Measuring Treatment Response
People receiving hepatitis C treatment should be followed on a regular basis to monitor side effects and have their HCV viral load tested periodically to make sure they are responding to therapy.
Managing Drug Side Effects
The majority of side effects of current therapy are from pegylated interferon and ribavirin. These side effects include mild to moderate flu-like symptoms, muscle and joint pain, nausea, headaches, fatigue, loss of appetite, dry skin, anxiety, depression, diarrhea, unusual taste sensation, itching, rash and insomnia.
Some physical symptoms may be reduced with low doses of ibuprofen or acetaminophen (Tylenol). Be cautious, however, since high doses of acetaminophen can be toxic to the liver. Never mix acetaminophen and alcohol.
People experiencing anxiety, irritability, or depression may be helped with mild tranquilizers or anti-depressants, and some studies suggest that they work best when started at the beginning of HCV therapy rather than waiting until symptoms emerge.
The most common reasons for stopping interferon and ribavirin based treatment are blood cell deficiencies, including anemia (low red blood cell count), neutropenia (low white blood cell count), and thrombocytopenia (low platelet count). These conditions can often be controlled with interferon or ribavirin dose reductions, but this may compromise effectiveness.
Another strategy is to use medications such as erythropoietin for anemia and GM-CSF (granulocyte macrophage colony-stimulating factor) for neutropenia. A low platelet count may indicate cirrhosis, and care should be taken during treatment.
Some people may develop thyroid dysfunction while on interferon. Thyroid function should be closely monitored prior to starting treatment and followed carefully while on treatment. Most people who develop thyroid dysfunction can treat it without discontinuing HCV therapy. After stopping interferon, thyroid function returns to normal for the majority of people, but a small minority may develop irreversible thyroid problems that will require continuing medication.
The key to managing treatment-related side effects is to know what to expect and to treat them as soon as they occur. Report any serious side effects to your medical provider as soon as possible so they can be treated before they become severe enough to require dose reduction or treatment discontinuation. For some people, physical side effects are worse when the medications are started and diminish over time. There are many simple tips to help alleviate some of the less serious side effects of hepatitis C treatment including:
- Taking pegylated interferon before bedtime and before a two-day weekend; this will allow most people to rest before returning to work since the majority of side effects usually occur within two days after injection.
- Drinking plenty of fluids (without caffeine or alcohol); it is especially important to drink water or clear fruit juices (apple, cranberry, or grape) right before and right after pegylated interferon injection.
- Taking an over-the counter pain reliever one hour before the injection helps relieve side effects for some, while others may find that taking a pain reliever just before or 2 to 3 hours after the injection works better.
- Exercising is one of the most important components of health maintenance, and this remains true during therapy. Physical activity helps you to stay positive and focused and improves well-being. Moderation is the key to physical activity. Some good choices for exercise include stretching, walking, yoga, or any activity that you enjoy.
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