Living With HepC

When should I consider treatment?

For some people deciding to do treatment has not always been an easy decision. Perhaps the main concern with HCV treatment using interferon/ribaviron has been the adverse effects that can be caused by the pharmaceutical drugs used. As the years have gone by it has also become very apparent that post treatment problems are an issue for some people.

The ‘pros’ of doing treatment

The major advantage which treatment offers you is that it’s the only ‘proven’ way of clearing the virus. People have undoubtedly cleared the virus in other ways, but only in very small numbers. So far there has been no other way that has been shown to work more consistently than interferon and ribavirin, then with an added protease inhibitor for genotype 1, However there are many new treatments about to come online that are shorter, easier to handle with less side effects during treatment and with a higher rate of SVR. Achieving a sustained viral response has also been shown to improve the health of the liver by reducing inflammation. It may also be able to reverse fibrosis or even cirrhosis. 

Aside from health, there are other benefits from clearing the virus. One of these is financial. You should find that any insurance connected with your health becomes significantly cheaper. This could make an important difference to your mortgage. If hepatitis C has made you incapable of working, once the virus has been cleared you may find you can go back to work.

Knowing that you are no longer carrying an infectious and harmful virus may also help you to feel better about yourself. If you are a woman, there is a small risk of passing hepatitis C to any child you give birth to. Clearing the virus would remove that risk. If treatment is successful, then you no longer risk infecting other people, through such ways as sharing a toothbrush or razor.

The cons of doing treatment

The major disadvantage to treatment consists of the side effects. Not everyone necessarily experiences them. There are things you can do to keep them to a minimum but it’s possible that you may feel quite unwell some of the time. It can take a few months after the treatment ends before the drugs are cleared from your system. Ribavirin can take up to 6 months to clear. Treatment could therefore impact on your work (you might have to take time off), on your relationships, and on your social life. This might mean you have to tell people that you are doing treatment and therefore that you have hepatitis C.

Occasionally, the side effects can be so severe that they could force you to abandon treatment. You could even be left with an illness after you stop treatment, such as thyroid disease or diabetes, although this is unlikely. Some people have reported that the side effects have persisted, leaving them feeling unwell long after the end of treatment. There is also the possibility that treatment might not work for you.

The information in the last two paragraph applies to the current standard of care which is in the process of change. Treatment with interferon/ribaviron and  telaprevir or boceprevir can produce the effects mentioned above. New treatments coming on-line are much easier to handle with less side effects. 

Some of these you may want to take into account are:

What are your priorities? Is clearing the virus your top priority? What are your individual chances of clearing the virus?

This will be most dependent on your genotype. Roughly, you have a 50% chance if you are genotype 1, or 70% if you are taking one of the new protease inhibitors, a better than 80% chance if you are genotype 2 and perhaps a 70% if you are genotype 3 (this is a little uncertainty as traditionally genotypes 2 and 3 have been considered together but it is now becoming clear that genotype 3 is very significantly less responsive to treatment than genotype 2).

With new treatments the chance of clearing the virus in raised to figures of approx 80% to 100% in some cases.

How long will you need to do treatment for?

If you are genotype 2 or 3, current treatment will generally last 24 weeks. If you are any other genotype (or if you have other complications) it will in most cases last 48 weeks, which is almost a year. 

Again the new treatments have changed some treatment times cutting many in half.

Questions, questions, questions...

The big question at the moment is are you prepared or able to wait for the availability of better drugs? From May 2015 the HSE has promised to make €30 Million available to treat all patients with cirrhosis with new drugs. 

If you don't have cirrhosis then it's possible that a delay of 1 to 2 years is possible.

Will you be able to deal with any side effects? If they are particularly difficult, will you be able to get the support you need?

Will you be able to plan your life around treatment? Can you be available for hospital visits, which are fairly frequent? Can you take time off work or other responsibilities if you have to?

Are you thinking of conceiving a child in the next year? (You should not conceive, as either a man or a woman, during treatment or for at least 6 months afterwards).

Be informed

The best way to come to the right decision is to be equipped with the right information. The following sections about conventional treatment are intended to help you to do that. Please take the time to read through them. Once you are informed, discuss it with your doctor. The idea behind medicine in the 21st century is that you and your doctor should work in partnership to improve your health. We are no longer in the era where the patient obediently does whatever the doctor says.

It is important to remember that deciding whether or not to do treatment is not clear-cut or easy. If anyone suggests otherwise, this may be because they have an agenda that is different from yours. This could include your doctor. If they really push you towards a decision, arm yourself with the facts and ask them why.

Other information that might be useful