Disclaimer

Will all my hair fall out during treatment? I have heard that patients on interferon lose their hair and develop thyroid disease. Is this true?

Hair thinning occurs 3 to 4 months into treatment and continues for 1 to 3 months after treatment has stopped. In general, this is reversible. Thyroid dysfunction can occur during treatment and is well controlled with medication. The condition can reverse or may be permanent at the end of treatment.

I take other medications. Will they hurt my liver?

All medications are possibly hepatotoxic. However, this occurs only in a small number of patients. You should avoid alcohol when combined with greater than 2 grams of acetaminophen (Tylenol) over a 24-hour period.

What are the side effects of treatment? Is it true that treatment is very difficult and toxic to my system?

The standard treatment-pegylated interferon (Peg-IFN; a weekly injection you give yourself) and ribavirin (pills you take every day)-has many side effects, although not everyone experiences them. Common side effects include flu-like symptoms such as fever, chills, muscle aches, joint pain, headaches, fatigue, and upset stomach (including nausea, vomiting, diarrhea), as well as changes in your blood sugar, skin reactions (including rash, dry/itchy skin, redness/swelling at the site of your peg-IFN injection), temporary hair loss, decreased appetite, dizziness, trouble sleeping, and decreases in your blood cell counts including red blood cells, white blood cells, and/or platelets (cells that help your blood clot).

If you are diabetic, there are some additional risks to taking the treatment medications such as eye problems. If you are diabetic, we will ask that you see an ophthalmologist to help decide if you will have any complications while on treatment. Peg-IFN can also affect your mood, causing mood swings, anxiety, irritability, and depression. If you tend to have problems with mood or be depressed, we ask that you see a therapist to help us decide if you can handle the medication. If needed, we will also prescribe an antidepressant to help you deal with the changes in your mood. If we see that some of your blood counts are dropping, we also can prescribe another medication that can raise your blood counts to prevent complications.

While the medication can be difficult for some people, most patients tolerate it without disrupting their lifestyle and are able to continue working. If you decide to undergo therapy, the medications and treatment regimen will be explained to you in great detail, and while you are treated we will monitor you closely and make adjustments where needed.

Should I wait for new treatments to become available? I heard the current ones cause a lot of side effects.

Currently, the most effective treatment regimen for HCV infection is a combination of pegylated interferon alfa and ribavirin (combination therapy), with a sustained virologic response (SVR) rate of up to 55%. However, one of the main drawbacks of combination therapy is the development of side effects. Four broad categories of side effects include nonspecific (eg, flu-like syndrome, itching, shortness of breath), neuropsychiatric (eg, depression, anxiety, irritability), hematologic (eg, anemia, neutropenia, and thrombocytopenia), as well as those involving other organs (eg, alopecia, thyroid dysfunction). These side effects are generally treated by dose reduction resulting in subtherapeutic doses of interferon and ribavirin. Hematopoietic growth factors have recently been assessed in an effort to avoid dose reduction or treatment discontinuation. Early data are encouraging, and large clinical trials are underway. In addition to strategies to enhance adherence, newer classes of antiviral drugs such as helicase or protease inhibitors are still in the developmental phases.

What medications do I need to avoid?

In general, caution should be exercised when taking medications with potential liver toxicity. For example, methotrexate is a medication used for a number of rheumatologic diseases. In the presence of liver disease or alcohol consumption, this drug may affect the liver adversely. If in doubt, the safety of any medication in the setting of HCV should be confirmed with a health-care professional.

You say I should take acetaminophen (Tylenol) to treat the side effects of therapy, but everyone says that I should not use Tylenol because I have liver disease.

Acetaminophen is present in many over-the-counter medications and is the principal ingredient in many that are promoted as aspirin-free agents to control mild pain and fever. There is a lot of confusion about the safety (or lack of safety) of acetaminophen use in those who have established liver disease such as hepatitis C. After all, a massive overdose of this medication will cause liver failure. At the same time, modest doses of acetaminophen (for example, 3 grams per day or less) seem to be well tolerated in those with liver disease including those with hepatitis C. It should be clear that no medication including this one should be taken unless really necessary. There is a further warning for products containing acetaminophen that those who drink considerable amounts of alcohol should not use this agent. All medications have the potential to cause harm. But considering the alternatives for controlling pain and fever, acetaminophen has an excellent track record in those with hepatitis C.