By Dr Ananya Mandal, MD
Hepatitis C treatment aims at reduction of inflammation of the liver, prevention of progression to liver fibrosis, cirrhosis and cancer.
The aims of treatment are achieved by eradication of the virus or to decrease infectivity of the virus. This also helps in control of spread of the infection.
For treatment of hepatitis C infection, a combination approach is preferred over the use of a single agent.
Because early cases show little or no symptoms many early cases of hepatitis C go undetected and untreated.
Further in around 30 to 40% cases of acute hepatitis C infection, the body’s immunity may fight off the infection by itself.
The patient is monitored during this period to detect if the infection is fought off effectively or if the person goes on to become a chronic carrier.
Treatment for chronic hepatitis C
There are two medications that are used for treatment of chronic hepatitis C. These are often used together in combination therapy. These include:-
Injections of pegylated interferon – interferon is a naturally occurring protein in the body that stimulates the immune system to attack virus particles. Pegylated interferon is the synthetic version of this protein that is given to help the body fight off the infection.
Ribavarin – these are orally taken medications (capsules or pills) that stop the hepatitis C virus from multiplying and spreading within the body.
Dosage and course of medication
Pegylated interferon is usually given as once or thrice a week injections while Ribavirin is prescribed to be taken twice a day with food.
The genotype of the hepatitis C virus infecting a person determines the course and dosage of the infection. For example, those with genotype 1 are prescribed a 48-week course and those with other genotypes are prescribed a course of 24 weeks.
After completion of 12 weeks of therapy a blood test is performed to see if there is any effect of the medications. If the person has not responded to the drugs, they are stopped as they may not be of much use to the patient.
Genotype 1 is the least responsive to anti-hepatitis C treatment compared to other genotypes.
Cure is seen in only half of people treated with combination therapy. Those infected with other genotypes may show a 75 to 80% chance of cure with combination therapy.
Side effects of combination therapy
Side effects with combination therapy may be common and nearly 75% will experience these side effects.
The side effects include anemia or fall in the numbers of red blood cells, depression, anxiety, irritability, and insomnia, loss of appetite, hair loss, itching, nausea, dizziness, fever and flu like symptoms after interferon injections. The side effects decline in severity over the course of treatment.
Ribavarin and pregnancy
Ribavarin is not to be taken by a pregnant woman as it may harm the unborn baby. If a woman of childbearing age is detected with hepatitis C, she needs to have a pregnancy test to rule out pregnancy before beginning treatment.
Contraceptives may be used during treatment to prevent pregnancy while on therapy with ribavirin.
Two new medications have been introduced in 2011. These are called boceprevir and telaprevir and belong to the group of drugs called protease inhibitors. These block the enzymes that help the virus to multiply in the host body.
These medications may be useful in persons who do not respond to combination therapy with interferon and ribavirin. The course is of 48-weeks on boceprevir or telaprevir taken as a tablet three times a day.
The medications are designed to be used in combination with pegylated interferon.
Boceprevir or telaprevir is appropriate for those with genotype 1 hepatitis C that has not previously been treated or those with genotype 1 hepatitis C with a previous unsuccessful treatment.
Boceprevir may cause side effects such as flu like symptoms, nausea, loss of appetite, weight loss, insomnia, breathlessness while telaprevir may cause nausea, vomiting, diarrhea, anemia, itchy skin rash etc.
Reviewed by April Cashin-Garbutt, BA Hons (Cantab)