How Is Hepatitis B or C Treated?

Treating your hepatitis quickly is the most important thing you can do. Unless your body has fought off the infection by itself, treatment may be your only hope of controlling chronic hepatitis B or C. Sometimes the treatment takes a long time, and it does not help everyone, but because this disease can get worse over time, it is very important to get proper treatment and follow-up.

What is interferon?

Interferon is currently cleared by the Canadian Health Protection Branch (HPB) and the U.S. Food and Drug Administration (FDA) for treating chronic hepatitis B or C. [Note: Interferon is the general name of the drug. There are different forms of interferon, just like there are different-forms of pain relievers like aspirin or ibuprofen. Interferon is also be combined with ribavirin for treatment of hepatitis C. This combination is sold commercially as Rebetron].

Interferon can completely eliminate chronic hepatitis B infections in some people. In people with chronic hepatitis B or C it may slow the disease by reducing the amount of virus in their body and slowing the damage to their liver. It is very important that you find out immediately if you should get treatment: the timing of your treatment can greatly affect your chances of benefiting from treatment.

Not everyone benefits from interferon therapy. You need to talk to your doctor about this therapy and it’s associated side effects, which are discussed later in this chapter. If the hepatitis B or C virus has already seriously damaged your liver, drug treatment may be out of the question; it might make you sicker without helping to cure the disease.

Finally, if you have chronic hepatitis but no sign of liver damage, it may not be worth it to take interferon for Hepatitis B or Rebetron for Hepatitis C. Your doctor will have to help you make a choice about treatment.

If your doctor does not recommend that you try therapy, find out why he or she thinks treatment wouldn’t work for you. Ask whether treatment may be possible, or even necessary, in the future if your condition changes.

To improve your chances of controlling your chronic hepatitis, you need to find out as much as you can about interferon and Ribavirin, your particular case of hepatitis – how your liver is working, what type of virus you have, whether the infection is new or old – and what you will need to do to make sure therapy works.

How interferon works?

One way the drug interferon works against chronic hepatitis is by protecting your healthy, uninfected cells from being taken over by the virus. Interferon is actually a natural substance that your body normally makes to help defend itself against invaders. But your body sometimes doesn’t make enough natural interferon to help you defeat the infection. Giving you additional interferon as a drug may make a difference. Interferon can also work in other ways, such as helping your body’s immune response against the virus and infected cells.

Treating hepatitis B

As we mentioned in¬†Chapter 3, about 90% of adults are able to fight off acute hepatitis B infection completely without having to take interferon, and they suffer no long-term effects from the disease. However, between 5% and 10% of adults with hepatitis B cannot get rid of the virus. Some of these people will become carriers, which means that they don’t become sick themselves but they can still infect other people. Others will have chronic hepatitis B for the rest of their lives, which means that the virus will continue to attack liver cells.

Currently, the drug is indicated for use in patients 18 years and older.

One way that interferon works is by stimulating the immune system’s attack on the infected liver cells. As a result, the patient may actually have a period during treatment in which his or her symptoms are worse than before. Remember, the virus makes your immune system attack healthy liver cells. This process is called a flare. It may be a good sign because it occurs more often in responders than non-responders in patients being treated for chronic hepatitis B.

Before treating any patient for hepatitis B, a doctor will check to determine that there is virus currently present in the patient’s blood and that the patient’s liver is being damaged. As we noted earlier, if the patient is too sick, the therapy may do more harm than good. The level of virus in your blood before treatment, as shown by a hepatitis B virus DNA test (HBV DNA), may help predict whether or not you are likely to be helped by interferon. People with less virus seem to get more benefit from interferon than those with higher levels of virus.

What to expect from treatment?

The treatment for chronic hepatitis B involves taking injections of interferon alfa-2, for 4 months.

