June 12, 2013

Treat now or wait?

United States Department of Veterans Affairs

for Veterans and the Public

Frequently Asked Questions

Q: With new hepatitis C drugs likely to come on the market, should I get treated now or wait?

Choosing when to start on treatment is a decision that only you and your provider can make. Hepatitis C treatment currently involves a combination of two or three drugs: pegylated interferon, ribavirin and sometimes telaprevir or boceprevir. These combinations can cause unpleasant side effects, including fatigue, depression, nausea, anemia, and rash. And the treatment doesn't always get rid of the virus.

However, new drug regimens are under study, which may be easier to take, may have fewer side effects, may need shorter duration of treatment, and may have much higher chances of getting rid of the virus.

So how do you decide if and when to get treated?

In general, the current treatments should be used for patients whose hepatitis C is more advanced. These patients shouldn't wait for new drugs if they can safely tolerate the treatment.

If you have mild liver damage, which is progressing at a very slow rate, waiting for new drugs to be developed might be a better choice. Even if you have had the virus for several years, or have a high viral load, there usually isn't a need to get treated right away if there isn't much liver damage.

There are other reasons why your provider may decide not to start you on treatment:

  • You may have serious liver damage and complications of liver disease and may be too ill to tolerate the currently available medications.
  • You may not have a strong likelihood of responding to the current medications because of your genotype, viral load, or other medical problems.
  • You may have other medical or psychiatric problems, such as chronic lung disease, heart failure, or severe depression, which could be worsened by taking medications for your hepatitis C.
  • You may be trying to conceive children or not be using regular birth control methods, and the ribavirin would be harmful to a fetus.
  • You may be drinking alcohol heavily or using drugs, which would interfere with the hepatitis C therapy.
  • You may have other issues or priorities in your life (such as preparing for an upcoming move, taking care of young children at home, or having travel commitments with your work) that would make the treatment, the side effects, and the necessary follow-up too difficult to manage at the current time.

Under these circumstances, the better option is "watchful waiting." Watchful waiting means that your health care provider carefully monitors the progression of your hepatitis C, keeping treatment with currently available medications in mind as an option.

Watchful waiting means close follow up and observation while not on treatment:

  • You MAY have liver enzyme blood tests done once or twice a year
  • You MAY consider having a liver biopsy every 3 to 5 years
  • You do NOT need to have the hepatitis C "viral load" rechecked or repeated
  • You SHOULD be going to regular doctor appointments
  • You SHOULD be following your doctor's lifestyle recommendations, such as avoiding alcohol, getting to or keeping a normal body weight, and treating other conditions such as diabetes and high cholesterol, so you will limit any further damage to your liver

Rena K. Fox, MD

June 04, 2013


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