Hepatitis C Management
Diagnosis of Hepatitis C
Diagnosis frequently occurs by accident. Since most patients have no symptoms, the Hepatitis Virus (HCV) is usually discovered during a routine liver blood test taken before donating blood, insurance physical, or just a checkup in your doctor’s office. Once your doctor notes an elevation in your liver enzymes, he or she will usually request additional blood tests to confirm the abnormality and to determine the cause. A hepatitis profile is often requested which tests for hepatitis A, B, and C. If the test is positive for hepatitis C then additional blood tests are done to confirm active infection, the amount of virus present and type of hepatitis C (genotype). Since 2014, the United States Preventative Task Force and the Centers of Disease Control recommend that all persons born between 1945-1965 have a single Hepatitis C antibody test performed, as the greatest percentage of all new Hepatitis C diagnosis are from the Baby Boomer generation.
Management of Hepatitis C
Once diagnosed with Hepatitis C, a patient should be referred to a physician with experience in managing the infection. Once infection is confirmed, the next steps are to determine the genotype and stage of liver damage. The Hepatitis C virus has 6 major genotypes (1-6), and sub-genotypes (a-e). In the United States the majority of patients are infected with genotype 1, then the remainder are usually 2 or 3. Genotype 4 infection originated in Egypt, genotype 5 in South Africa, and genotype 6 in Asia.
Staging of the amount of liver damage is assessed by non-invasive or invasive means. Liver biopsy was previously done routinely, but is rarely requested now. Staging can be determined non-invasively with a FibroScan test, which is available within Digestive CARE. This machine creates a non-painful shock wave into your liver (similar to ultrasound), and measures the speed of transmission of the wave. The speed varies by the degree of fibrosis (scarring) of the liver. Other modalities to determine disease stage include liver imaging and blood tests (Fibrotest, CBC, etc.).
Drug Therapies for Hepatitis C
Since 2014 there has been a major shift in the treatment of Hepatitis C. Previously used interferon/PEG interferon based therapies are no longer used. Multiple new DAA’s (Direct Acting Antiviral) drugs have been developed leading to CURE of the infection in over 96% of patients, regardless of genotype or previous treatment history. Patients that have never been treated (treatment-naïve) or treatment- experienced patients that failed previous treatments with interferons and possibly the first generation of protease medications (boceprevir, telaprevir) respond very well to the new medications. Patients whose disease has progressed to cirrhosis have a slightly lower treatment success rates.
Depending on genotype and staging, all oral medications are prescribed for 8-12 weeks, and have minimal side effects. Many of these medication regimens are only 1 pill daily. The medications are combinations of anti-virals that block replication of the virus at 3 major sites: NS3/4 (protease), NS5A, or NS5B sites (polymerase). At times ribavirin is added to the regimen in order to increase the overall success rate. Your doctor will look at a variety of factors to determine the ideal medication and duration for your infection.
It is important to treat the infection regardless of symptoms. Hepatitis C is the leading cause of liver cirrhosis, liver transplantation and liver cancer in the U.S. Hepatitis C infection also increases a patient’s risk of developing Type 2 diabetes, chronic kidney disease, stroke and heart attack. These risks greatly improve with successful treatment.
Note: Patients with liver disease and/or who regularly use alcohol should never take more than four regular-strength Tylenol per day and should not take Tylenol on a daily basis due to risk of liver failure.
In severe cases if the liver is damaged beyond repair even with viral eradication, liver transplant is an option. In fact, Hepatitis C has now become the most common reason to perform liver transplant in the United States.