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Hepatitis is a liver disease caused by a virus, resulting in inflammation and possible liver damage. Of the many types of viruses causing hepatitis, the hepatitis C virus (HCV) is the most common cause of chronic liver disease, which leads to liver failure and end-stage disease.
Why Early Treatment of Hepatitis C is Necessary
Hepatitis C is known to be passed through direct contact with infected blood. This may come from blood transfusions, organ transplants, tattooing and body piercing, but the most common route is through shared needles from illegal drug abuse. Most people who are infected do not know they have the disease until they develop liver damage that results in chronic liver disease around two decades after they have been infected. Acute symptoms, if any, manifest as flu-like symptoms, which may include fatigue, poor appetite, fever, nausea, muscle pains, joint pains, and yellowing of the eyes and skin. For most infected people, symptoms appear only when liver damage has occurred and is discovered through a blood test.
Early treatment of hepatitis C is necessary to avoid complications from chronic hepatitis C. About a quarter of patients eventually develop serious liver disease such as cirrhosis and liver cancer after several years, for which there is no cure. Only a liver transplant could possibly prolong life if successful. However, according the American Liver Foundation, with early treatment, sustained viral suppression may be achieved in up to 40% of patients and cure or eradication of infection obtained for a few patients.
Standard Treatment of Hepatitis C
A person who tests positive for Hepatitis C but does not have physical or laboratory evidence of liver inflammation or damage (acute infection) may not need any treatment. Although some studies suggest that a short course of interferon therapy for acute hepatitic C infection may reduce the risk for chronic liver disease, it is not easy to identify or screen patients for infection especially if they do not have symptoms. Furthermore, the risks for side effects from drug therapy may outweigh the benefits of treatment if liver disease is not apparent. However, monitoring of liver function and follow-up tests may be recommended.
This is currently the gold standard and mainstay of hepatitis C therapy. Another type of drug (a protease inhibitor) such as telaprevir (Incivek) or boceprevir (Victrelis) may also be added to the treatment regimen . These medications are used for six to twelve months to help the body suppress or eliminate the virus. However, relapses or nonresponse to treatment may occur, and treatments may be repeated. Others may experience side effects for which adjustment of dosages may be necessary.
Advanced liver disease due to hepatitis C involves supportive therapy to support liver function and manage complications. Only a liver transplant may restore liver function but interferon therapy may be continued because hepatitis C infection may recur even in the new liver.
Interferon Therapy for Hepatitis C
Interferon is a protein (cytokine) naturally produced and secreted by immune cells of the body in response to an invading microbe, such as a virus. It acts as an immune-regulating and antiviral chemical, which interferes with a virus's ability to make copies of itself (replicate). In addition, interferon boosts the strength of special immune system cells to fight the viruses. Scientists have found that synthetic interferons, when administered to the body infected with a virus, may help fight or suppress the virus.
There are different types of interferons (alpha, beta and gamma) and their sub-types. Alpha interferon has been used for the treatment of hepatitis B and C, leukemia, genital warts, Kaposi’s sarcoma and some cancers of the bone marrow and blood. It has been the standard treatment for hepatitis C until pegylated interferon (PEG interferon), a new form of interferon was discovered. This is a long-acting, time-release interferon, which is administered less often than the alpha interferon (once or twice a week versus daily injections).
Interferon therapy for hepatitis C is often combined with another antiviral agent called ribavirin, a medication that is taken orally. It is a synthetic analogue of the cellular genetic material (RNA or DNA) that “misleads” the virus to use it, thus slowing down its replication. Although combination therapy may have more side effects that using interferon alone, it is able to sustain viral response in up to 50% of patients. This means that the ultimate goals of therapy are met: HCV is eliminated, transmission is prevented, liver tests show improvement, and progression of the disease is prevented.
In addition, protease inhibitors, a new class of drugs, has been approved for the treatment of Hepatitis C . These medications include boceprevir (Victrelis) and telaprevir (Incivek), which are given in combination with PEG interferon and ribavirin. This mode of treatment can shorten the overall duration of therapy for some patients.