Managing Hepatitis C with Interferon Therapy

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.

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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.

Side Effects Of Interferon Treatment For Hepatitis C

The most common side effects of these drugs are fatigue, fever, headache, muscle pains and insomnia. Gastrointestinal side effects such as nausea, loss of appetite and diarrhea are also common. It is notable that these are also the symptoms one experiences when the body normally reacts to a virus infection as it naturally fights the infection with its own interferon. Less common side effects include hair loss, skin rashes, chest pain, difficulty breathing and visual changes.

Interferon can lower blood cell counts, leading to anemia or increased susceptibility to infections. The treatment might affect thyroid function, causing it to be overactive or underactive.

To reduce the side effects, doctors may adjust the dosages of interferon and ribavirin. Patients are also advised to take acetaminophen for headaches, fever and body pains, and to take some rest and enough sleep for other symptoms. Supportive therapy is often given because most symptoms may subside as the body adapts to the medications.

How Effective is Interferon Therapy?

This depends on how much virus is in the blood, the genotype of the virus, and how much your liver has already been damaged. People who have been infected with hepatitis C genotype 1 are the most difficult to treat and will probably need 12 months of combination treatments. Those who have been infected with genotypes 2 or 3 may need at least six months of treatment with pegylated interferon and ribavirin. People who have low levels of the virus in the blood and have a low level of liver damage when treatment starts are also more likely to respond to treatment. In general, studies show that interferon treatment for genotype 1 is effective in up 50% of patients and higher for those with genotype 2 or 3 (80%).

A few patients, however, will not respond to initial treatment or will experience a relapse after treatment. Therapy may be repeated to reduce liver inflammation, slow down the progression of liver damage and reduce the risk of cirrhosis or liver cancer.

Coping with Hepatitis C and Side Effects of Interferon Treatment

Patients may experience various symptoms of the disease or side effects of treatment with antiviral drugs. To cope with these, doctors advise patients to slow down, adjust their schedules and allow themselves more time to rest. Although strenuous exercise is not recommended after interferon treatment, one may do some physical activity as tolerated. This will improve your energy levels and reduce depression, which some patients experience.

Over-the-counter pain relievers can alleviate flu-like symptoms. For depression or mood changes, consult your doctor - they might refer you to a mental health specialist or adjust your medication.

Read More: Hepatitis C Kills More Americans Than Hiv

It may be necessary to consult a dietician for a suitable diet. Patients with hepatitis often lose their appetite and experience gastrointestinal discomfort such as nausea. A nutritious diet with plenty of fruits and vegetables is recommended. Salty foods must be avoided.

It is also important to avoid taking unnecessary drugs and alcoholic beverages. Consult your doctor about using prescription medicines, over-the-counter drugs and dietary supplements. People who have an alcohol or drug abuse problem must seek professional help to deal with their condition to reduce their risk of liver failure. Family and group support are also important for patients coping with the stigma of the disease.

While it may seem challenging, focusing on the end goal of treatment - eradicating the virus - can provide motivation. Remember, medical treatments continue to evolve, and the journey with Hepatitis C today is more hopeful than ever before.