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Hepatitis C
Hepatitis C Treatment

Hepatitis C Treatment

Unlike hepatitis A and B, there currently is no vaccine available for hepatitis C. The disease is primarily treated using prescription antiviral medications. Common hepatitis C treatments include:

Prescription Medications

People who test positive for hepatitis C are usually evaluated for liver disease before starting treatment for the condition. The treatment of choice is combination therapy using pegylated interferon and ribavirin.

Many medications have side effects, some of which are serious and others are not. People who experience severe or intolerable side effects should notify their health care provider. Some people who experience severe side effects when taking hepatitis C medications may be prescribed a reduced dosage or may decide to stop their treatment. New antiviral treatments with less serious side effects are being tested.

The following list of medications isn't inclusive. Additional information, side effects, and drug interactions can be obtained by clicking the name of the highlighted medications. It's important for people to ask their healthcare provider or pharmacist in advance for possible drug side effects or interactions.

The following prescription medications are used to treat hepatitis C:

Interferon

Interferons are a family of proteins produced naturally by the immune system or synthetically to fight viral infections and affect their ability to multiply in liver cells. People with hepatitis C require three injections each week.

  • interferon alfa-2a (Riferon-A)
  • interferon alfa-2b (Intron-A)
  • interferon alfacon-1 (Infergen)

Pegylated interferon

Pegylated interferon  bonds interferon with polyethelene glycol (a gelatinous compound used to thicken food). People with hepatitis C treated with pegylated interferon only require a single weekly injection.

People who experience severe or intolerable side effects should notify their health care provider. Taking interferon at night helps reduce some of the symptoms. Flu-like symptoms (fever chills, and headache) can be reduced by taking acetaminophen (Tylenol) before each dose. To avoid liver damage, alcohol should be avoided and acetaminophen should only be taken in small doses as directed by a physician.

Ribavirin

Ribavirin is an oral antiviral medication, which is taken daily. It is not used alone to treat hepatitis C. Instead, it is taken in combination with interferon or pegylated interferon. Ribavirin is believed to work by interfering with the survival and multiplication of HCV.

Monotherapy Versus Combination Therapy

Current hepatitis C therapies approved by the Food and Drug Administration (FDA) include treatment with a single drug or a combination of two drugs. Monotherapy treats people with either interferon or pegylated interferon. Combination therapy treats people with ribaviron and either interferon or pegylated interferon.

Combination therapy with pegylated interferon alfa-2a and ribavirin has about a 55% sustained response rate. Approximately 40% of patients with genotype 1 and 80% of people with genotypes 2 or 3 respond to treatment. In contrast, monotherapy using pegylated interferon alone has only a 24% response rate.

Although combination therapy is usually more successful than monotherapy, some people have conditions that prevent them from taking ribavirin (including pregnancy and severe anemia). Monotherapy using either interferon or pegylated interferon is the treatment of choice for these people.

In 2007, a study of the use of the drug peginterferon, either alone or in combination with the drug ribavirin, found that 99% of people with hepatitis C had no detectable virus up to 7 years later.

Because the current treatment for hepatitis C is lengthy, not always successful, expensive, and may cause severe side effects, not everyone is treated as soon as they're diagnosed. The NIH and CDC recommend treating people with hepatitis C who are most likely to progress to cirrhosis. Most people with mild cases of hepatitis C don't require treatment other than avoiding alcohol, a healthy diet, regular exercise, and periodic monitoring of their condition by a healthcare provider.

People with the following health issues may not be suitable for hepatitis C treatment and need to be evaluated before starting therapy:

  • Active alcohol or substance abuse
  • Advanced cirrhosis
  • Autoimmune diseases (including lupus, psoriasis, or rheumatoid arthritis).
  • Bone marrow compromised
  • Certain medical diseases (including advanced diabetes, heart disease, or seizures)
  • Neurological disease
  • Pregnant or unable to practice birth control
  • Renal dysfunction
  • Serious depression or other psychiatric problems
  • Severe anemia

Some people find the side effects of hepatitis C treatment difficult to tolerate, and either require a lowered dose of their medications or stop treatment entirely.

Hepatitis C treatment is not a cure. At the end of treatment:

  • Sustained responders don't have a measurable level of HCV in their blood for at least six months.
  • Relapsers don't have a measurable level of HCV in their blood but the HCV returns.
  • Nonresponders have measurable levels of HCV in their blood.

