by Kelsey Trull, PA-C, MPAS
For many patients struggling with a chronic hepatitis C virus (HCV) infection, treatment has been an unnerving and daunting process; however, that is no longer the case due to several well-tolerated and short duration treatment options that are now available and effective in eradicating the virus.
Previous treatment options, like interferon and ribavirin, had significant side effects that precluded many patients from considering treatment, while other patients were excluded from being a treatment candidate due to associated chronic medical conditions.
Over the last year, however, there have been momentous advancements in the field of hepatitis C treatment and now many of these patients can receive treatment for their HCV infection. Recent developments in the types of hepatitis C medications available now provide more options to both patients and providers when determining a treatment plan.
Prior to beginning treatment, there are a few vital aspects of the patient’s history that need to be determined, including: HCV genotype, viral load, degree of liver damage, other co-existing health conditions and any prior response to previous treatments for hepatitis C.
The hepatitis C genotype is the strain or genetic arrangement of the virus. There are six well-studied HCV genotypes and it is important to identify the genotype via a blood test because it determines both the type and length of treatment needed. The most common genotype in the United States is genotype 1, which accounts for approximately 75 percent of cases. The viral load tests the amount of the virus in the blood. While the amount of virus does not predict whether a patient will go on to develop cirrhosis, it can help determine the length of treatment needed. The viral load is also used to determine if a patient is responding well to treatment.
Following determination of the genotype and viral load, the provider may need to order further laboratory studies or diagnostic imaging studies to determine if the liver has any damage. This can be done with either a liver biopsy or noninvasive test that assesses for liver fibrosis, or scarring of the liver.
Once a patient is ready for treatment, he/she can increase the chances of being considered for hepatitis C treatment by avoiding alcohol and illicit drugs, establishing care with a primary care provider and maintaining a healthy lifestyle.
Currently, there is an oral treatment regimen approved for all genotypes. Treatment duration usually ranges from 8 to 24 weeks depending on genotype, prior treatment experience and degree of fibrosis. In clinical trials, most newer treatment options offer a sustained virologic response (the clinical term used to describe the eradication or clearance of the hepatitis C virus) of approximately 95 percent.
During hepatitis C treatment, it is critical to adhere to recommendations made by your provider, such as scheduling follow-up visits and coming in for necessary laboratory testing. Compliance with both the treatment regimen and recommendations made by your provider will ensure the best chance at receiving a cure.