Hepatitis - Hepatitis C

Prevention of Hepatitis C

No vaccines are available, but immune globulin helps protect against developing hepatitis C after transfusions. Periodic doses of immune globulin in sexual partners of infected people also appear to confer protection. In infected people, preventing transmission is similar to those for hepatitis B.

Treatments for Chronic Hepatitis C

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Interferons Alone and in Combination with Ribavirin. Pegylated (PEG) interferon combined with ribavirin (a nucleoside analogue), is now the gold standard for treating for chronic hepatitis C. Interferons are natural proteins that activate certain immune functions in the body and have antiviral properties. Ribavirin is poor at inducing initial responses alone but it can double sustained response rates when combined with an interferon. A number of natural and synthetic interferons are available:

Natural interferons were the first used for HCV and include interferon alpha-2a (Intron) and Interferon alpha-2b (Roferon). Rebetron is the combination of interferon alpha-2b and ribavirin.
Pegylated interferons (PegINF) are long-acting formulations of interferon. They include alfa-2b (Peg-Intron) or alfa 2a (Pegasys). Rebetol is a combination of alfa-2b and ribavarin.
Alfacon-1 (Infergen), also called consensus interferon, is a genetically modified interferon. A combination of alfacon-1 with ribavirin is proving to help some patients who were nonresponsive to ribavirin with interferon.

The combination of pegylated interferon alfa-2b with ribavirin (Rebetol) has achieved the best success rates to date of all interferons and their combinations. It has achieved responses of up to 51% with genotype 1 and nearly 80% with genotype 2 and 3. According to a 2002 comparison study, the Pegasys combination may even produce better results.

PegINF combinations are proving to slow progression of scarring, and have even achieved improvement in some patients who already have cirrhosis. Whether the combination treatment protects against future liver cancer is still unclear. (A higher total dose, rather than a longer duration of treatment, may be the critical factor for protection.)

Side Effects of the Combination Treatment. The side effects of the combination include those of both interferon and ribavirin. Interferon side effects may occur more often in the combination treatment. Ribavirin used in the combination treatment adds the following specific side effects:

Hemolytic anemia. This complication is reversible and usually stabilizes after a month or two of treatment. However, some patients may become so anemic that they have to withdraw. Since anemia can worsen heart disease, patients with a history of significant heart problems should not be treated with ribavirin. Other nucleoside analogues, including levovirin and viramidine, are under investigation that may have a lower risk for anemia than ribavirin.
Skin disorders.
Coughing and shortness of breath.
Emotional and neurologic symptoms, such as severe sleep disturbances, depression, and anxiety.
Gastrointestinal symptoms (heartburn, and weight loss).
Temporary thyroid dysfunction (either over or under activity). The presence of hypothyroidism (low activity) is, in fact, associated with long-term remission of hepatitis.