Hepatitis C: Should I Take Antiviral Medicine?

Hepatitis C is a virus that infects the liver. You can get hepatitis C when you share needles to inject illegal drugs with someone who has the virus. You can also get it by having a shot, tattoo, or piercing with a needle that has infected blood on it.

When most people get hepatitis C, they don't even know they have it. Early symptoms are mild and don't last long.

Some people who get the virus have it for a short time and then get better. This is called acute hepatitis C. But up to 85 people out of 100 who are infected with the virus get long-term (chronic) hepatitis C.¹ "Chronic" means that the virus is active in your body for more than 6 months.

Chronic hepatitis C can cause swelling and tiny scars to form in your liver. When this happens, your liver doesn't work well. About 25 out of 100 people who have chronic hepatitis C get more serious liver problems such as cirrhosis, liver cancer, or liver failure. This most often happens over a period of 20 years or more.² If the damage is severe, you may need a liver transplant.

A combination of antiviral medicines is the main treatment for hepatitis C. When used together, peginterferon and ribavirin can stop or slow the growth of the virus. A protease inhibitor (such as boceprevir or telaprevir) also may be added to increase effectiveness.

Treatment may be needed for 6 months to 1 year.

If you have chronic hepatitis C, you may need treatment. Your chance of getting serious liver disease is higher if your liver is damaged and the levels of the virus and liver enzymes in your blood have been high for at least 6 months.

Results from your blood tests can help you and your doctor decide if you should start treatment. Your doctor may also take a tiny piece of your liver, called a biopsy, to see if it has been affected by the virus.

You may not need to take medicines if your liver isn't damaged and the level of liver enzymes in your blood is normal or only a bit higher than normal.

Doctors likely won't want you to use these medicines if you are pregnant or if you have:

• Major depression.
• Heart, kidney, or thyroid problems.
• Advanced cirrhosis of the liver.
• Low levels of red cells, white cells, and platelets in your blood.
• An autoimmune disease.
• Had an organ transplant.
• Drug or alcohol abuse problems.

Even though hepatitis C is serious, most people can manage the infection and lead active lives. Two key steps are to take good care of yourself and get regular checkups to watch for liver problems.

Antiviral medicines can stop or slow the growth of hepatitis C and help prevent serious liver problems. There are several types of the hepatitis C virus that cause infection. Six different strains (genotypes) of hepatitis C have been found. Most people in the United States have genotype 1.

Studies have shown that:

• A combination of peginterferon and ribavirin works for as many as 45 out of 100 people with genotype 1.³ This means that it doesn't work for the other 55 people.
• The combination also works for as many as 80 out of 100 people who have genotype 2 or 3.³ This means that combination therapy doesn't work for 20 out of 100 people who have these genotypes.
• Adding a protease inhibitor (such as boceprevir or telaprevir) to peginterferon/ribavirin therapy controls hepatitis C in up to 88% of people with genotype 1.⁴

Antiviral medicines may not decrease the amount of the virus in your blood. But some studies have shown that treatment may still reduce scarring in your liver. This can lower your chance of getting cirrhosis and liver cancer.^{5, 1}

A combination of medicines is more likely to work if you have:

• Low levels of the hepatitis C virus in your blood when you start treatment.
• Small amounts of liver damage when you start treatment.
• Genotype 2 or 3.

Treatment may not be an option for everyone who has hepatitis C. These medicines don't work for everyone, and they cost a lot. Some insurance companies may cover all or part of the cost of these medicines. If you don't have health insurance, the drug company that makes peginterferon may be able to help cover the cost of your treatment.

What are the side effects of antiviral medicines?

About half of the people who take both peginterferon and ribavirin have serious side effects during their treatment. Some people may need to stop taking their medicines because the medicines make them feel very sick. Talk to your doctor if your hepatitis C medicines are causing serious side effects.

Side effects of the peginterferon and ribavirin combination therapy include:

• Fatigue, headache, fever, chills, and muscle and joint aches.
• Nausea, loss of appetite, and weight loss.
• Irritability, insomnia, and confusion.
• Depression.
• Thyroid problems.
• Hair loss or skin rash.
• Low levels of red cells, white cells, and platelets in your blood.

Side effects of the protease inhibitors boceprevir and telaprevir include:

• Fatigue.
• Rash or itching.
• Nausea and diarrhea.
• Headache.
• Low red blood cell count (anemia).

Why might your doctor recommend antiviral medicines?

Your doctor might advise you to take antiviral medicines if:

• You have active infection. This means that you have high levels of the virus in your blood.
• Your liver enzyme levels are more than twice the normal amount.
• You are likely to develop serious liver disease such as cirrhosis or liver cancer.
• You have mild to severe liver damage.
• You have another serious health problem, such as HIV infection.