Several things, particularly how long you have been infected with the virus, will make a big difference in whether or not it is likely you will be cured. But there is no easy way to tell which patients will get better after taking interferon. About half of all patients with chronic hepatitis B who are treated with interferon will have some benefit from the treatment – there will be less virus in their blood, their liver damage may have slowed, and their symptoms will improve. In clinical studies, 45% of patients who are treated for chronic hepatitis B with INTRON A will have no evidence of the hepatitis virus in their blood over time.

While you are being treated, your doctor may regularly check your ALT test to see if your liver is still inflamed. He or she may also use the anti-HBeAg or the HBV-DNA test to see if there is still virus in your blood, and how much there is. (See Chapter 5.) You may also experience side effects which are discussed later in this chapter.

It can take a while for all evidence of the virus to clear from your blood. As a result, your HBsAg test may still be positive for weeks to years after you have been treated. Many patients get rid of the virus for good, but on occasion patients may have a relapse – a return of the infection – because the drug will not have completely cleared the virus from the body. If you have a relapse, your doctor may recommend another round of interferon treatment or another kind of treatment.

Even if the virus is controlled, it can take time for your liver to recover from the infection. Despite the absence of virus, the liver needs time to grow healthy new cells to replace those that were damaged or destroyed by the infection.

How Ribavirin works?

Ribavirin belongs to a group of drugs called nucleoside analogs, which are believed to prevent viruses from multiplying. Studies have found that the combination of Ribavirin Capsules and INTRON A Injection helps to reduce the amount of virus found in a patient’s blood (called “viral load”).

Treating hepatitis C

As we noted in Chapter 5, the antibodies your body produces to defend against hepatitis B work much better than those directed at hepatitis C. As a result, your body more often needs help beating chronic hepatitis C.

Again, your doctor will try to see just how much damage your liver has had before starting your therapy. The interferon is usually given 3 times a week, while the Ribavirin capsules are taken twice daily. Treatment often lasts much longer for chronic hepatitis C than for chronic hepatitis B; it may take anywhere from 6 months to 2 years for your treatment to be completed. During treatment, your doctor will carefully follow your ALT level and HCV-RNA levels and do other tests to see if your liver is getting better through treatment.

These benefits may include periods of remission and a lower risk of developing cirrhosis and/or liver cancer. So it is very important that you stick to your treatment for as long as it takes to see if you are improving. Often your doctor can tell after about 3 months of treatment for hepatitis B and about 6 months of treatment for hepatitis C whether or not treatment is helping you. At that point, he or she may recommend that you stop the drugs if they don’t seem to be working, or your doctor may change your treatment.

Follow-up with your doctor, even if you seem to be rid of the virus, is very important. At the end of therapy, your doctor may again test for the presence of the virus and may measure its level in your blood using the HCV-RNA test. Even if you have no sign of the virus in your body at the end of treatment, there is a chance that you will suffer a relapse, or return of your infection. If this happens, you and your Doctor will discuss the possibility of future treatment options. Many patients who had a relapse or were non-responders to interferon alone (monotherapy) have a very good chance (about 49%) of responding to combination treatment (Rebetron).

As with chronic hepatitis B, it seems that how much hepatitis C virus you have in your blood may affect whether or not treatment will help you. It also seems that the amount of virus, and the related damage to your liver, increases with time. This makes it especially important for you to get treatment as soon as possible.

So it is very important that you stick to your treatment for as long as it takes to see if you are improving.

Coping with side effects

Almost everyone who uses interferon and or Ribavirin notices side effects, some of which are unpleasant. But you should not let that discourage you from using them. Some of the side effects of interferon are similar to the symptoms of hepatitis, so you may use some of the same approaches¬†to handle these problems whenever they arise. There are also ways to lessen the unpleasant effects that are due only to interferon, which are usually the worst during the first few weeks of treatment. After that they tend to lessen. One side effect that can happen while on Ribetron (Intron-A and Ribavirin together) is an increase in the breakdown of red blood cells resulting in anemia. This side effect happens within the first eight weeks of treatment so your doctor will likely check your blood work very often during this time. The anemia may make you feel more tired. It is important that you stick with the treatment and don’t give up. It does get better! Call your healthcare professional if you do need help coping.

