Drug therapy

Medications
The goal of drug therapy is sustained virological response (SVR) resulting in elimination of detectable hepatitis C virus (HCV) in the blood.

“Treatment isn't always necessary: A diagnosis of hepatitis C infection doesn't necessarily mean you need treatment. If you have only slight liver abnormalities, you may not need treatment, because your risk of future liver problems is very low. Your doctor may recommend follow-up blood tests to monitor for liver problems.” -- Mayo Clinic

Interferon (alpha) is a protein body makes naturally to fight infections. 2 types are used in hepatitis C treatment: It is usually taken with ribavirin; rarely it can be taken alone.
 * 1) long-acting (pegylated) alfa-2a or -2b: 1 shot/week, more effective
 * 2) short-acting (standard) alfa: 3 shots/week, less common

Ribavirin is an antiviral drug. It must be combined with interferon to work (combination therapy). Rebetron is a combination of Ribavirin and Intron A (engineered version of interferon alpha), consisting of interferon injections taken with ribavirin capsules. Combination therapy is shown to be more effective than interferon alpha alone.

Boceprevir (Victrelis) and/or telprevir (Incivek) may be prescribed to supplement the therapy. Protease inhibitors may be added to treatment if combination drug therapy alone is not sufficient.

Side Effects
Depression and suicidal thoughts or behavior may occur. Flu-like symptoms could be present.

Common side effects include trouble sleeping, feeling anxious, being short-tempered, depression or sadness (stops within 1-2 wks of stopping treatment), anemia, fatigue, headaches, fever (worse within first few shots; report promptly), muscle aches, body aches, poor appetite, bad taste in mouth, dry mouth, thick saliva, sore mouth, sore throat, nausea, vomiting, diarrhea, hair loss, skin rash, injection site red areas, chest pain, shortness of breath, vision changes (uncommon; report promptly), thyroid problems, low red blood cells, low white blood cells, low platelets.

Side Effect Rates
1% more (12% vs 13%) of patients discontinued treatment due to adverse reactions with combination therapy including boceprevir.

Treatment Success
Drug therapy: virus is removed in 30-50% of genotype 1 and 65-75% of genotype 2 or 3 patients.