Most cases of acute hepatitis C go untreated as a person either does not experience any symptoms or they mistake the symptoms for the flu.
If hepatitis C is detected during this acute phrase then it is normally recommended that you are monitored for three months to see if your body fights of the virus.
If it doesn’t then a six month course of pegylated interferon (see below) may be recommended. This is usually 95% successful in terms of curing the infection.
Chronic hepatitis C
Treatment for chronic hepatitis C usually involves using a combination of two medication:
- pegylated interferon, a synthetic version of a naturally occurring protein in the body that stimulates the immune system to attack virus cells (which is given as an injection)
- ribavirin, a type of antiviral drug that stops hepatitis C from spreading inside the body (given as a capsule or tablet)This is known as combination therapy
Course and dosage
The length of your recommended course will depend on what genotype of the hepatitis B virus you have.
If you have genotype 1 then a course of 48 week is recommended. For all other genotypes a course of 24 weeks will be recommended.
You may be tested 12 weeks into your course with a blood test. If the test shows that the medications are having little effect in removing the virus then it may be recommended that treatment is stopped as further treatment may be of little use
You are normally given weekly injections of pegylated interferon and ribavrin is normally taken twice a day with food.
How effective is treatment?
The effectiveness of combination therapy is also determined by the genotype of the hepatitis C virus.
Genotype 1 is more challenging to treat and only half of people treated with combination therapy will be cured.
Other genotypes respond better to treatment with a cure rate of around 75-80%.
Side effects
Unfortunately side effects of combination therapy are common and can be severe. Three out of 4 people being treated will experience one or more side effects.
Side effects of combination therapy include:
- a drop in the number of red blood cells (anaemia) which can make you feel tired and out of breath
- loss of appetite
- depression
- anxiety
- irritability
- problems sleeping (insomnia)
- difficulties concentrating and remembering things
- hair loss
- itchiness
- feeling sick
- dizziness
- flu-like symptoms such as a high temperature that occur in the 48 hours after an interferon injection
Side effects may improve with time as your body gets used to the medications.
Tell your care team if any side effect is becoming particularly troublesome as your dosage may need to be adjusted.
It can be sometimes challenging trying to cope with side effects but it is recommended that you continue to take medication as instructed.
Missing doses to try and minimise side effects will reduce the chances of you being cured.
Ribavirin and pregnancy
Ribavirin will harm an unborn child if it is taken by a pregnant woman. So if you are a woman of childbearing age you will need to have a pregnancy test to confirm you are not pregnant before treatment can begin. If it is found you are pregnant then treatment will need to be delayed until you have your baby.
If you are not pregnant you will still need to use a reliable method of contraception (preferably two methods) if you are sexually active.
Men who are taking ribavirin should not have sex with a pregnant woman unless they use a condom.
And if you partner is not pregnant but is of childbearing age she will need to be tested for pregnancy each month during treatment and for the 7 months after treatment has stopped.
New medication
In 2011 two new medications were released called boceprevir and telaprevir. Both medications are what are known as protease inhibitors.
Protease inhibitors block the effects of enzymes that viral cells need to reproduce.
Some experts have stated that these new medications could be effective in some people who fail to respond to conventional combination therapy.
The recommended course for both medications for people who fail to respond to combination therapy is 48 weeks, where you take a tablet three times a day.
The medications are designed to be used in combination with pegylated interferon and ribavirin and not as a sole treatment.
It is still unclear whether boceprevir is more effective than telaprevir or vice versa.
Side effects of boceprevir include:
- flu-like symptoms such as a high temperature, chills
- loss of appetite
- feeling sick
- insomnia
- loss of appetite
- weight loss
- shortness of breathe
Side effects of telaprevir include:
- anaemia
- feeling sick
- being sick
- diarrhoea
- haemorrhoids)
- itchy skin rash
A practical consideration is that neither boceprevir or telaprevir has yet been approved by the National Institute for Health and Clinical Excellent (NICE – which is the organisation that decides what treatment should be provided by the NHS).
This means the decision to fund treatment for either boceprevir or telaprevir is at the discretion of your local primary care trust.
If your primary care trust refuses you do have the option of paying for the medications though they are both very expensive.
A 48 week course of boceprevir will cost around £33,000 and a 48 week course of telaprevir will cost around £90,000.
Deciding against treatment
Some people with chronic hepatitis C decide against treatment. There can be a number of reasons why a person may come to this decision:
- they are not experiencing any symptoms
- they are willing to live with the risk of cirrhosis at a later date
- they do not feel that the potential benefits of treatment outweigh the side effects that treatment can bring
Your care team will be able to provide advice but the final decision will be yours.
If you change your mind at a later date you can still request to be treated.
Re-infection
If the virus is cleared with treatment, you are not immune to future infections of hepatitis C.
This means, for example, that if you continue to inject drugs after taking the medicines, you risk becoming re-infected with hepatitis C.
