for hepatitis C are aimed at doing 2 things:

stopping or slowing down the damage to your liver

making you feel better

Good candidates for watchful waiting are patients with mild liver disease and patients in whom interferon and ribavirin could be particularly dangerous. This includes patients with serious heart, lung, or kidney disease; psychiatric disease; or cancer, or patients who are older than 75.

Watchful waiting involves the following:

having liver enzyme blood tests once or twice a year

having a liver biopsy every 3 to 5 years

going to regular doctor appointments

following your doctor's lifestyle recommendations, because reducing further damage to your liver is crucial

What are the benefits of treatment?

If you and your doctor decide that you should begin taking medicines for your hepatitis C, the drugs are intended to do 3 things:

remove (or clear) all the hepatitis C virus from your body

stop or slow down the damage to your liver

make you feel better

Clearing the hepatitis C virus from the blood does not happen in all patients. If this does not happen, there are still some ways that treatment can help you.

The treatment can:

decrease the amount of damage to your liver

lower the amount of hepatitis C virus in your blood

improve your overall well-being and quality of life

lower your alanine aminotransferase (ALT) liver enzyme level

Drug treatments are not right for everyone. Only you and your doctor can decide if a certain treatment is right for you.

Only patients with hepatitis C in their blood (chronic hepatitis C infection) are considered for therapy. In general, doctors suggest treatment if you:

have high liver enzyme levels, especially ALT levels

have a liver biopsy that showed damage (inflammation, and particularly fibrosis)

have not used alcohol or other drugs for at least 6 months

If you want to start treatment for hepatitis C, speak with your VA doctor. It is a good idea to talk about any concerns you have before you start treatment. You and your doctor will decide if treatment is right for you and which medicines might work.

Before your doctor can prescribe a treatment for hepatitis C, it has to be approved for that purpose by the U.S. Food and Drug Administration (FDA). Several treatments for hepatitis C already have been approved by the FDA:

long-acting (pegylated) interferon combined with another drug called ribavirin (combination therapy)

long-acting (pegylated) interferon by itself

short-acting (standard) interferon with ribavirin

Interferon

Interferon is a protein that your body naturally makes to fight infections. People with hepatitis C can inject extra interferon into their bodies to help fight the virus. Interferon can be given only as a shot.

There are 2 types of interferon used to treat hepatitis C:

long-acting (pegylated) interferon, given as 1 shot a week

short-acting (standard) interferon, given as 3 shots a week

Pegylated (or once a week) interferon is a newer form. As of 2002, pegylated interferon was shown to be at least slightly more effective than standard interferon in most patients. For this reason, it is the main form of interferon used today.

Another advantage for patients is that they only have to get 1 shot a week of pegylated interferon, instead of 3 shots a week with standard interferon.

Standard (or 3 times a week) interferon is being used less and less. Each shot of standard interferon contains 3 million units of the drug. Because of the way drugs are measured, 3 million units sounds like a lot more medicine than it actually is. 

• Treatment options for patients with chronic HCV have evolved from interferon (IFN) monotherapy to combination therapy with IFN and ribavirin (RBV) to combination therapy with pegylated interferon (PEG IFN) and RBV.

Ribavirin is a medicine that fights certain viruses. It comes in a capsule that you can swallow. Ribavirin by itself doesn't work in treating hepatitis C. It has to be combined with interferon to be effective.

If you take ribavirin and interferon together, then both medicines work much better. This is called combination therapy, and it is currently the recommended treatment for hepatitis C.

Treatment success varies a lot from person to person. Depending on specific factors, patients have anywhere from a 20% to an 80% chance of having hepatitis C removed from their bodies.

Treatment time varies. In general, standard combination therapy lasts between 24 and 48 weeks, with 6 months of follow-up after treatment has ended. If a patient is treated in a clinical trial, treatment duration may be adjusted.

Sometimes, if the treatment is not working or if you have too many side effects, your doctor may stop your treatment early.

What are the side effects?

Almost all medicines have side effects, including medicines for hepatitis C. Side effects vary a lot from person to person. Most patients on hepatitis C treatment have side effects, such as fatigue and flulike symptoms. Some side effects go away and some of them last the whole time you are on treatment. (See the Side Effects Guide for more information.)

Will you be able to continue working while you're on treatment?

Some patients keep a normal work schedule while they are on treatment. Others may have to cut down their work hours or stop working altogether. The side effects are different for every patient, so it is hard to say how much hepatitis C treatment will affect your work schedule.

Here are some work-related factors to consider before starting treatment:

If your job is busier or more stressful during certain times of the year (for example, during the holidays), ask your doctor about beginning treatment at the start of a less busy period.

Learn about your rights in the workplace. The Americans with Disabilities Act (ADA) says that employers can't discriminate because of a person's disability (such as a physical illness). Depending upon your situation, the ADA may apply.

How successful is treatment for hepatitis C?

In patients who complete drug therapy, the virus is cleared from the blood between 20-80% of the time, depending on a number of factors (see below). In most patients, the chances of clearing the virus are in the 40-50% range.

What factors can affect treatment outcomes?

Not everyone will have the same results from hepatitis C treatment. The following are some things that can affect how the treatment works: Factor Effects Viral genotype (the type of hepatitis C virus you have) Not all hepatitis C viruses are the same. We know of 6 different types--called genotypes--for hepatitis C. Some of them respond to treatment better than others. For genotype 1, the virus generally is removed in 30-50% of patients. For genotypes 2 or 3, the virus usually is removed in 65-80% of patients. Viral load This is the amount of virus in your blood. If you have lower levels of virus in your blood when you start treatment, you may have a better chance of getting rid of the virus. (Note: A high viral load does not necessarily mean you have worse liver damage.) Iron If you have less iron in your blood or in your liver cells, your treatment may work better. Iron levels can be checked with a blood test or a liver biopsy. Gender Hepatitis C treatment works slightly better for women than for men. Ongoing use of alcohol Studies have found that patients who continue to drink alcohol regularly during treatment have lower rates of clearing the virus. Ethnicity Studies in the United States have shown that African American patients have lower rates of clearing the virus than do Caucasian patients, though the reasons are not apparent. Other ethnic groups have not been studied as well, but there may be other differences in response rates among ethnic groups. Length of infection You may have a better chance of clearing the virus from your body if you haven't been infected with the hepatitis C virus for very long. Adherence (taking medications as prescribed) Adherence to prescribed medications can be challenging but is a very important part of making sure the treatment works. Studies have shown that patients who receive adequate doses of interferon and ribavirin have much higher rates of clearing the virus. Obesity A number of studies have shown that patients who are overweight have lower rates of clearing the virus. If you are overweight, losing some weight prior to treatment may make the medications more effective.

If you are ready to start drug therapy, talk with your VA health care provider about which treatment plan is right for you.

Many things need to be considered before you begin treatment. Your doctor will need to know more about the amount of the virus in your blood (viral load) and the type of hepatitis C virus (genotype) that you have.

Here are some questions that you should discuss with your doctor:

	Do I need to start treatment?
	What is my genotype and how can it affect my treatment outcome?
	What is my viral load and how can it affect my treatment outcome?
	What kind of treatment should I receive?
	How long will treatment last?
	Do I have any other conditions that will complicate treatment?
	Should I be tested for hepatitis A and B?
	Do I need a liver biopsy?
	What medications should I avoid while I am on treatment?
	What precautions do I need to take while I am on treatment?
	How often will I have doctor appointments?
	What tests will I need to take?
	How will treatment affect my daily life? Will treatment affect my ability to work?
	What side effects will I have?
	Are there any long-term risks from treatment?