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Treatment for Hepatitis C has three goals:
- Removing (or clearing) all of the Hepatitis C virus from your body
- Stopping or slowing down damage to your liver
- Making you feel better
There have been significant advances in treatment success rates over the past decade. The most commonly used treatment today involves a two-pronged approach that uses an injectable Interferon combined with the oral medication, Ribavirin. Approved pharmaceutical treatments in Canada include:
Standard Interferon:
Synthetic Interferon is a genetically engineered product based on a natural set of proteins found in the body. Standard interferon is given by a subcutaneous (under the skin) injection, up to three times a week. At present, standard interferon is less commonly used. Pegylated Interferon has become the interferon of choice for HCV treatment.
Pegylated Interferon:
Pegylated interferon is a long-acting form of interferon that is injected only once a week. Pegylated interferon maintains a more constant level of interferon in the blood thereby reducing the ability of the Hepatitis C virus to replicate.
Ribavirin:
Ribavirin is an oral antiviral medication used in combination with interferon to treat HCV infection. Ribavirin alone is not effective in combating HCV.
Ribavirin Waring:
Ribavirin has been shown to cause birth defects and miscarriages. Women of childbearing age, their male partners, and female partners of males taking ribavirin, must use at least two different effective forms of contraception during drug treatment and during the six-month post treatment period.
Treatment Decisions:
While most people benefit from and respond well to treatment, not everyone with Hepatitis C needs to start treatment immediately. The decision to initiate treatment is a joint one - made between you and your health care provider. Beyond the initial decision to start treatment, you and your health care provider will need to decide "when" to start treatment. Talking to the important people in your life, such as your partner, family members and trust friends, can also be helpful during the decision making process.
Watchful Waiting:
You and your health care provider may choose not to embark upon treatment at this time. Rather, your health care provider may advise a period of "watchful waiting". Watchful waiting does not mean doing nothing. Instead, it means that your health care provider will carefully monitor the progress of your Hepatitis C while keeping the option of medical treatment open. You will be an active participant in watchful waiting by monitoring your overall health and symptoms and reporting back to your health care provider as well as by incorporating healthy lifestyle changes into your management strategy. Watchful waiting involves effective teamwork with your health care provider that must include open and honest communication.
Watchful waiting involves regular testing as follows:
- Having liver enzyme blood tests two times a year
- The possibility of having a liver biopsy every three to five years
- Going to regular appointments with your health care provider
- Following your health care provider's lifestyle recommendations, because reducing further damage to your liver is crucial
Deciding on Treatment:
Choosing to treat your Hepatitis C is one of the most significant decisions you will ever make. Before making that decision, both you and your health care provider will require more information. For example, your health care provider will need to determine what Genotype of the Hepatitis C virus you have. Differing genotypes respond differently to treatment.
Your health care provider will do a thorough assessment of your current and past, personal and family medical history. He or she will also weigh you (The dosage of some treatments are given according to body weight) and check for current medical conditions.
Your health care provider may ask you questions about your use of alcohol and/or recreational drugs. It is important to answer these questions honestly. Remember, your health care provider is trying to help you. He or she may also assess you for signs of psychiatric illnesses. The treatment protocol of depressive illness may not exclude you from treatment but your health care provider will want to monitor your well-being.
Your health care provider may refer you to a specialist for assessment, monitoring and management of your HCV treatment.
A Gastroenterologist is a medical doctor who specializes in the diagnosis and treatment of diseases of the digestive system, such as hepatitis, ulcerative colitis, Crohn's disease, and colon or rectal cancer. Gastroenterologists may perform many specialized tests, such as endoscopy, to diagnose or treat diseases. When necessary, they may consult with surgeons.
A Hepatologist is a gastroenterology doctor who further specializes in the diagnosis and treatment of diseases of the liver, such as hepatitis or cirrhosis, and most have also completed additional study in the are of liver transplantation. Hepatologists may perform many specialized tests to diagnose liver disease or obtain liver biopsies.
Every person's situation is unique. Your health care professional(s) will work together with you to determine the starting of HCV antiviral therapy. This complex decision will take into account; your interest, clinical and laboratory findings, the probability of disease progression without therapy, odds of treatment success, contraindications for therapy, likelihood of unpleasant side effects and any barriers to your ability to stay committed to the treatment regiment.
Note:
Every time you call your health care provider, pharmacy, provincial or territorial government, social service provider, drug benefit company or insurance company, keep notes of dates, names and issues that you discussed. Having a bound notebook for this purpose is useful.
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