Hepatitis C

Similar to hepatitis B, hepatitis C can lead to chronic hepatitis (liver inflammation), cirrhosis ( "liver hardening "), liver failure and liver cancer.

Treatment is aimed at eradicating the virus and to prevent/delay complications.

Alpha-Interferon: The current recommended regime for treatment is alpha-interferon 3 million units 3 times per week for 12 months. Interferon is administered subcutaneously. It is believed to act by obstructing viral replication and also boosting the immune system to destroy the virus.

Flu like symptoms (fever, chills, malaise, headache, bone and muscle pain, rapid heart beat rate) are common in the initial part of treatment with interferon. Later side effects are fatigue, hair loss, suppression of white and red cell production, and psychiatric complications. Occasionally these patients may become irritable and depressed to the point of suicide.

Severe side effects occur in less than 2% of patients treated with interferon. These include thyroid problems, fits, heart and kidney failure, eye and lung problems, hearing impairment and infection. Rare deaths from liver failure or infection have occurred in some, especially those with cirrhosis.

The milder side effects of interferon may sometimes be ameliorated by administering interferon at night or taking paracetamol (Panadol). Occasionally a dose reduction or even discontinuation of treatment may be required in those with more severe side-effects.

Following the initiation of interferon alfa therapy, the patient is monitored clinically and by blood tests. Visits to the liver specialist should be weekly initially (first month), followed by 2 to 4 weekly. If patients do not respond after 3months of therapy with interferon alone, they should be considered for combination therapy of interferon and ribavarin. Ribavarin is an oral anti-viral agent which is believed to act through inhibition of some effector of tissue damage.

The main side effect of this drug is the breakdown of red blood cells ( haemolysis), resulting in anaemia  (low red blood cell count).

The response to interferon alfa therapy is between 20 and 30 percent. The goal of therapy is reduction of liver inflammation and the eradication of hepatitis C virus.

What kind of surveilance will my doctor do to detect liver cancer?

Although there is a lack of data supporting cost-effectiveness, unlike in hepatitis B patients, patients with HCV cirrhosis should have a liver ultrasonography and serum alfa-fetoprotein level every 6 months for screening of liver cancer. Non-cirrhotic HCV carriers generally require 6 monthly alfa-fetoprotein levels and yearly ultrasonography of the liver.

Who should receive treatment for Hepatitis C virus (HCV) infection?

Patients with raised liver enzymes and liver biopsy indicating active inflammation. The role for intervention is strengthened if the patient's blood shows the presence of viral RNA (HCV RNA).

• Patients with acute hepatitis C
• Patients with HCV infection complicated by essential mixed cryoglobulinemia
• Patients with concurrent stable HIV infection, as these patients may have an accelerated course
  

Who should not be treated with interferon?

• Patient with normal liver function tests
• Patient with only mild symptoms like fatigue and no other clinical or laboratory abnormalities
• Patients who are drug abusers or active alcoholics. These patients are generally not compliant and should therefore receive treatment for substance abuse before commencing HCV therapy.
• Patients with major psychiatric illness
• Patients with hyperthyroidism
• Patients with blood disorders
• Patients with abnormalities of the immune system eg. systemic lupus erythematosis Patients who have had a renal transplant and is currently receiving immunosuppressive treatment to prevent graft rejection.