How is HCV treated?
Hepatitis C treatment is a combination of two drugs, pegylated interferon (PegIFN) and ribavirin (RBV).
Interferon is a man-made version of a chemical made by the human body that works against HCV in two ways. It works directly against the virus. It also stimulates the immune system to fight viruses. Pegylated means that a small molecule has been attached to interferon to keep it in the body longer. This means you only need to inject once a week, and makes it more effective at treating HCV.
There are two types of PEG interferon:
- Alpha-2a (manufactured by Roche,trade name ‘Pegasys’). Pegasys is a liquidthat comes in one vial and is stored in the refrigerator. Everyone uses the same dose of Pegysys, regardless of their weight.
- Alpha-2b (manufactured by Schering Plough,trade name ‘PegIntron’ or ‘ViraferonPeg’).PegIntron is a powder that has tobe reconstituted with purified water,both of which come in separate vials.PegIntron is dosed by weight.
Different formulations have been studied differently in patients with different severity of disease. They have not been compared directly, and so it is difficult to know whether one may be better than another in different circumstances.
Ribavirin is a nucleoside analogue, from the same family as many HIV drugs, but it does not work against HIV.
On its own, ribavirin is not effective against hepatitis C. It needs to be used with PEG interferon. Ribavirin is given as pills or capsules, twice daily. It is usually dosed by body weight. Brand names for ribavirin include Copegus, Rebetrol and Ribasphere.
How long is HCV treated for?
In HIV-positive people, treatment is currently recommended for at least a year, for all genotypes, although recently, researchers have looked at tailoring treatment according to individual response.
Some doctors are treating coinfected people with genotypes 2 and 3 for less time if they have an early response to HCV treatment (see How response to HCV treatment is measured).
Some doctors treat people with genotype 1 and 4 for longer than a year. In particular, people with HIV/HCV coinfection may require a longer course of HCV treatment, especially people with HCV genotype 1.
Both AZT and ddI increase the toxicity associated with ribavirin.
These HIV drugs should not be used during HCV treatment.
I am squeamish and I thought I would never manage to self-inject. I asked to see the needles and when I saw how tiny they are I was reassured but still frightened. I asked the nurse do the first three and when it came to doing it myself I was thrilled to find that I could. It was painless and over in a flash. This made me so proud that I almost wanted to do it twice!