When to Start Hepatitis C Treatment

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Many people live with hepatitis C for quite some time before starting treatment–sometimes a decade or even longer.

In some cases, their doctors have decided it’s okay to wait. But in many other cases, they don’t start treatment because they don’t even realize they have a hepatitis C infection. They don’t realize they’ve even been infected because they don’t feel sick. In fact, the Centers for Disease Control and Prevention (CDC) estimates that about three-quarters of people with an acute hepatitis C infection don’t exhibit any symptoms—and others may only experience mild symptoms. 

Unfortunately, the majority of acute infections—as many as 85%, according to the CDC—develop into chronic hepatitis C infections.

Consider these factors when deciding if it’s the right time to start treatment:

The Status of Your Infection

If you have acute hepatitis C, your doctor can chart out a course of treatment for you. It may not even involve medication, but it will very likely require regular blood tests to gauge how your body is reacting to the virus. Treatment for chronic hepatitis C infection, on the other hand, usually involves a combination of antiviral medications.

The State of Your Liver

According to the American Liver Foundation, even if blood tests and a liver biopsy prove you have a chronic hepatitis C infection, you may be able to put off treatment for a while if your liver remains undamaged. However, immediate treatment is recommended for people with cirrhosis or severe fibrosis (scarring of the liver). If you have one of these serious liver conditions, many experts will recommend you start the treatment for hepatitis C right away.

Your Viral Load

When you get tested for hepatitis C, one of the tests will determine how much of a presence the virus has in your bloodstream. A subsequent test will determine the strain, or genotype, of the virus you have. If you have the most common strain, Genotype 1, you may be looking at a longer treatment regimen than if you had Genotype 2 or 3. 

Your Tolerance for Side Effects 

Are you prepared to cope with possible side effects of medications? A 2010 report in the journal American Family Physician noted that  50 to 60% of patients can experience some influenza-like symptoms when receiving interferon-based treatment—fatigue, muscle aches, fever, headaches, etc. If you do start treatment and experience side effects, don’t stop taking your medications. Consult your doctor first.

Your Risk for Depression 

Interferon has long been used to treat chronic hepatitis C, but interferon therapy can increase your risk for depression. Between one-third to one-half of the people who receive this drug in conjunction with the drug ribavirin develop symptoms of depression. If you already suffer from depression, notify your doctor immediately because you might be a better candidate for one of the newer interferon-free treatments.

Your Pregnancy Status

If you hope to become pregnant, your healthcare provider may want to start you on treatment right away. The goal is to clear the infection before you try to conceive. But if you’re already pregnant, your doctor may hold off on treatment because there’s not an approved treatment for hepatitis C during pregnancy yet. For example, ribavirin is teratogenic, which means it could harm a developing fetus and cause birth defects.

Your Overall Health 

Your healthcare provider may want to assess your overall health before giving you any medication to treat your hepatitis C infection. If you have kidney disease, advanced heart disease, diabetes, or certain autoimmune diseases, any of these diseases may affect your course of future treatment.

If you decide to take a wait-and-watch approach and not go forward with treatment, your doctor will likely want to monitor you anyway to make sure that your liver does not develop any new or progressive liver deterioration. Depending on your clinical circumstances, there may be some other steps you can take to manage your infection.

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2019 Apr 26

  1. Diagnosis: What Other Tests Might I Have? American Liver Foundation. http://hepc.liverfoundation.org/diagnosis/who-should-get-tested/more-tests-you-might-need/

  2. Diagnosis: Testing for Hepatitis C. American Liver Foundation. http://hepc.liverfoundation.org/diagnosis/who-should-get-tested/testing-for-hep-c/

  3. Hepatitis C Information for the Public. Centers for Disease Control. http://www.cdc.gov/hepatitis/c/cfaq.htm

  4. Easier Hepatitis C Treatment. Mayo Clinic. http://www.mayoclinic.org/diseases-conditions/hepatitis-c/in-depth/easier-hepatitis-c-treatment/art-...

  5. Arshad M., et al. Hepatitis C Virus Infection During Pregnancy and the Newborn Period. Journal of Viral Hepatitis. 2011;18(4):229-236. http://www.medscape.com/viewarticle/741439

  6. Keller DM. Depression in HCV Often Resolves After Interferon Treatment. April 13, 2013. Medscape. http://www.medscape.com/viewarticle/782355

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