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Over-the-Counter Medications

There are no over-the-counter medicines to help treat hepatitis C infections and some may even be dangerous when taken by someone with hepatitis C. According to the Food and Drug Administration (FDA), drug-induced liver injury is now the most frequent cause of acute liver failure in the United States, exceeding all other causes combined. Although the liver is able to recover from most injuries, people with health issues may develop serious and progressive illness as a result.

The liver is susceptible to drug-induced injury due to its role in processing and removing all drugs that enter the blood stream from the body. Toxins can attack and injure the liver. People with hepatitis C should always check both prescription and over-the-counter medications for the potential to cause liver damage.

Although acetaminophen is usually safe when taken as prescribed, severe liver damage can occur when it is taken in a single excessive dose or over a period of time. Moreover, its toxic effects increase when taken with alcohol (which is also toxic to the liver). Acetaminophen is found in many over-the-counter and prescription pain killers (including Alka-Seltzer Plus Cold & Sinus, Excedrin, Nyquil, Tylenol, Darvocet, Percocet, and Vicodin).

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Liver Transplantation

Liver transplantation is a surgical procedure that replaces a diseased liver with a donor liver. The leading cause of liver transplantation is liver failure due to hepatitis C. Liver transplantation may be the only option if the extent of liver damage caused by HCV progresses to the point that a person's life is threatened.

In the past, donor livers were only available from people declared brain dead (the person's brain has stopped functioning although the heart is beating with the help of a respirator). Today, living donor transplants are possible. Only a small portion of the donor's liver is used. Living donor transplantation works because the liver is the only organ that is able to regenerate by forming new tissue. Within a few weeks after the surgery, both the donated liver segment and the original liver grow to their normal sizes.

A living donor organ is usually obtained from a family member, spouse, or friend. The only requirement is for the donor to be healthy, and have an appropriate blood type and body size. Sometimes a living donor can't be found. In such cases, a search is made for a donor liver from a person who has been declared legally brain dead.

There is a long waiting list of people who need donated livers. One approach to shortening the waitlist for people with hepatitis C is to use HCV-infected livers for transplantation. Recent studies indicate that the surgical outcome for people with hepatitis C remains the same whether they receive healthy livers or HCV-infected livers.

Antirejection Medications

Immunosuppressants are used after transplantation to prevent the immune system from attacking the transplanted liver and causing the liver to fail. Most patients are prescribed a combination of medications. Although the dose of each drug and the number of drugs taken may be reduced after the first few months of therapy, most people require immunosuppressants for the rest of their lives.

Imunosupprssants may make people more likely to develop an infection or certain types of cancer (such as lymphoma and skin cancers). Healthcare workers should be notified immediately if signs of infection or other serious side effects should occur.

Medications used after liver transplantation may include:

  • Prednisone
    Prednisone belongs to a class of corticosteroids. It reduces swelling and prevents the immune system from attacking the transplanted liver.

  • Cyclosporins
    Cyclosporins prevent the immune system from attacking the transplanted liver.

  • Mycophenolate mofetil
    Mycophenolate mofetil prevents the rejection of transplanted livers by suppressing the immune system.

  • Tacrolimus
    Tacrolimus prevents liver transplant rejection by suppressing the immune system.

The one-year survival rate of liver transplantation is over 85%. Some people who need a liver transplant to survive are unable to survive the strain of a major surgical procedure. People are evaluated in advance to determine if they will survive a liver transplant. Some of the factors that may cause people to be rejected for liver transplantation include:

  • Advanced liver cancer
  • AIDS (acquired immunodeficiency syndrome)
  • Cancer (other than liver cancer) within the past 3 to 5 years
  • Certain severe medical conditions (such as hardening of the arteries, heart, lung, or kidney disease)
  • Continued alcohol or illegal drug use
  • Extreme poor health
  • Inadequate post surgical support at home
  • Poor track record for following healthcare instructions
  • Psychological problems

After undergoing a liver transplant, most people are able to live normal or near-normal lives. Some of the issues faced by liver transplant recipients include:

  • Infections due to immunosuppressants
  • Lifelong follow-up medical care
  • Lifelong immunosuppressants
  • Possible liver rejection
  • Return of HCV
  • Secondary medical conditions (including diabetes, hypertension, high cholesterol)
  • Surgical side effects (including infection, bleeding, delayed return of liver function, liver failure)

Although immunosuppressants prevent the transplanted liver from being rejected by the body, they also weaken a person's immune system. As a result, people are at constant risk of infection and are more susceptible to cancers, such as lymphoma and leukemia. Immunosuppressants also contribute to recurrence of HCV.

