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Treatment for hepatitis C

Treatments are available for hepatitis C and aim to cure the condition. People with HIV who are newly diagnosed with hepatitis C should consider the pros and cons of starting treatment.

Before treatment is started it is important to have a test to show which strain, or genotype, of hepatitis C you have been infected with, as hepatitis C genotype can predict your response to treatment.

There are at least six types of hepatitis C genotype.

Type 1 is the most common in the UK and Europe. Unfortunately, type 1 responds least well to the currently available treatments for hepatitis C. Genotype 4 is also harder to treat. People with genotypes 2 or 3 respond better to treatment.

Factors such as age, gender, duration of infection, degree of liver damage and whether cirrhosis has developed are also important in predicting if treatment is likely to be effective.

Unlike antiretroviral therapy, treatment for hepatitis C is not indefinite. The length of your course of treatment is dependent upon the genotype you are infected with and how well you respond to treatment. A test after 12 weeks can predict if you are not going to respond to treatment at all. If that is the case, your doctor may suggest you stop treatment.

The current treatments for hepatitis C are ribavirin and pegylated interferon.

Treatment with pegylated interferon and ribavirin is now the standard of care recommended in the UK. Improved response rates are also seen when ribavirin is dosed according to a patient’s weight, and avoiding dose reduction. Supporting therapy may be provided, where needed, with a hormone called erythropoietin (EPO).

The best results in people with HIV are seen when treatment is provided soon after a person is infected with hepatitis C. Up to 65% of people who are given treatment at this time, even when infected with the harder-to-treat strains of hepatitis C, clear the virus.

The response rate is much lower – about 30% – when treating hepatitis C that has become chronic in people with the harder-to-treat genotypes 1 and 4, and higher in people with genotypes 2 and 3.

Some people respond to hepatitis C treatment more slowly, and in these cases it may be recommended that they stay on treatment for up to 72 weeks.

If you don’t respond to treatment, a second attempt may be possible in some circumstances. This is especially the case if you were not given weight-based ribavirin, or had pegylated interferon or ribavirin dose reductions during treatment, or if you were taking anti-HIV drugs that could interact with your hepatitis C treatment. There may also be new, more effective drugs available in the future.

Your clinic nurse will need to take regular blood specimens while you are on treatment (usually every month) to monitor your health and how you are responding to treatment. They should also be able to provide you with support to increase your chances of taking all the doses of your treatment, and give you tips, support and treatment to reduce any side-effects of the medication.

Aims of hepatitis C treatment

The aim of treatment should be to eradicate hepatitis C virus completely. Doctors often talk about achieving a ‘sustained viral response’, or SVR, which means that you have no detectable hepatitis C virus in your body six months after your treatment has ended. You will not be considered to have an SVR unless you still have an undetectable hepatitis C viral load at this point.

Side-effects

The side-effects of hepatitis C treatment can be severe, though they can lessen as treatment goes on and, as with the side-effects of any drug, will differ in severity from person to person.

Side-effects may include high temperatures, joint pain, weight loss, skin problems, thinning hair, feeling sick, and depression. Depression is particularly common in people taking interferon and you may be offered antidepressants if you are taking this drug. Some people choose to take an antidepressant to prevent depression occurring. (You can find more information on the links between depression, hepatitis and hepatitis treatment, and on managing depression in NAM’s booklet, HIV, mental health & emotional wellbeing, in this patient information series.)

Other major side-effects of interferon include blood abnormalities such as low haemoglobin (anaemia), a low white blood cell count (neutropenia), and/or a low platelet count (thrombocytopenia).

Anaemia is a common side-effect and can lead to fatigue and shortness of breath. Doctors may use injections of erythropoietin (EPO) to increase red cells and haemoglobin to counter this. Injections of another drug, G-CSF (filgrastim), can also be used to increase white cell counts.

Most HIV-positive patients will experience a decrease in their CD4 cell counts whilst on treatment with interferon. This is an interferon effect rather than an HIV effect. Once treatment is complete the CD4 counts should return to the level they were at when hepatitis C treatment was started.

Ribavirin must not be given to pregnant women. It is possible that this could lead to the loss of the baby, or the birth of a baby with deformities or other problems. 

Ribavirin can enter the sperm. It is important that sperm that contains ribavirin is not allowed to start a pregnancy and that ribavirin is not allowed to reach an unborn child. Couples who have been treated with ribavirin should avoid pregnancy for at least six months after the completion of treatment.

If either you or your partner has been taking ribavirin and you think there is a chance of pregnancy, tell your doctor straight away.

Drug interactions

The drugs used to treat HIV and hepatitis C can interact, so also needing hepatitis treatment can affect your choice of HIV treatment.

The anti-HIV drug ddl (didanosine, Videx) should never be taken with anti-hepatitis C drugs.

If you have other options available, you should not take AZT (zidovudine, Retrovir, also in Combivir and Trizivir), or d4T (stavudine, Zerit), at the same time as treatment for hepatitis C.

Abacavir (Ziagen, also in the combination pills Kivexa and Trizivir) may reduce levels of ribavirin, so its use should be avoided if possible.

Hepatitis C drugs in development

Many doctors are optimistic that much better drugs will be available for hepatitis C in the future. These include hepatitis C protease inhibitors and polymerase inhibitors. However, it could be a few years before these drugs are available. If you have less serious liver damage, you may want to discuss with your doctor whether waiting for new drugs would be appropriate for you.

One option is to consider joining a clinical trial, if there’s one available. You should discuss the pros and cons of this with your doctor. This may be an important option for people who have tried hepatitis treatment in the past.

HIV & hepatitis

Published August 2010

Last reviewed August 2010

Next review February 2014

Contact NAM to find out more about the scientific research and information used to produce this booklet.

Hepatitis information

For more information on hepatitis visit infohep.org.

Infohep is a project we're working on in partnership with the European Liver Patients Association (ELPA).

Visit infohep.org >
This content was checked for accuracy at the time it was written. It may have been superseded by more recent developments. NAM recommends checking whether this is the most current information when making decisions that may affect your health.