By Nina L. Paul, PhD from "Living with Hepatitis C For Dummies"

The hepatitis C treatment process isn’t easy, and it isn’t for everyone. Because of the possibility of serious side effects with peginterferon and ribavirin, undergoing treatment isn’t a decision to take lightly.

Your doctor will carefully evaluate the type and progression of your disease, your overall health, factors that may rule out treatment, your commitment to seeing the process through, and whether the timing is appropriate. All these evaluations help determine whether peginterferon plus ribavirin therapy will have enough potential benefit.

Because of the serious side effects of peginterferon plus ribavirin, it’s important to determine whether you:

* Should get treated because you’re at a high risk for developing cirrhosis. Your liver biopsy would show evidence of fibrosis, which is the precursor of cirrhosis. Or perhaps you have cirrhosis already, and you want to prevent development of decompensated cirrhosis.

* Shouldn’t take the treatment, because the side effects pose an unacceptable risk.

* Can take a wait-and-see approach. Some folks with less-advanced disease may want to wait a few years to see if better treatments come along. Your doctor will still check your liver enzyme/function tests regularly and may recommend a repeated biopsy.

The physical evaluations include:

Testing for virus and liver disease: To start the evaluation process, your doctor will perform many virus and liver blood tests. Remember: Everyone who’s treated must have hep C virus RNA in their blood. Treatment is usually recommended if you have chronic hepatitis C with clear evidence of liver disease — your liver biopsy shows some fibrosis. Treatment is recommended on a case-by-case basis if:

  • You have absent to mild liver disease — liver biopsy showing no or mild fibrosis.
  • You have acute hepatitis C (early infection).
  • You’re co-infected with HIV.
  • You’re under 18 years of age.
  • You have decompensated cirrhosis. (End-stage liver disease must be treated at a liver transplant center.)
  • You’re a liver transplant recipient.

Your doctor will also look for certain factors that may lessen your success with interferon treatment. You and your doctor must weigh the danger of your liver disease against the problems that might ensue with peginterferon plus ribavirin treatment, which may be greater for folks with HIV, end-stage liver disease, or a liver transplant.

Determining genotype: Your doctor will test your blood to see what type of genotype your virus is. The most common genotype in the United States and Canada is genotype 1, followed by genotypes 2 and 3. The genotype is a major factor in determining how well and how quickly peginterferon plus ribavirin therapy rids your body of hep C:

  • Genotype 1: The success rate for genotype 1 is about 50 percent, and a 48-week treatment is required. Because the chances are about 50–50 that you might go through a rigorous treatment protocol and not eliminate the virus, your doctor will probably perform a biopsy and discuss with you the risks and benefits of treatment.
  • Genotype 2 or 3: When patients are treated with peginterferon with ribavirin, the success rate is 70 to 80 percent. Some doctors, after finding out that you have genotype 2 or 3, will recommend treatment and may not even suggest you go through the risk of a liver biopsy. The treatment time for these genotypes is 24 weeks. The most-recent studies show (for reasons that aren’t yet clear) that genotype 3 infection may cause more fatty change in the liver, which may also influence the response to treatment.
  • There haven’t been as many clinical trials to see how people with other genotypes (4 through 6) respond to treatment, though it appears to be in the range between genotypes 1 and 2.