Effective treatment for hepatitis C is available and can permanently clear hepatitis C from the blood and prevent further liver damage. Once you are diagnosed with hepatitis C it is important to get a prompt referral to a liver specialist doctor. They can give you information about the risks and benefits of treatment. Treatment can be prolonged and have side effects, so it is important you know that treatment is right for you before starting on it.
NICE (National Institute for Health and Clinical Excellence) recommends using the drugs pegylated interferon and ribavirin within the NHS to treat people with mild, moderate or severe chronic hepatitis. This was based on evidence showing that treatment with these drugs is effective in fighting the virus and stopping the disease getting any worse even when used in the early, mild stage of disease.
Because the damage caused by hepatitis C is very gradual in most people, even when treatment is needed there is often some choice of when to start it. Your specialist or medical advisor will be able to discuss these issues with you and your decision should be made in consultation with them.
Treatment will usually last for either six or 12 months, depending on the strain of hepatitis C you have and will consist of two different drugs taken in combination for the whole of this time:
- injections of interferon, now more likely to be a type called pegylated interferon (or ‘peginterferon’), which is a slow release version of the drug. It is given as a weekly injection, just under the skin.
- tablets taken twice every day called ribavirin.
Pegylated interferon can be injected by syringe or with a pen device.
Side effects
Interferon can cause a number of symptoms (similar to those caused by a viral illness when your immune system naturally releases interferon) including:
- fever
- headaches
- fatigue
- muscle aches.
In addition, the injections can cause:
- low mood (depression)
- susceptibility to other infections
- minor bruising and skin redness at the injection site
- sleep disturbance and poor concentration
- thyroid gland problems
- blood sugar disturbance
- skin irritation and hair loss.
Ribavirin can cause:
- stomach upsets (diarrhoea)
- anaemia.
Treating side effects
Some side effects will respond to reducing the dose of treatment used and others can be helped with additional drugs.
Depression can be treated using anti-depressant tablets. For some people who have a high chance of developing depression, anti-depressants may be started before the HCV treatment.
Low blood counts (anaemia and low white cells) caused by the treatment can sometimes be helped with additional injections of medicines called growth factors. These are drugs that act on the bone marrow to make more of the cells that you need.
Treatment course
For people with type 2 or 3 hepatitis C, treatment usually lasts for six months. For those able to tolerate the full treatment the hepatitis C virus will be cleared permanently in up to eight out of ten people.
For people with type 1 and other genotypes, treatment usually lasts for up to 12 months.
For those able to tolerate the full treatment, the hepatitis C virus is cleared permanently in half of all cases. However, specialists should be able to accurately predict if the treatment is going to work or not after three months, and treatment may be stopped at that stage.
In some people who have a very good response within a few weeks of starting treatment, shorter courses can be as good, or almost as good, as the full length treatment. Please ask your doctor for more information on this.
New drugs
There are many new drugs to treat hepatitis C being developed in clinical trials at the moment. Ask your medical advisor or consultant about recent developments.
Liver transplants
For some people with hepatitis C who go on to get cirrhosis and develop life-threatening complications, a liver transplant may be an option.
A liver transplant will not cure hepatitis C, but in over eight out of ten people who are desperately ill this major operation is successful. The virus does infect the new liver and can sometimes cause disease after some years. However, the new liver does restore health and hepatitis C can potentially be treated even after a liver transplant.
Models of care
Most patients are being treated in hospital clinics. It may be possible in the future to treat some patients in GP surgeries or even at home and some pilot schemes have been launched to look at this. Ask your medical advisor about recent developments.
Complementary care
Many people with hepatitis C think about having complementary or alternative treatments in addition to, or instead of, their normal medical treatment.
If you are thinking of trying a type of CAM you need to look carefully at the possible risks and benefits. As with orthodox medical treatment, not all CAM treatments are safe. Make sure the person who is going to provide treatment is registered with an accredited body and knows about hepatitis C. Some CAM treatments can react with the medical treatments prescribed by your doctor (take particular care with herbal remedies). Because of this it is very important to talk to your doctor before starting a CAM. Do not stop taking the treatments given to you by your doctor without talking about it with her or him first.
There are many forms of CAM such as massage, aromatherapy, reflexology, t’ai chi and meditation which are aimed at relaxing the mind and body to relieve symptoms such as tiredness and aching muscles.