• Monitoring your drug therapy
• Side-effects of treatment
• How will you respond to treatment?
• Relapses
• Drug reimbursement programs in Ontario

There are effective treatments for hepatitis C. Drug therapy can clear the virus in more than half of those treated. The two primary drugs are Pegylated Interferon and Ribavirin. If you are eligible for treatment, you would usually receive dual therapy, with Pegylated Interferon by weekly injection and oral Ribavirin daily.

Treatment usually takes 24 to 48 weeks.

Your health care provider will discuss treatment with you. Treatment is usually offered to people with moderate to severe liver damage. You will be advised not to drink alcohol during your therapy, because it may limit the effectiveness of the anti-viral drugs and contribute to the development of cirrhosis (see Living with Hepatitis C).



Monitoring your drug therapy

If you are eligible for drug therapy, you may experience side-effects that require constant monitoring. This includes regular return visits to the treatment centre or to your health care provider for blood tests and general assessment. PCR (Polymerase Chain Reaction) testing is an important part of treatment monitoring and involves blood tests that look for the virus. These tests play a major role in clinical assessment for therapy and ongoing monitoring.

PCR viral detection tests: These tests are sometimes called "qualitative tests" and simply show if the hepatitis C virus is present in your blood. They are used during therapy to help determine whether Interferon therapy is working well.

PCR genotype tests: These tests are used before therapy to determine what type of hepatitis C virus you have. Knowing the genotype of your virus will determine what type and duration of treatment is appropriate for you.

PCR viral load tests: These tests are sometimes called "quantitative tests" and measure the amount of hepatitis C virus in your blood. Viral load tests are used for monitoring response to therapy. They can also help determine the likelihood of response to therapy.

Even after successful therapy you could become re-infected, so make sure to avoid blood-to-blood contact. Also, you will continue to manufacture antibodies so the antibody test will remain positive. Successful therapy over the long term is based on the progressive suppression of the virus, so you should have follow-up visits at six months and one year with your health care provider.



Side-effects of treatment

The drugs used to treat hepatitis C can have several side-effects that can be significant, although they may not affect everyone in the same way or to the same degree.

The most common side-effects are flu-like symptoms such as fatigue, headaches, aches and pains and decreased appetite. Other side-effects may include confusion, nausea, anemia, depression, itching and skin rashes.

Side-effects are usually worse at the beginning of treatment, and as your body becomes used to the drugs, side-effects should become less severe. However, fatigue and depression may increase over the course of treatment.

Treatment may not be appropriate for some patients, including those with certain pre-existing medical conditions, as well as pregnant women. Very advanced liver disease can actually worsen with therapy. If you are offered treatment, your health care provider will be able to provide more information.



How will you respond to treatment?

There are three ways to define your response to drug therapy:

Non-response: No significant reduction in the virus level after 12 weeks of your treatment period.

End of treatment response: Undetectable virus level at the end of your treatment period. This response does not necessarily mean that you are clear of the virus.

Sustained Viral Response (SVR): This means that the virus cannot be detected immediately after therapy and for six months afterwards. Recent research shows that 99% of people with an SVR will be clear of the virus for at least four years, and it is believed their response will last indefinitely. Recent studies show that that the majority of people with an SVR will enjoy a reversal of underlying liver damage, even from the stage of cirrhosis.



Relapses

The hepatitis C virus may return to detectable levels even though it was undetectable during treatment. Some people who relapse may respond to re-treatment. While a Sustained Viral Response is not usually achieved in people who relapse, there is often some improvement in the liver upon re-treatment. Preliminary data suggests that about 10% of non-responders and about 20% of relapsing patients achieve a Sustained Viral Response. Even if you do not respond to therapy, or if you experience a relapse after your therapy, you should have regular follow-up visits with your health care provider.



Drug Reimbursement programs in Ontario

Ontario Drug Benefit
www.health.gov.on.ca/english/public/forms/form_menus/odb_fm.html

Trillium Drug Program
www.health.gov.on.ca/english/public/pub/drugs/trillium.html