Not everyone experiences all of the same side effects – and not everyone gets side effects – but the most common ones are like symptoms of the flu. You may experience fatigue, fever, muscle pains, general body aches, chills, and nausea. You may also find that food tastes different or that you have a metallic taste in your mouth. Mild hair thinning and dry, itchy skin can also occur.

If at all possible, you may want to take a week or two off work when you begin treatment. Since the side effects are typically the worst during the first 2 weeks, it may help to stay at home or at least plan to rest more. If your home life is busy, try to have others take over some of the chores. Or, if possible, get some temporary help for the first week. Do whatever you can to make it easier on yourself; you are more likely to stick with the treatment once you make it through the most difficult time – the first 2 weeks.

Because the side effects tend to occur 4 to 6 hours after the injection, many people have found that taking the injection before bedtime allows them to sleep through the worst of it. However, you should see how quickly your own side effects occur. Then you can make up your own time schedule. You may be able to adjust the injection schedule around your work week as well. For example, if you work Monday through Friday, and you receive 3 injections a week, you can arrange to get your injections on Tuesday, Thursday, and Saturday. This way, you will have side effects on only 2 of your workdays. You’ll need to take your injections at the same time and on the same day each week.

Drinking plenty of fluids (without caffeine or alcohol) may help relieve the side effects. It is especially important to drink water or clear fruit juices (apple, cranberry, or grape) right before and right after receiving the injection.

Some people take over-the-counter pain relievers 1 hour before their injection to help relieve side effects. Others have found that 1 tablet of the pain relievers 2 or 3 hours after the injection works better in relieving the side effects. It is important that you talk to your doctor before taking any over-the-counter or prescription medication for side effects. (Remember, alcohol and acetaminophen [an ingredient in some over-the-counter pain relievers, and many drug combinations used for colds] taken together and cause a condition called fulminant hepatitis, which can lead to fatal liver failure. Clearly, you should never combine these two substances, and talk to your doctor about any medications you take.)

Some medication can have bad effects when taken during interferon therapy. You must tell your doctor about any other medications, including vitamins or any herbal remedies you take regularly for your health. Some medications don’t work as well if they are taken with another drug, or can cause a bad reaction, so it is important that your doctor knows about any other medicines you are using while you are getting interferon.

You can try relieving headaches with massage, heat applied to the back of the neck, or just resting. Fever can sometimes be reduced by sponging yourself with lukewarm water (don’t use cold or hot water). Eating can be a problem if you are nauseous or just have no appetite. You may want to eat several small meals throughout the day, or have some healthy snacks on hand for nibbling when you feel up to it. Food is very important to keep yourself well nourished during treatment. (See Chapter 8¬†for a discussion of proper eating habits.)

Your emotional well-being is also important to getting you through this, so be aware of the symptoms of depression and other troubling feelings. Indeed, very infrequent reports of suicidal behavior (ideation, attempts, and completed suicides) have been associated with interferon treatment. (See Chapter 9.) <> Good oral hygiene, such as using mouthwash and brushing your teeth several times a day, may help get rid of the metallic taste. There isn’t much you can do about hair thinning, but your hair loss will be mild and it will stop falling out and grow back once the interferon therapy is completed. In the meantime, you might want to get a hairstyle that makes your hair look more full, use hair extensions, or experiment with caps and scarves.

More serious side effects can also occur, so report any changes in your health to your doctor. If you have little appetite or are losing weight, or vomiting, you need to contact your doctor immediately. It is especially important that your bone marrow – a part of your body that makes immune cells for you – keeps working correctly during therapy. Sometimes interferon makes the bone marrow slow down production of certain blood cells. If this happens, your doctor may reduce your dose of interferon, or give you a brief break from therapy.

Rebetron combination therapy could cause serious birth defects and harm (including death) to your unborn fetus. If you or your partner are pregnant, you should not receive Rebetron combination therapy. Pregnancy should not be planned while you or your partner are on therapy and for 6 months after therapy.

