Hepatitis C Treatment and Side Effects
Treatment for hepatitis C today is a combination of pegylated interferon and ribavirin, which has been approved for the Pharmaceutical Benefits Scheme (PBS). In rare instances, pegylated interferon monotherapy may be used.
Interferon is a substance naturally produced by the body to defend itself from infections, including the hepatitis C virus, and tumours. The interferons used in treatment are synthetically manufactured and taken in much higher doses than would occur naturally in the body. They work to boost the body’s normal defences against hepatitis C. Interferon was the first proven treatment for hepatitis C, requiring three subcutaneous (under the skin) injections per week, and effective for only a small number of people.
The addition of a large polyethylene glycol (PEG) molecule to interferon produces a molecule that lasts a lot longer in the body, meaning that only one injection per week is required. This change has resulted in considerably fewer peaks and troughs in drug levels in the blood, greater tolerability and improved effectiveness in fighting the hepatitis C virus.
Ribavirin is an antiviral drug which, when given in combination with pegylated interferon, reduces the virus’ ability to reproduce. The dosage of ribavirin is based on a person’s weight and is taken orally twice daily. Some people may require a dosage adjustment during treatment.
CAUTION: Ribavirin should not be used while pregnant, or planning on becoming pregnant, or by men whose female partners are pregnant or planning to become pregnant. Ribavirin is a category X drug (causes birth defects) and must not be given to pregnant women. Pregnancy in female patients or in the partners of male patients must be avoided during treatment and during the 6 month period after stopping treatment. It has been shown to cause serious birth defects and other problems in animal studies. It is not known whether ribavirin passes into human breast milk. However, ribavirin does pass into the breast milk of animals and can cause problems for their offspring.
Subsidised pegylated interferon and ribavirin treatment, managed by an accredited treatment centre, is available to people who satisfy all of the following PBS S100 criteria:
- Must be 18 years or older
- Must have compensated liver disease
- Documented chronic hepatitis C infection (repeatedly anti-HCV positive and HCV RNA positive);
- Female patients of child-bearing age are not pregnant, not breast-feeding, and both patient and their partner are using effective forms of contraception (one for each partner).
- Male patients and their partners are using effective forms of contraception (one for each partner).
- Female partners of male patients are not pregnant.
Note: Treatment centres are required to have access to the following appropriate specialist facilities for the provision of clinical support services for hepatitis C:
- a nurse educator/counsellor for patients; and
- 24 hour access by patients to medical advice; and
- an established liver clinic; and
- facilities for safe liver biopsy.
http://www.pbs.gov.au/html/healthpro/search/results?term=peginterferon&publication=&form-type=simple. Downloaded 2 July 2010, page last updated 1 July 2010.
Treatment duration is based on genotype and liver health.
- Genotypes 2 and 3 without cirrhosis or bridging fibrosis receive 24 weeks of treatment.
- Genotypes 2 and 3 with cirrhosis or bridging fibrosis may receive 48 weeks of treatment.
- Genotypes 1, 4, 5 and 6 receive 48 weeks of treatment.
For anyone undertaking the 48 week course of treatment and having genotype 1, 4, 5 or 6 there is a requirement that certain goals be achieved by week 12. These are as follows:
- The hepatitis C virus is undetectable in the blood (negative PCR), OR
- The viral load has decreased by at least a 2 log drop – the virus must then be undetectable at week 24 to continue with treatment.
For people with genotype 2 or 3 with cirrhosis or bridging fibrosis treatment may only continue after the first 24 weeks if the virus is undetectable at that time.
For those who have previously undergone treatment which has been unsuccessful, re-treatment is available for up to 48 weeks but the virus must be undetectable at week 12.
Combination therapy of pegylated interferon and ribavirin requires one self-administered subcutaneous (under the skin) injection per week and twice daily tablets of ribavirin for the duration of the treatment. It is important that a routine be established and adhered to so that the drug levels in the body are maintained at a therapeutic level and the treatment has the greatest opportunity of effectiveness. Therefore, planning is important in deciding which day of the week the pegylated interferon injection will be taken and the timing (morning and night) of the ribavirin dosing.
As with any medication, pegylated interferon and ribavirin treatment may have unwanted side effects. All of the possible side effects of pegylated interferon and ribavirin are not experienced by everyone undertaking treatment and the degree to which they are experienced is variable. It has also been noted that the severity of some side effects of pegylated interferon are reduced when compared to unpegylated interferon. Some of the more common side effects include.
- Myalgia (muscle pain)
- Flu-like symptoms
- Mood swings
- Loss of concentration
- Skin rashes and dry skin
It has been found that many people who plan strategies around the possible side effects of treatment manage the treatment experience more ‘easily’ than those who don’t plan. While the majority of people either don’t suffer severely from side effects or are able to manage their side effects well, some will experience side effects more severely and find them more difficult to manage. There is no way of predicting who will or will not experience the various side effects, or to what degree they may be experienced. It is important that people planning to undertake combination treatment for hepatitis C take the likelihood of side effects seriously. They should plan strategies for managing side effects and explore their practical and emotional support options prior to beginning the treatment. Support in planning strategies is available both from the Support Officer at HepatitisWA and from the nursing staff at the liver clinics.
Managing Side Effects
Some side effects may require medical intervention, e.g. depression may require antidepressant medication, while other side effects can be effectively self-managed. There are some simple guidelines for managing most side effects, some of which are listed below.
It is important to maintain a positive, but realistic attitude while undertaking treatment. Studies show a positive attitude is beneficial in a number of illnesses and treatment situations. A recent report into the experiences of hepatitis C treatment defines positive attitude as one of the factors that helped people cope with the side effects they experienced. It may, however, be difficult at times to do this. Some steps that may help in maintaining a positive attitude are listed below:
- Make a list of the reasons for undertaking treatment
- Read them often
- Each morning think of things to be grateful for
- Restructure negative thoughts into positive thoughts
- Each night, define what worked (and what didn’t) during the day
- Congratulate yourself at the end of each day–you are a step closer to achieving your goal of treatment completion
(Max Hopwood, Carla Treloar, Louise Redsull – Monograph 4/2006 – Experiences of hepatitis C treatment and its management: What some patients and health professionals say – NCHSR)
An effective support system in place prior to going on treatment is important. Secure support from as many people as possible including family, friends, work colleagues and health care providers. Find out about support available from HepatitisWA and Liver Clinics.
One of the most important factors in maintaining good health, exercise is beneficial in reducing treatment-related fatigue and is important in helping you feel better physically and mentally. Moderation is the key and physical activity needs to be at a level that is realistic and achievable. Some low-impact activities include:
- T’ai chi
Undertaking treatment can be stressful. Some people will be overwhelmed by the experience of treatment, managing side effects and maintaining their normal life. Building in time for relaxation can help to reduce stress.
- Meditation. Some people find it helpful to have a mantra to help them maintain focus while meditating. Guided meditation CDs and tapes are available at most music stores and can be helpful to those new to meditation.
- Aromatherapy used in conjunction with gentle music or a guided meditation.
- Controlled breathing exercises.
- Sit or walk somewhere quiet and relaxing and just take some time out.
A nutritious balanced diet is vital to maintain energy levels, general good health and feelings of well-being. For further information on healthy eating, check out our fact sheet on Diet and Hepatitis C.
Support is available from the Support Officer at HepatitisWA and from the nursing staff at the Liver Clinics.
Page last updated: Sunday 10 July, 2011