Hepatitis C: Should I take antiviral medicine?

Get the facts
Compare your options
What matters most to you?
Where are you leaning now?
What else do you need to make your decision?

1. Get the facts

Your options

Take antiviral medicine for hepatitis C.
Don't take antiviral medicine. Have regular blood tests and maybe a liver biopsy to check for liver problems.

Key points to remember

Some people who get hepatitis C have it for a short time and then get better without treatment. But others may get a chronic (long-term) infection, which can cause serious liver damage. If this happens, you may need a liver transplant.
Experts recommend antiviral medicines if a biopsy shows signs of severe liver damage and you have high levels of the hepatitis C virus and liver enzymes in your blood for at least 6 months.
Medicines can stop or slow the growth of the hepatitis C virus, but they can have serious side effects. Some people stop taking their medicines because they feel too sick to finish them.
You may not need to take antiviral medicines if your liver isn't damaged and the level of liver enzymes in your blood is normal or only a bit higher than normal.
Even though hepatitis C is serious, most people can manage the infection and lead active lives.
Some people may not be able to take antiviral medicines. For example, if you are pregnant, have certain health problems, or have alcohol or drug abuse problems, you may not be able to take the medicines.
Treatment may not be an option for everyone who has hepatitis C. Antiviral medicines don't work for everyone, and they cost a lot.

FAQs

What is hepatitis C?

Hepatitis C is a virus that infects the liver. You can get hepatitis C when you share needles to inject illegal drugs with someone who has the virus. You can also get it by having a shot, tattoo, or piercing with a needle that has infected blood on it.

When most people get hepatitis C, they don't even know they have it. Early symptoms are mild and don't last long.

Some people who get the virus have it for a short time and then get better. This is called acute hepatitis C. But up to 85 people out of 100 who are infected with the virus get long-term (chronic) hepatitis C.¹ "Chronic" means that the virus is active in your body for more than 6 months.

Chronic hepatitis C can cause swelling and tiny scars to form in your liver. When this happens, your liver doesn't work well. About 25 out of 100 people who have chronic hepatitis C get more serious liver problems such as cirrhosis, liver cancer, or liver failure. This most often happens over a period of 20 years or more.² If the damage is severe, you may need a liver transplant.

See a picture of a healthy liver compared to a liver with cirrhosis .

What medicines are used to treat hepatitis C?

A combination of two antiviral medicines is the main treatment for hepatitis C. When used together, peginterferon and ribavirin can stop or slow the growth of the virus. This is called combination therapy.

Treatment can last from 6 months to 1 year. Peginterferon is given as a shot once a week. Ribavirin is taken as a pill 2 times a day.

Peginterferon and other interferons may also be given without ribavirin if you have anemia or heart or kidney problems.

Who should take antiviral medicines for hepatitis C?

If you have chronic hepatitis C, you may need treatment. Your chance of getting serious liver disease is higher if your liver is damaged and the levels of the virus and liver enzymes in your blood have been high for at least 6 months.

Results from your blood tests can help you and your doctor decide if you should start treatment. Your doctor may also take a tiny piece of your liver, called a biopsy, to see if it has been affected by the virus.

You may not need to take medicines if your liver isn't damaged and the level of liver enzymes in your blood is normal or only a bit higher than normal.

Doctors likely won't want you to use these medicines if you are pregnant or if you have:

Major depression.
Heart, kidney, or thyroid problems.
Advanced cirrhosis of the liver.
Low levels of red cells, white cells, and platelets in your blood.
An autoimmune disease.
Had an organ transplant.
Drug or alcohol abuse problems.

Even though hepatitis C is serious, most people can manage the infection and lead active lives. Two key steps are to take good care of yourself and get regular checkups to watch for liver problems.

How well do antiviral medicines work?

Antiviral medicines can stop or slow the growth of hepatitis C and help prevent serious liver problems. There are several types of the hepatitis C virus that cause infection. Six different genotypes of hepatitis C have been found. Most people in the United States have genotype 1.

Studies have shown that:

A combination of peginterferon and ribavirin works for as many as 45 out of 100 people with genotype 1.³ This means that it doesn't work for the other 55 people.
The combination also works for as many as 80 out of 100 people who have genotype 2 or 3.³ This means that combination therapy doesn't work for 20 out of 100 people who have these genotypes.

Antiviral medicines may not decrease the amount of the virus in your blood. But some studies have shown that treatment may still reduce scarring in your liver. This can lower your chance of getting cirrhosis and liver cancer.^4, ¹

A combination of medicines is more likely to work if you have:

Low levels of the hepatitis C virus in your blood when you start treatment.
Small amounts of liver damage when you start treatment.
Genotype 2 or 3.

Treatment may not be an option for everyone who has hepatitis C. These medicines don't work for everyone, and they cost a lot. Some insurance companies may cover all or part of the cost of these medicines. If you don't have health insurance, the drug company that makes peginterferon may be able to help cover the cost of your treatment.

What are the side effects of antiviral medicines?

About half of the people who take both peginterferon and ribavirin have serious side effects during their treatment. Some people may need to stop taking their medicines because the medicines make them feel very sick. Talk to your doctor if your hepatitis C medicines are causing serious side effects.

Side effects of the combined medicines include:

Fatigue, headache, fever, chills, and muscle and joint aches.
Nausea, loss of appetite, and weight loss.
Irritability, insomnia, and confusion.
Depression.
Thyroid problems.
Hair loss or skin rash.
Low levels of red cells, white cells, and platelets in your blood.

