Hepatitis - Outlook

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Treatment is generally recommended for patients with chronic hepatitis C who are at least 18 years old and have:

• Detectable virus levels as measured by an HCV RNA test
• An increased risk of developing cirrhosis
• Indication of liver scarring (fibrosis) as detected by liver biopsy
• Abnormal levels of alanine aminotransferase (ALT), an indication of liver cell damage

Treatment is generally not recommended for people who have:

• Advanced cirrhosis or liver cancer
• Major uncontrolled depression, particularly if they have attempted suicide in the past
• Autoimmune hepatitis or other autoimmune disorders such as hyperthyroidism
• Received bone marrow, lung, heart, or kidney organ transplantation
• Severe high blood pressure, coronary artery disease, heart failure, kidney disease, or other serious non-liver disorders that may affect life expectancy
• Severe anemia (low red blood cell count) or thrombocytopenia (low blood platelet count)
• Women who are pregnant or who do not use birth control
• Patients who actively abuse drugs or alcohol may not be appropriate candidates.

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Side Effects of Treatment. Side effects of combination treatment include those caused by both pegylated interferon and ribavirin.

Side effects and complications of pegylated interferon include:

• Fatigue
• Flu-like symptoms (such as fever, chills, and muscle aches)
• Nausea and vomiting
• Headaches
• Weight loss
• Irritability
• Depression
• Hair thinning
• Bone marrow suppression
• Soreness at the injection site
• Serious infections

Side effects and complications of ribavirin include:

• Anemia, which can worsen heart disease
• Fatigue
• Severe itching
• Rash
• Cough
• Shortness of breath
• Birth defects

Investigational Drugs for Chronic Hepatitis C. The current drugs used for hepatitis C still do not meet the needs of all patients. They are expensive, have significant side effects, do not work in half the patients who take them, and are unsuitable in many others. Investigation is ongoing to find better solutions. Telaprevir and boceprivir are two new protease inhibitor drugs that are being tested in combination with interferon and ribavarin. These drugs have shown promising results in clinical trials for improving response rates for HCV genotype 1, but have potentially serious side effects including rash and severe anemia.

Review Date: 09/29/2010
Reviewed By: Harvey Simon, MD, Editor-in-Chief, In-Depth Reports; Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org).