An important point that bears much repeating is that you should not drink alcohol while you are undergoing therapy. You are, after all, trying to defend your liver against a serious infectious disease, and drinking can cause damage to your liver that is very much like the damage that viral hepatitis causes. There are even some reports that drinking alcohol while you are on therapy may affect how well treatment works.

Alternative treatments for hepatitis

Many people, particularly those who do not improve with interferon, also try alternative therapies, including homeopathy, herbs, vitamins, acupuncture, or special diets.

You need to be very careful before using any alternative therapies, particularly herbs or other “natural” medicines that you may have heard about, such as ginseng or licorice root. Such therapies have not been tested in the same way as a prescription drug, and some of these alternative medicines can hurt you, particularly if you have hepatitis.

These products are usually sold as “food supplements” or “vitamins.” As a result, they are not regulated or monitored as closely as prescription drugs.

There is no harm in finding out about alternative therapies. But get as much information as you can about any such therapy before you try it. Talk to your doctor before you take anything he or she has not recommended. If you need answers to questions about a specific alternative therapy, call the National Council Against Health Fraud. (See Resource List for contact information.) It keeps track of many dangerous treatments. You can also read about these topics at your local bookstore (look under topics like herbs and homeopathy).

Looking forward

Overall, treatment with interferon offers you the best chance for a cure or at least improvement. While some people do experience side effects, everyone reacts differently. Don’t expect to have unpleasant side effects; you may not. Some side effects are just like the symptoms of hepatitis, so it could be your disease causing the problem, not the drug. Sticking to your doctor’s recommendations, doing everything you can to stay comfortable, and keeping a positive outlook are all very important. Remember, the chance for better health is the reward for your efforts.

You will need to follow the progress of your disease carefully even if interferon does not work for you. By working with your doctor, you can minimize the damage that hepatitis causes to your liver. If the damage to your liver becomes too great, you may need a transplant, which is not a simple procedure. Hepatitis C is the leading reason for liver transplants. Transplants bring whole new challenges, such as finding the right donor and taking medication for the rest of your life to keep your body from damaging the new liver with your own immune cells.

Current treatments do not help everyone! Your Physician may discuss other future therapy options with you, such as PEG interferon combined with ribavirin (not yet approved).

Besides fighting the virus, you will also want to stop the symptoms of your disease if you can. Keeping your overall health in good shape is also important. You’ll get information about these topics next, in¬†Chapter 7.

Q U I Z

Q. What is the name of the drug cleared by the HPB and FDA to treat chronic hepatitis B or C ?
A. Interferon is the general name, but there are several brands of interferon, just as there are several brands of aspirin. For hepatitis C, interferon can be used in combination with ribavirin, which has demonstrated even better treatment results for many patients.

Q. Do most people with hepatitis B need treatment with interferon?
A. No, because most people who get hepatitis B are able to fight off the infection themselves, without using interferon.

Q. How long does interferon treatment take?
A. For chronic hepatitis B, treatment usually lasts about 4 months. For chronic hepatitis C, it may take as long as 2 years.

Q. Does treatment with interferon ever have to be repeated?
A. Some people with either chronic hepatitis B or C may have a relapse, or return, of their infection. Hopefully a course of treatment with combination therapy will help these hepatitis C patients. Physicians may choose to retreat hepatitis B patients with a second course of interferon.

ACTION STEPS

– Find out everything you can about interferon and Ribavirin (for hepatitis C), your particular case of hepatitis, and what you need to do to make sure the treatment works.

– If you start treatment, make sure that you are ready to make changes in your life, such as getting extra help at home, or taking some time off from work, so you can stick with your treatment.

– Keep a record of any side effects you experience. Then, talk to your doctor about the side effects and ways to fight them.

– If treatment does not help you, talk to your doctor about possible new alternative therapies you could try.

BY MALORYE ALLISON

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