Although liver transplantation is not a cure for hepatitis C, treatment with HCV medications can help prevent HCV from damaging the donated liver.

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Complementary and Alternative Medicine

Complementary and alternative medicine refers to those medical and health care treatments that are not part of traditional medicine. Whereas, complementary medicine is used with traditional medicine, alternative medicine is used in place of traditional medicine.

At present, prescription medicines are the only products proven effective in treating hepatitis C infection.

Research into herbs and supplements to treat hepatitis C is being conducted. Herbs and supplements suspected of being useful for people with hepatitis C include:

Milk thistle

Milk thistle (Silybum marianum) has been used in Europe as a treatment for liver disease and jaundice since the 16th century. So far the study results are mixed. Milk thistle has few side effects.

Licorice root

Licorice root (Glycyrrhiza glabra) has been used in China since the second and third century B.C., and was used for liver conditions by ancient Egyptians, Greeks, and Romans. Laboratory studies of glycyrrhizin suggest that it may have antiviral properties to reduce long-term complications in chronic hepatitis C. People who take licorice root for an extended period may develop serious side effects, such as hypertension, salt and water retention, and swelling.

SAMe

The use of SAMe (S-Adenosylmethionine) for people with chronic hepatitis who have cholestasis (backup of bile in the liver) has been shown to significantly improve liver-related symptoms. SAMe is generally considered safe.

Lecithin

The supplement lecithin (phosphatidylcholine) is a phosphorous-containing lipid found in egg yolks and soybeans. It has been shown to enhance the effect of interferon in people with chronic hepatitis C. Lecithin is generally considered safe.

Serious Side Effects

People with liver disease should not use any medicinal herbs or supplements except under the supervision of a physician. Many natural products may damage the liver and other safe products may contain dangerous contaminants.

Herbs and supplements with known or suspected liver-toxic properties include barberry, borage, chaparral, coltsfoot, comfrey, germander, germander, greater celandine, kava, kombucha, margosa oil, mate tea, mistletoe, pennyroyal, pokeroot, sassafras, skullcap, and various herbs and minerals used in traditional Chinese herbal medicine.

Vitamin A taken at doses above 50,000 IU per day taken for several years can cause liver injury. All forms of vitamin B3 used above the standard daily requirement level may damage the liver when taken in high doses.

People with hepatitis C should avoid iron supplements. HVC may increase the amount of iron stored in the liver, which can damage the liver and interfere with the effectiveness of hepatitis C treatment.

Some of these therapies haven't been well studied, and little information is available about their effectiveness, side effects, and drug interactions. It's important to discuss any of these therapies with your doctor before trying them. 

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Lifestyle Changes

The following lifestyle changes can help relieve some of the symptoms:

Avoid All Alcohol

People with hepatitis C should not drink alcohol, which is toxic to the liver. Alcohol not only increases the progress of hepatitis C, it also interferes with the effectiveness of hepatitis C treatment.

Eat a Healthy Diet

People with hepatitis C should eat a well-balanced diet. People who suffer from a loss of appetite can eat frequent, small, high-calorie meals help. People who are overweight should eat a low fat, low-calorie diet.

Get Rest and Exercise

Sufficient rest and moderate exercise improves a sense of well-being and helps strengthen the body's natural immune system.

Get Vaccinated for HAV and HBV

To avoid additional liver damage, people with hepatitis C who aren't already infected with hepatitis A or B should get vaccinated for these diseases.

Join Support Groups

Hepatitis C support groups provide coping suggestions, education, emotional support, social interaction, and help avoid feelings of isolation.

Prevent Drug-Induced Liver Injury

Check all prescription and over-the-counter medications, herbs, and supplements for liver-toxicity. Take only as directed.

Protect Others from Exposure

People diagnosed with hepatitis C can use the following steps to avoid infecting others with HCV:
  • Clean both wet and dried blood spills. Use latex gloves and a solution of one part household bleach to 10 parts of water. Disinfect cleaning equipment with a fresh bleach solution.
  • Cover all wounds.
  • Don't donate blood, blood products, or body organs.
  • Don't share personal items (such as razors, toothbrushes, and nail clippers).
  • Notify all healthcare workers that you are infected with HCV.