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Chronic Hepatitis C

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Chronic Hepatitis C Treatments

Treatment of chronic hepatitis C varies depending on the individual. A person with chronic hepatitis C may not need or benefit from treatment. Some people may not be able to tolerate treatment because of side effects.

Currently, the FDA has approved the following treatments for hepatitis C:

  • pegylated interferon alfa-2a
  • pegylated interferon alfa-2b
  • ribavirin
  • standard interferon alfa
  • Incivek
  • Victrelis
  • Olysio
  • Sovaldi

The latest drugs approved to treat hepatitis C are Olysio (simeprevir) and Sovaldi (sofosbuvir). Olysio and Sovaldi are combined with the older drugs interferon and ribavirin. This combination is quickly becoming the new standard for treating hepatitis C. Taking these combinations has increased cure rates for people with type 1 hepatitis C (the most common form in the U.S.) from less than 50% to between 68% and 75%. Also, some patients have been able to stop treatment in as little as 24 weeks. 

Interferon is a naturally occurring protein that fights infection. Injecting more interferon helps the body fight the hepatitis C virus. Pegylated interferon is usually preferred, as it only requires a single shot every week and has been found to be more effective. This is usually combined with ribavirin, which combats certain viruses and is taken orally in capsule form along with interferon.

Incivek (telaprevir) and Victrelis (boceprevir) are also approved as add-on therapy that can boost the chances that hepatitis C will be cured. They both target the HCV protease enzyme, making it nearly impossible for the virus to replicate. Although the virus quickly becomes resistant to either drug used alone, combination therapy with interferon and ribavirin keeps HCV in check. Also, be aware the FDA has warned that Incivek and Victrelis may interact with certain medicines, including some drugs that are used to treat HIV.

This combination therapy can last up to 48 weeks. Many people do not experience side effects when taking the treatment, but it is possible you may feel fatigue and flu-like symptoms. The FDA has warned that it has received reports of a serious skin rash from combination treatment with Incivek, which has led to several deaths. Your doctor may stop the treatment if you experience too many side effects.

Other common side effects of interferons include fatigue, muscle pain, headache, nausea, vomiting, weight loss, and depression, and changes to your blood cell counts. Side effects of ribavirin include anemia, skin rash, fatigue, and nose/sinus congestion. Prior to starting the treatment, you may wish to organize medical leave or reduce working hours in case it makes you feel ill.

Chronic Hepatitis C Prognosis

In the best case, the treatment will achieve a sustained virological response (SVR), which means that the hepatitis C virus is not detectable in the blood six months after treatment ends. An SVR is the goal of treatment. Although the virus is not eradicated, its growth is suppressed.

The chance of achieving an SVR depends mostly on the genotype, or strain, of the virus. Successful treatment should be followed by regular check-ups and a healthy lifestyle.

Although the overall prognosis for chronic hepatitis C is good, some people will progress to cirrhosis and end-stage liver disease. A liver transplant may be an option, but any replacement liver will also become infected with hepatitis C.

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WebMD Medical Reference

Reviewed by Melinda Ratini, DO, MS on June 21, 2013
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