Hepatitis C - Treating hepatitis C

Most cases of acute hepatitis C are not treated as the person either does not have any symptoms or mistakes the symptoms for the flu.

If hepatitis C is detected during this acute phase, it is normally recommended that you are monitored for three months to see if your body fights off the virus.

If it doesn’t, a six-month course of pegylated interferon (see below) may be recommended. This is successful at curing the infection in around 85% of cases.

Chronic hepatitis C

Treatment for chronic hepatitis C usually involves using a combination of two medicines:

pegylated interferon (given as an injection) – a synthetic version of a naturally occurring protein in the body that stimulates the immune system to attack virus cells
ribavirin (given as a capsule or tablet) – an antiviral drug that stops hepatitis C from spreading inside the body

This is known as combination therapy.

Course and dosage

The length of your recommended course will depend on which genotype of the hepatitis C virus you have.

If you have genotype 1, a 48-week course is recommended. For all other genotypes, a course of 24 weeks will be recommended.

You may have a blood test four weeks into your course, and again at 12 weeks. If the test shows that the medications are having little effect in removing the virus, 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. Ribavirin is normally taken twice a day with food.

How effective is treatment?

The effectiveness of combination therapy depends on the genotype of the hepatitis C virus.

Genotype 1 is more challenging to treat. 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

Side effects of combination therapy are common and can be severe. Three out of four people being treated will experience one or more side effect.

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.

Coping with side effects may be challenging, but it is recommended that you continue to take medication as instructed.

Missing doses to try to 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. 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 you find out you are pregnant, 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. If their partner is not pregnant but is of childbearing age, she will need to be tested for pregnancy each month during treatment and for seven months after treatment has stopped.

Boceprevir and telaprevir

In April 2012, the National Institute for Health and Care Excellent (NICE) released guidance for two newer medications, boceprevir and telaprevir.

Both medications are known as protease inhibitors. Protease inhibitors block the effects of enzymes that viral cells need to reproduce.

The NICE guidance recommends that boceprevir or telaprevir should be made available free of charge on the NHS for people who:

have genotype 1 hepatitis C that has not previously been treated (a genotype is a particular viral strain)
have been treated for genotype 1 hepatitis C but treatment was unsuccessful

The medications are designed to be used in combination with pegylated interferon and ribavirin and not as a sole treatment. The tablet is taken three times a day for 48 weeks.

It is still unclear whether boceprevir or telaprevir is more effective.

Side effects of boceprevir include:

flu-like symptoms such as a high temperature and chills
loss of appetite
feeling sick
insomnia
weight loss
shortness of breath

Side effects of telaprevir include:

anaemia
feeling sick
being sick
diarrhoea
haemorrhoids
itchy skin rash

Deciding against treatment

Some people with chronic hepatitis C decide against treatment. There can be several reasons for this, for example if they:

do not have any symptoms
are willing to live with the risk of cirrhosis at a later date
do not feel the potential benefits of treatment outweigh the side effects treatment can cause

Your care team can give you advice about this, but the final decision about treatment will be yours.

If you decide not to have treatment but then change your mind, 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.

Vaccination

It is possible to be infected with more than one type of hepatitis, which can complicate treatment.

Therefore, if you have chronic hepatitis C, your GP or practice nurse may recommend that you are vaccinated against hepatitis A and hepatitis B.

They may also recommend that you consider vaccination against seasonal flu and pneumococcal infections.