Exams and Tests
Your health care provider will interview you about your illness. You will be asked about your symptoms and about any exposures to hepatitis viruses.
If your doctor determines that you may be at risk for contracting hepatitis, you will have blood drawn. The laboratory will be able to determine whether you have been exposed to HCV and certain other hepatitis viruses.
- Several tests are available for this, but the most widely used test detects antibodies to these viruses. Antibodies are substances made by your body's immune system to defend against a specific infection. You won't have the antibody unless you have been infected with HCVunless the test was performed so soon after exposure that your immune system did not have time to make the antibody.
- Tests are also available to identify which of the 6 known strains (genotypes)of the virus is causing the infection. This can help determine the best treatment plan.
- Other tests will probably be done to check the effects of the infection on other body systems, such as the kidneys.
- If you have had a large amount of vomiting or have not been able to take in liquids, your blood electrolytes will be checked to see if they are in balance.
Self-Care at Home
If you have symptoms, these measures will help you feel better faster.
- Take it easy; get plenty of rest.
- Drink plenty of fluids to prevent dehydration.
- Do not drink alcohol of any kind, including beer, wine, and hard liquor.
- Avoid medicines and substances that can cause harm to the liver such as acetaminophen (Tylenol) and other preparations that contain acetaminophen.
- Avoid prolonged, vigorous exercise until symptoms start to improve.
Medical Treatment
If you are dehydrated, your health care provider may prescribe IV fluids to help you feel better.
If you are experiencing significant nausea and vomiting, you will receive medicines to help control these symptoms.
If your symptoms are well controlled, you can be cared for at home. If dehydration or other symptoms are severe or if you are showing signs of confusion or delirium, then you may be hospitalized.
The treatment that has shown the most promise in chronic hepatitis C is an agent called pegylated interferon alpha (Pegasys, PEG-Intron). This agent is often combined with an antiviral drug called ribavirin (Virazole).
- Decisions to start medications for treatment of hepatitis C are usually made in consultation with a gastroenterologist or liver specialist (hepatologist).
- The decision is based on the results of lab tests of liver function, on results of tests for HCV and liver biopsy, and on the person's age and general medical condition.
- Depression and certain other mental and neurologic disorders
- Active alcohol or drug abuse
- Autoimmune diseases such as rheumatoid arthritis, systemic lupus emphysematous, or psoriasis
- Low blood hemoglobin level(anemia) or blood cell counts
- Cirrhosis that is severe enough to cause symptoms such as jaundice, wasting, fluid retention that causes swelling, or mental disturbances
Medications
Interferon alpha (Intron A): Interferon is a protein that the body makes naturally in response to viral infections in orderto fight the infection. It also has other actions in the body and has been used to treat a variety of diseases such as leukemias,other types of cancers, andmultiple sclerosis.
Pegylation describes a chemical process that makes the interferon last longer in the body.
- Levels of the older type of interferon were difficult to regulate in the body. The drug had to be given several times a week. The pegylated type(Pegasys, PEG-Intron) is given only once a week and maintains a steady level in the blood between doses.
- This is a considerable advantage because interferon has to be taken by shot and has many side effects.
- More importantly, though, the pegylated formulation is more effective against HCV.
Ribavirin (Virazole): Ribavirin is like an antibiotic for certain viruses. By itself, ribavirin has little effect on HCV, but interferon increases its potency. Ribavirin is usually given with interferon unless there is a particular reason not to give it to a specific individual. It has to be taken every day in 2 doses but is a pill rather than a shot.
The combination of interferon alpha and ribavirin works betterthan interferon alone. The duration of treatment depends on the strain (genotype) of the virus. For genotype 1 and 4, the treatment is given for 48 weeks. For genotype 2, the treatment is only for24 weeks. During treatment, you will have blood drawn every few weeks to test the effects on your liver, kidneys, and blood.
Treatment is followed by a period of no treatment in which the person's response to the treatment is checked.
- This is measured by the amount of HCV RNA (similar to DNA) in the person's blood.
- The level of HCV RNA goes down to nearly zero during treatment in about 70% of people.
- Treatment is considered successful if the RNA level remains near zero for at least 6 months after treatment. This occurs in about 55% of people treated with combination therapy and about 15% of people treated with interferon alone.
- The side effects range from mild to debilitating.
- If they are severe enough, the person may have to stop taking one or both drugs, or take a lower dose.
- Lower doses generally do not work as well against the disease.
- Fatigue
- Lowhemoglobin levelin the blood (anemia) or low blood cell counts
- Muscle aches
- Nausea and vomiting
- Mild fevers
- Depression
- Irritability
- Headaches
- Weight loss
The side effects of ribavirin can be severe enough that the person has to switch to interferon-only therapy. Like interferon, ribavirin can be harmful to an unborn child, and persons taking ribavirin must practice effective birth control during treatment and for at least 6 months afterward. Common side effects include the following:
- Fatigue
- Anemia
- Irritability
- Itching
- Skin rash
- Sinus congestion and cough
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