Health Tips

Hepatitis refers to the inflammation of the liver, which can be caused by various reasons: heavy alcohol use, toxins, some medications, and certain medical conditions. However, hepatitis is most commonly caused by a virus. Hepatitis viruses include hepatitis A virus, hepatitis B virus and hepatitis C virus. 

While three of the viral hepatitis cause similar signs and symptoms, they are spread in different ways and can affect the liver differently. Hepatitis A is usually a short-term infection. Hepatitis B and hepatitis C can also begin as short-term infections, but in some people, the virus remains in the body and causes chronic (long-term) infection. There are vaccines to prevent hepatitis A and hepatitis B; however, there is no vaccine for hepatitis C.

Signs and symptoms of hepatitis C

Many individuals newly infected with the hepatitis C virus don’t look or feel sick, and therefore don’t know they are infected. For people who develop symptoms, they usually happen 2–12 weeks after exposure to the hepatitis C virus.

Image credit to liver.ca

On the other hand, most people with chronic hepatitis C do not have specific signs and symptoms or only mild nonspecific symptoms that are difficult to attribute to the infection, such as fatigue, weight loss and reduced appetite. 

Before starting hepatitis C treatment

Prior to starting treatment for hepatitis C patients, doctors would run blood tests to identify other medical conditions and if the person has already developed liver cirrhosis. The cirrhosis status and the presence of other medical conditions (such as hepatitis B or HIV/AIDS) are important as it would require a different treatment regimen from those who do not.

Image credit: https://www.myupchar.com/en, CC BY-SA 4.0 , via Wikimedia Commons

The healthcare provider would also evaluate drug-drug interactions among the medications the person is currently taking and the hepatitis C medications. The hepatitis C patient would also be evaluated on genotype (i.e. genetic makeup), as this would also affect treatment choice for hepatitis C. 

Pharmacological treatment of hepatitis C

Based on the signs and symptoms described above, hepatitis C does not sound like a really big deal, right? Well, that couldn’t be further from the truth. Untreated hepatitis C can lead to cirrhosis (i.e. scarring of the liver), liver cancer and eventually liver failure. At the stage of liver failure, liver transplantation is the only way out. 

Liver is an essential organ that detoxifies substances in our body and is responsible for a huge chunk of biochemical reactions that keep us alive and healthy. We wouldn’t want a vital organ like this to lose its functions.

Luckily, hepatitis C is curable. In the past, individuals with hepatitis C were treated using pegylated-interferon (PEG-IFN), which is an injection treatment that has low cure rates and has many side effects. In the present days, however, we’re blessed with a group of medications called direct-acting antivirals (DAAs), which can be taken orally, has a higher cure rate, has lesser side effects and with short duration of treatment (usually between 12 to 24 weeks). The DAAs available in Malaysia are:

• Sofosbuvir, which is a NS5B polymerase inhibitor (nucleotide analogue)

• Daclatasvir, which is a NS5A inhibitor

• Combination of sofosbuvir and ledipasvir (NS5B polymerase inhibitor/NS5A inhibitors)

• Combination of sofosbuvir/velpatasvir (NS5B polymerase inhibitor/NS5A inhibitors)

Image credit: Guido4, CC BY-SA 4.0 , via Wikimedia Commons

NS5B polymerases and NS5A are important enzymes that allow viral replication of the hepatitis C virus. These DAAs inhibit the enzymes, thereby inhibiting the hepatitis C virus from reproducing more of itself.

These DAAs are also commonly prescribed with ribavirin, which is a broader spectrum antiviral. PEG-IFN are less relevant in the treatment of hepatitis C now, but may still be used in some cases.

Ensure a successful hepatitis C treatment

At the end of the treatment, the doctor would run a test to check if there’s still hepatitis C virus RNA left in the person’s body. The treatment is considered successful and the person is cured if hepatitis C virus RNA is undetectable (called a sustained virological response, or SVR). 

To ensure a successful treatment, here are a few tips:

Take the pills at the right time everyday

It’s important for hepatitis C patients to take their medications on time everyday. For instance, if the person is prescribed sofosbuvir and daclatasvir, the tablets should be taken together, do not take either alone. The tablets should be taken once daily at the same time with meals. Do not stop taking the treatment without informing the doctor who prescribes it.

If the person accidentally missed a dose, take the tablets as soon as possible if it is within 18 hours of the usual time, and resume the next dose at the usual time. However, if it is more than 18 hours, skip the dose and continue the next dose at the usual time. The total treatment duration will extend 1 more day. Do not take a double dose at once.

Managing the side effects of hepatitis C treatment

Although DAAs have tremendously improved the treatment experience, they do come with a fair share of side effects:

• Headache

• Fatigue *This is difficult to ascribe to the side effect or the disease alone when many other factors can also cause fatigue, such as depression.

• Nausea and vomiting

• Insomnia 

Talk to your healthcare professional on how to better manage these side effects. 

Check with healthcare provider before starting any new treatment, herbs or supplements

Hepatitis C treatment can interact with many other medications, herbs or supplements. If you’re taking any hepatitis C treatment, consult your doctor or pharmacist first before taking the new product. 

Things to know about pregnancy when receiving hepatitis C treatment

Counselling to avoid pregnancy during and six months after completion of treatment should be given to both female patient and female partner of male patient who are taking DAAs regime containing ribavirin. This is because animal studies have found that ribavirin is toxic to babies (significant teratogenic and/or embryocidal effects).

Whereas for those who take DAAs, it is also advisable to avoid pregnancy during and three months after completion of treatment. There is a lack of safety data of DAAs used in pregnancy. 

A word from DOC2US

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Disclaimer: As a service to our users and general public, DOC2US provides health education contents. Please note the date of last review or update on all articles. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.

References

1. Ministry of Health - CPG Management of Chronic Hepatitis C in Adults 2019

2. UpToDate - Overview of the management of chronic hepatitis C virus infection

3. WHO - Hepatitis C Fact Sheet

4. WHO - Hepatitis C Questions and Answers for Health Professionals

Specific references were linked in its relevant part of the article. 

Cover image credit: BruceBlaus, CC BY-SA 4.0 , via Wikimedia Commons

Written by

Ms Joyce Toh