Turning the Corner in Hepatitis C Treatment (cont.)
Even when hepatitis C treatment works, it can be difficult. Therapy lasts from 24 to 48 weeks. It requires weekly injections and regular check-ups. While pegylated interferon causes less severe side effects than older drugs, it can cause flu-like symptoms, fatigue, depression, muscle aches, and hair loss. More severe side effects are rare. Ribavirin can also cause potentially serious anemia.
"A lot of people come in expecting the treatment to be awful," says David Thomas, MD, professor of medicine at Johns Hopkins School of Medicine. "But it's often not so bad."
Also, while the length of treatment -- up to a year -- might seem daunting, Thomas encourages his patients to look at it in smaller steps.
"Within a couple of months of starting treatment, we can usually tell if it's working," Thomas says. He explains that if tests show that treatment isn't working after a few months, it's very unlikely that a full year's worth will do any good. As a result, your doctor may suggest stopping treatment.
But if treatment is working after a few months, there's almost a 70% chance that a full cycle of treatment will cure the disease, says Thomas. So a person has a good idea if treatment will work before committing to a whole year of it.
Who Needs Hepatitis C Treatment?
Before a person gets caught up in the pros and cons of treatment, it's important to consider a more basic question: do you need treatment at all? In many cases, you don't.
"A lot of people and even some doctors act like hepatitis C is cancer," says Howard J. Worman, MD, associate professor of medicine at Columbia University's College of Physicians and Surgeons. "They behave as if you'll get sick and die if you don't treat it right away. But that isn't what hepatitis C is like."
Since hepatitis C may not cause problems for decades, if at all, merely having the virus is no reason to begin treatment. Instead, doctors usually consider hepatitis C treatment in people who have high viral levels and biopsies that show fibrosis, or scarring of the liver.
"Deciding whether to get treatment is almost never an emergency," Worman tells WebMD. "It's usually not even urgent. People should take their time in deciding what to do."
In cases where a person has acute hepatitis C -- meaning that he or she has recently been infected - Worman does advise quick treatment because it's likely to work in the early stages. However, he and other experts don't see many cases of acute hepatitis. Most of the people newly diagnosed with hepatitis C have had the virus for a long time.
One frustrating aspect of the disease is that it's hard to predict how it will develop in any one person. While many people will go decades without problems, others will have faster progression of the disease. No one knows why. Currently, the only good way to find out how a person is doing is with periodic liver biopsies.
If Treatment Doesn't Work
Don't assume that you will suffer serious complications if treatment fails. It's true that there is no other combination of medications that works as a second line of defense right now. But behavioral changes, such as reducing or cutting out alcohol, can make a difference. The disease itself progresses so slowly that researchers may develop new hepatitis C treatments before you run into serious problems, if you ever do at all.
Doctors and researchers are also looking into the possibility that continuing treatment with peginterferon and ribavirin may have benefits even in people who didn't have sustained response. Continued therapy may be able to suppress the virus, even if it can't get rid of it. However, because treatment does have risks, it's important to be cautious in prescribing long-term therapy.
"A lot of people are doing research on the benefits [of continued therapy]," Thomas tells WebMD. "We're trying to figure out whether it helps."
Researchers are currently looking at other drugs that might help. One possible approach is to add a third drug -- amantadine -- to pegylated interferon and ribavirin. Preliminary results look like the triple combination might help, but more research is needed.
Also, don't worry that you're on an irrevocable path to a liver transplant. You may have heard the statistic that hepatitis C is the leading cause of liver transplants in the US. While it's true, that statistic shows just how common hepatitis C is in the population. According to the Organ Procurement and Transplantation Network there were fewer than 6,200 liver transplants total in the U.S. in 2004. However, there are almost 4 million people with hepatitis C in this country. So you don't need to be a statistical wiz to see that the vast majority of people with hepatitis C never need a liver transplant.
Worman encourages his patients to look at a possible transplant from a positive perspective.
"Instead of being afraid of that small chance that they'll need a transplant," Worman says, "I tell my patients to look at it as an insurance policy. Most people never get that sick. But if you're one of the few who do reach that stage, you should be assured by the fact that even then, we can still do something."
Alternative Therapies for Hepatitis C
Turning to alternative therapy may be tempting for people with a disease like hepatitis C. After all, treatment is difficult and may not work in half the people. You may feel like there's no harm in giving an alternative treatment a shot first.
Understand that no matter what you might find in books or on the Internet, researchers have not found a diet, supplement, or herbal remedy proven to treat hepatitis C.
"I think there should be studies of these alternative medicines," says Thomas. "But until we have good evidence, they should be considered experimental."
Some herbs that look more promising than others. Milk thistle has been used for centuries for various liver complaints, and studies have shown mixed results. Currently, the National Center for Complementary and Alternative Medicine at the National Institutes of Health is sponsoring a clinical trial of milk thistle in people with hepatitis C. [NOTE for JAYNE: I checked and there are no results yet, it seems.]