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Treatment options
The most appropriate treatment for hepatitis C should be in accordance with the latest management guidelines. These guidelines are continually changing according to the new evidence. Doctors are recommended to stay updated with recent changes in treatment options by the Infectious Diseases Society of America and the American Associations for the Study of Liver Diseases (AASLD/ISDA).
Spontaneous resolution of the disease is improbable and only experienced in 15-50% of acute disease patients. Thus, when the acute disease is detected, it is reasonable to wait for 6 months and monitor the disease’s resolution. In patients still infected with hepatitis C after 6 months, standard therapy includes interferon or pegylated interferon drugs, but other treatment types do not involve interferons.
The most common treatments for hepatitis C are as follows:
- Interferons and pegylated interferons: More specifically, Interferon alfa-2b (Intron-A) and Interferon alfa-2a (Roferon-A).
- Interferons and ribavirin: Ribavirin can be used in addition to interferons. It is an oral nucleoside analog, and the combination usually eradicates the disease in up to 12 months.
- Direct-acting antiviral agents: These drugs interrupt HCV replication, similar to what antiretroviral drugs do with HIV. According to the genotype of HCV, a different combination of direct-acting antiviral agents may be required.
- Liver transplantation: In advanced liver disease, organ transplantation is sometimes the only choice left.
Special treatment regimens are recommended for different types of patients. It will be different in treatment-naïve patients, treatment-experienced patients, patients with HIV or hepatitis B coinfection, or those with complications such as decompensated cirrhosis.
A special regime is recommended for women of reproductive age if they want to get pregnant. No intervention reduces the risk of transmission to the fetus, and they are not a candidate for aggressive treatment during their pregnancy. A multidisciplinary team should treat patients with injection drug habit or alcohol abuse.
