Viral Hepatitis

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FAQ: Why would my doctor not start me on treatment?

for Veterans and the Public

Frequently Asked Questions

Q: Why would my doctor not start me on treatment right now?

Treatment for hepatitis C usually involves a combination of 2 medications: pegylated interferon and ribavirin. These drugs can cause unpleasant side effects such as fatigue, depression, and nausea, and they don't always succeed in getting rid of the virus.

Patients with chronic hepatitis C should be medically evaluated and should work with their doctors to consider whether treatment is right for them.

There are several reasons why your doctor may decide not to start you on pegylated interferon and ribavirin medication:

  • May not be needed right now. Your liver may not be affected much by the hepatitis C (you may have a low stage of liver damage). Even if you have had the virus for several years, or have a high viral load, there isn't a great need to take the medications if there isn't much liver damage.
  • May be waiting for newer drugs with better chance of success. You may have mild liver damage, but be progressing at a very slow rate. If so, waiting for new drugs to be developed might be a better choice than going through the currently available medications, which can be difficult to tolerate.
  • May be medically unsafe for you to take hepatitis C medications. You may have serious liver damage and complications of liver disease, and may be too ill to tolerate the medications.
  • May have too low a chance of success on current drugs. You may not have a strong likelihood of responding to the current medications because of your genotype, viral load, or other medical problems.
  • May have other medical problems which make hepatitis C treatment too risky. You may have other medical or psychiatric problems, such as chronic lung disease, heart failure, or severe depression, which could be worsened by taking medications for your hepatitis C.
  • May be too close to pregnancy. You may be trying to conceive children or not be using regular birth control methods, and the ribavirin would be harmful to a fetus.
  • May be drinking or using drugs heavily. You may be drinking alcohol heavily or using drugs, which would interfere with the hepatitis C therapy.
  • May not be a convenient time for you. You may have other issues or priorities in your life (such as preparing for an upcoming move, taking care of young children at home, or having travel commitments with your work) that would make the treatment, the side effects, and the necessary follow-up too difficult to manage at the current time.

In general, deciding whether to start therapy is as important as deciding when to start therapy. Because hepatitis C typically progresses very slowly, many patients are better off postponing treatment until other existing medical problems or circumstances in their daily lives are well controlled.

For these patients, the better option is "watchful waiting." Watchful waiting means that you and your doctor carefully monitor the progression of your hepatitis C, keeping in mind the currently available medications and keeping in mind the potentially new drugs being developed.

Watchful waiting involves the following:

  • having liver enzyme blood tests once or twice a year
  • having a liver biopsy every 3 to 5 years
  • going to regular doctor appointments
  • following your doctor's lifestyle recommendations, such as avoiding alcohol, to limit further damage to your liver