Why might your doctor recommend antiviral medicines?

Your doctor might advise you to take antiviral medicines if:

You have active infection. This means that you have high levels of the virus in your blood.
Your liver enzyme levels are more than twice the normal amount.
You are likely to develop serious liver disease such as cirrhosis or liver cancer.
You have mild to severe liver damage.

2. Compare your options

	Take antiviral medicine	Don't take antiviral medicine
What is usually involved?	You take shots and pills for 6 months to a year. You have regular exams and blood tests to check for liver problems.	You have regular exams and blood tests to check for liver problems. You take steps to prevent further liver damage by not drinking alcohol or using illegal drugs.
What are the benefits?	Antiviral medicines can stop or slow the growth of the hepatitis C virus. They can help prevent serious liver problems.	You can avoid the side effects and cost of antiviral medicines.
What are the risks and side effects?	Possible side effects may include: Fever. Muscle aches. Headaches. Nausea. Depression. Hair loss. Skin rash. Trouble sleeping. Low blood counts.	If the hepatitis C virus is active in your body, you may: Get severe liver disease. Get severe liver cancer. Spread the infection to others.

Personal stories

Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.

For more information, see the topic Hepatitis C.

Personal stories about antiviral treatment for hepatitis C

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

" I would like to try combination treatment with peginterferon and ribavirin to try to keep my liver healthy. I realize that I may never have liver failure, even if I don't have treatment, but I want to feel like I've done everything possible to prevent it."

— Frank, age 29

" I was shocked when I tried to donate blood and found out that I had hepatitis C. My liver enzymes have been up, but my liver doesn't show any signs of damage yet. I'm glad. I hate the thought of having a treatment that might make me sick, and I really don't believe that my liver will be damaged. I am just going to keep visiting my doctor to keep an eye on my condition."

— Rick, age 50

" I have two teenagers, and I really want to stay as healthy as I can for as long as I can while they grow up and have their own families. My doctor says antiviral treatment is the best chance I have of staying healthy and active, so I am going to take my doctor's advice and have treatment."

— Nina, age 45

" The side effects of treatment worry me. It also costs a lot of money, and it doesn't help everyone. I don't feel sick, even though my doctor says that my liver enzymes have been a little high for about the past 8 months and my liver biopsy showed some mild damage. Because of my concerns, my doctor and I decided to keep checking my liver enzymes and repeat the liver biopsy in a few years. "

— Karen, age 53

3. What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to take antiviral medicine for hepatitis C

Reasons not to take antiviral medicine for hepatitis C

I'm willing to take pills and get shots to help get rid of the virus in my body.

I don't like taking pills or getting shots.

More important

Equally important

More important

I'll do whatever I can to avoid getting liver disease or liver cancer.

I'm not worried about getting liver disease or liver cancer.

More important

Equally important

More important

I'm worried that I might spread the virus to others if I don't treat the infection.

I'm not worried about spreading the virus to others.

More important

Equally important

More important

I'm not worried about missing work to go to the doctor for the exams and tests that I need.

I can't afford to take time off from work to go to the doctor.

More important

Equally important

More important

My other important reasons:

More important

Equally important

More important

4. Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Taking antiviral medicine

NOT taking antiviral medicine

Leaning toward

Undecided

Leaning toward

5. What else do you need to make your decision?

Check the facts

1. If I have a lot of the virus in my blood and my liver enzymes are high, I may need to take medicines to treat the infection and prevent liver disease.

True
False
I'm not sure

That's right. Experts recommend antiviral medicines if a biopsy shows signs of severe liver damage and you have high levels of the hepatitis C virus and liver enzymes in your blood for at least 6 months.

2. Taking antiviral medicines may not be an option for me if I have certain health problems or drink too much alcohol.

True
False
I'm not sure

That's right. Some people, such as pregnant women and people who have certain health problems or alcohol or drug abuse problems, may not be able to take antiviral medicines.

3. I may not need to take medicine if I have only had hepatitis C for a short time.

True
False
I'm not sure

That's right. Some people who get the virus have it for a short time and then get better without treatment. But others may get a chronic infection, which can cause serious liver damage.

Decide what's next

1. Do you understand the options available to you?

2. Are you clear about which benefits and side effects matter most to you?

3. Do you have enough support and advice from others to make a choice?

Certainty

1. How sure do you feel right now about your decision?

Not sure at all

Somewhat sure

Very sure

2. Check what you need to do before you make this decision.

I'm ready to take action.
I want to discuss the options with others.
I want to learn more about my options.

3. Use the following space to list questions, concerns, and next steps.

References

Citations

Dienstag JL (2005). Chronic viral hepatitis. In GL Mandell et al., eds., Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases, 6th ed., vol. 1, pp. 1441–1464. Philadelphia: Elsevier/Churchill Livingstone.
Flamm SL (2003). Chronic hepatitis C virus infection. JAMA, 289(18): 2413–2417.
Hoofnagle JH (2008). Chronic hepatitis C. In L Goldman, D Ausiello, eds., Cecil Medicine, 23rd ed., pp. 1113–1116. Philadelphia: Saunders Elsevier.
Management of hepatitis C: 2002. Consensus Development Conference statement, National Institutes of Health Consensus Development Conference (2002 June 10–12). NIH Consensus Development Program. Available online: http://consensus.nih.gov/2002/2002HepatitisC2002116html.htm.