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Drug Therapy
The decision to initiate treatment should occur only after a thorough medical evaluation and extensive discussion between the clinician and patient to review risks and benefits of medical therapy. People who are infected but show no signs of liver damage may not be appropriate candidates for drug treatment.
Hepatitis C is usually treated with a long-acting form of interferon alpha called pegylated interferon, combined with the antiviral drug ribavirin. Interferon alpha is a protein that cells secrete naturally in response to viruses; it results in a stronger immune response and interferes with the virus's ability to replicate. The pegylated interferon is injected once a week; ribavirin is taken by mouth twice daily.
Depending on the type or "genotype" of hepatitis C virus a person has contracted, treatment may be necessary for six months to a full year; even then, not all treated patients can achieve a "sustained response," meaning no virus can be detected in their bloodstream. Treatment success is achieved when no virus is detectable in the blood 24 weeks after the end of treatment; depending on the genotype of the virus, therapy is successful in 40 percent to 80 percent of cases. This represents a significant improvement over the track record of past therapy.
Interferon and ribavirin, however, cause numerous adverse side effects. The impact of these adverse effects on a given individual can be unpredictable. Certain medical conditions generally preclude treatment with interferon and ribavirin. These include, but are not limited to, severe heart disease, kidney disease, poorly controlled psychiatric disease, ongoing infection, autoimmune disease, pregnancy or planned pregnancy, and blood disorders such as a low red blood cell count, low white cell count, or low platelets. Treatment, even in otherwise very healthy patients, requires close monitoring to ensure safety. This includes frequent blood work and office visits.
Among the factors associated with higher likelihood of elimination of the virus are a low amount of virus in the blood at diagnosis, body weight of less than 165 pounds, non-African American race, minimal fibrosis or hardening of the liver on biopsy, the ability to tolerate full-dose medicine for the length of treatment, and infection with a type of hepatitis C known as "non-1 genotype." A small number of patients may experience a recurrence months or years after treatment has succeeded. It is uncertain if this represents reinfection or reactivation of disease.
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