for Veterans and the Public

Watchful waiting doesn't mean that you will be doing nothing. Instead, it means that you and your doctor will carefully monitor the progression of your hepatitis C, keeping treatment with currently available medications in mind as an option. Newer medications which increase the chance an SVR (sustained virological response) are continuing to be developed and some are anticipated to be FDA approved as early as 2011 . Many patients with hepatitis C can defer treatment until these newer drugs are available, in order to have the highest likelihood of achieving an SVR when they do undergo treatment.

Watchful waiting and lifestyle changes for hepatitis C are aimed at doing 3 things:

• stopping or slowing down the damage to your liver
• keeping you feeling well and helping you to feel better
• monitoring the natural course of the liver before deciding if treatment is necessary

Good candidates for watchful waiting are:

• patients with mild liver disease in whom treatment is not needed at the current time
• patients in whom pegylated interferon and ribavirin could be particularly too risky in terms of side effects. For example, patients with serious heart, lung, kidney disease or cancer may have these medical issues as much more active and antiviral HCV treatment would be too risky
• patients who are ready for treatment but would potentially benefit from waiting until new drugs are available.

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 alcohol or tobacco, because reducing further damage to your liver is crucial
• attaining or maintaining a healthy BMI
• minimizing risk of steatosis with good control of diabetes and lipids