Should I Take Antiviral Therapy for Hepatitis C?

Introduction

This information will help you understand your choices, whether you share in the decision-making process or rely on your doctor's recommendation.

Key points in making your decision

Your decision about taking antiviral medicine for hepatitis C depends on your current health and your chances of developing cirrhosis or liver cancer in the future. Consider the following when making your decision:

You may not need to take antiviral medicines if you have normal or only slightly elevated liver enzyme levels and your liver biopsy results indicate little or no liver damage.
Doctors recommend treating long-term (chronic) hepatitis C if you are at risk of developing serious liver damage, such as cirrhosis or liver cancer. The risk of serious liver damage increases if you have high levels of liver enzymes in your blood for at least 6 months and a liver biopsy shows that you have significant liver damage. See a picture of a healthy liver compared to a liver with cirrhosis .
Treatment usually is not recommended if you have major depression, low blood counts, heart disease, a risk of stroke, hyperthyroidism, kidney disease or transplant, an autoimmune disease, or active substance abuse (including alcoholism).
Treatment usually is not recommended if you are pregnant.
Treatment is more likely to stop the virus if you have the genotype 2 or 3 strain of hepatitis C than if you have genotype 1. Most people with hepatitis C have genotype 1.
Significant side effects of medicine include flu-like symptoms, such as sore muscles and fever, irritability, and depression. About 10% to 25% of people stop their treatments because they feel too sick to finish them.¹
Antiviral treatment for hepatitis C is expensive. Sometimes, your insurance company will help pay for the costs of the medicines. If you do not have insurance, you may be able to get help in paying for treatment from the drug companies that make peginterferon.

Medical Information

What is hepatitis C?

Hepatitis C is a liver disease caused by infection with the hepatitis C virus. Most infections begin with a short-term, acute illness that often is so mild that most people who have it do not know anything is wrong. But up to 85% of people who are infected with the virus will go on to develop long-term, chronic hepatitis C.² Over time, hepatitis C can lead to serious liver problems such as cirrhosis, liver cancer, or liver failure.

What is the treatment for hepatitis C?

Treatment involves taking a combination of antiviral medicines: peginterferon and ribavirin. Peginterferon is given as a shot once a week. Ribavirin is a pill taken 2 times a day.

Acute hepatitis C is rarely treated because most people do not have symptoms and therefore are not diagnosed at this stage. But doctors may recommend treating acute hepatitis C when it is diagnosed.

Doctors recommend treatment for chronic hepatitis C when you have a risk of further liver damage, such as from the development of cirrhosis or liver cancer.

How effective is treatment with antiviral medicines?

How well treatment works is measured by whether you still have the virus in your blood 6 months after your treatment has ended. In general, treatment works anywhere from 40% to 80% of the time, depending on different factors, including your viral genotype.³

Your Information

Your choices are:

Try antiviral therapy.
Monitor your liver with regular blood tests and possibly a biopsy to make sure that your liver isn't being severely damaged. (You also will need these blood tests if you try antiviral therapy.)

The decision about whether to take antiviral medicines for hepatitis C takes into account your personal feelings and the medical facts.

**Deciding about antiviral medicines**
Reasons to take antiviral medicine	Reasons not to take antiviral medicine
Antiviral medicine is the only treatment at this time for chronic hepatitis C infection. You are at increased risk of developing cirrhosis over time because you have a chronic hepatitis C infection (elevated enzyme levels for more than 6 months); a high level of virus in your blood, indicating an active infection; and a liver biopsy that shows significant liver damage. You are more likely than not to have a good response to treatment because you are infected with genotype 2 or 3. You have no other serious medical conditions, such as heart disease, poorly controlled diabetes, depression, or active substance abuse. The newer peginterferon medicine (combined with oral ribavirin) only needs to be injected once a week, rather than 3 times a week as is needed for standard interferon treatment. Your health insurance plan will pay for most of the treatment. Or, you have other resources to pay for your treatment. Are there other reasons that you might want to take antiviral medicine for hepatitis C?	About half of people who take these medicines develop significant side effects, including flu-like symptoms, such as fever and muscle aches, as well as anemia and mood changes such as depression. You are not likely to develop cirrhosis, because you have normal or only slightly elevated liver enzyme levels and a liver biopsy shows little or no significant liver damage. You have another serious medical condition such as diabetes, an autoimmune disease, depression, heart disease, or active substance abuse. Studies on the effectiveness of antiviral treatment have not been done on people who have other serious conditions. You have no health insurance, or you have insurance but cannot afford to pay for costs not covered by your plan. Sometimes, however, medicines for hepatitis C are available free of charge through the companies that make them. You will not be able to perform your job or take time off if you have significant side effects from the medicines. Are there other reasons that you might not want to take antiviral medicine for hepatitis C?

These personal stories may help you make your decision.

Wise Health Decision

Use this worksheet to help you make your decision. After completing it, you should have a better idea of how you feel about antiviral treatment. Discuss the worksheet with your doctor.

Circle the answer that best applies to you.

My liver enzyme levels have been elevated for more than 6 months.	Yes	No	Unsure
The genetic material (RNA) of the hepatitis C virus has been found in my blood, which means that I have an active infection.	Yes	No	Unsure
A liver biopsy showed that I do not have any liver damage.	Yes	No	Unsure
I have genotype 1, which is harder to treat.	Yes	No	Unsure
I have genotype 2 or 3, which is easier to treat.	Yes	No	Unsure
I have another serious condition such as diabetes, heart disease, depression, or substance abuse.	Yes	No	Unsure
I am worried about side effects such as flu-like symptoms, depression, and anemia.	Yes	No	Unsure
I feel okay about having a shot once a week (peginterferon).	Yes	No	Unsure

Use the following space to list any other important concerns you have about this decision.

What is your overall impression?

Your answers in the above worksheet are meant to give you a general idea of where you stand on this decision. You may have one overriding reason to take or not take antiviral medicine for hepatitis C.

Check the box below that represents your overall impression about your decision.

Leaning toward taking antiviral medicine

Leaning toward NOT taking antiviral medicine

Return to the topic Hepatitis C.

References

Citations
Group Health Cooperative (2003). Hepatitis C Guideline, pp. 1–27. Seattle: Group Health Cooperative.
Dienstag JL (2005). Chronic viral hepatitis. In GL Mandell et al., eds., Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases, 6th ed., vol. 1, pp. 1441–1464. Philadelphia: Elsevier/Churchill Livingstone.
Lindsay KL, Hoofnagle JH (2004). Chronic hepatitis C. In L Goldman, JC Bennett, eds., Cecil Textbook of Medicine, 22nd ed., vol. 1, pp. 917–924. Philadelphia: Saunders.

Credits

Author	Maria G. Essig, MS, ELS
Editor	Susan Van Houten, RN, BSN, MBA
Associate Editor	Pat Truman, MATC
Primary Medical Reviewer	Kathleen Romito, MD - Family Medicine
Specialist Medical Reviewer	W. Thomas London, MD - Hepatology
Last Updated	August 27, 2007

Author:	Maria G. Essig, MS, ELS	Last Updated: August 27, 2007
Medical Review:	Kathleen Romito, MD - Family Medicine W. Thomas London, MD - Hepatology
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