Hepatitis C Treatment: Options When Interferon Fails

Hepatitis C treatment

Hello Dr.
Chen, my father was diagnosed with hepatitis C previously.
After a liver biopsy, his condition was deemed eligible for National Health Insurance coverage.
He has been receiving weekly injections (which he believes are interferon) and taking medication regularly, which I assume is considered interferon combination therapy, correct? Six months is within the scope of a National Health Insurance treatment regimen.
As of yesterday, it has been exactly three months, and during his hospital visit, the doctor stated that the test results showed no effectiveness.
Does this mean it has been declared a failure? Could you please clarify what is meant by "no effectiveness"? If the doctor says it is ineffective, should we continue with the treatment? If not, are there alternative treatment options available? We have previously consulted a traditional Chinese medicine specialist who indicated that treatment would be out-of-pocket, costing around 24,000 NT dollars per month, with significant improvement expected after six months.
Should we consider switching to traditional Chinese medicine treatment? My father was very distressed upon hearing that the treatment was ineffective and couldn't sleep all night.
Our family is also very concerned.
We kindly ask for your guidance on what steps we should take next.
Thank you.

Hàoyuè, 20~29 year old female. Ask Date: 2005/12/15

Dr. Chen Jianhong reply Gastroenterology and Hepatology

Hello! Doctor, my father was previously diagnosed with hepatitis C.
After a liver biopsy, his condition was deemed eligible for insurance coverage.
He has to go to the hospital every week for injections (which he says are likely interferon), and he also takes medication regularly.
This is considered interferon combination therapy, correct? Although the letter did not clarify this, based on the description, it seems he is receiving interferon treatment for hepatitis C.
Six months is considered a treatment course covered by insurance.
As of yesterday, it has been exactly three months, and when he returned to the hospital for a check-up, the doctor said the test results showed no effectiveness.
Does this mean it has been declared a failure? Could you please explain what is meant by "no effectiveness"? If the doctor says there is no effectiveness, should he continue the treatment? If not, are there other treatment options available?
We are unclear about what your father's attending physician means by "no effectiveness." It could refer to the situation where, after treatment, the viral load or liver enzyme levels have not decreased or returned to normal, which would be termed "ineffective." However, to confirm this, it is best to conduct an HBV RNA viral load test (at the three-month mark of treatment), but this test must be paid for out-of-pocket.
Clinically, the effectiveness is often assessed at the three-month mark; if there is still no decrease or normalization of the indices after three months, the prognosis for effectiveness at six months is not very promising.
However, some patients may show gradual improvement later on, so if the patient can tolerate the side effects, completing the full 26-week treatment may still be an option.
Currently, aside from this method, there are no new treatment options for hepatitis C.
I have also consulted a traditional Chinese medicine practitioner specializing in liver and gallbladder issues, who mentioned that treatment would require out-of-pocket expenses, with monthly medication costs around 24,000 TWD, claiming significant improvement after six months.
Should we consider switching to traditional Chinese medicine treatment?
I do not encourage this, as there are no rigorous scientific studies supporting claims of effectiveness for treating hepatitis C.
Yesterday, my father was deeply affected upon hearing that the treatment was ineffective, and he couldn't sleep all night.
Our family feels very distressed about this, and we kindly ask the doctor to provide guidance for us to consider.
Thank you.

I still recommend that your father, if possible, complete the entire treatment course (i.e., six months) to see the results.

Reply Date: 2005/12/15

More Info

Understanding Hepatitis C Treatment: Options When Interferon Fails
Dear patient,
I understand that your father has been undergoing treatment for Hepatitis C, specifically with interferon therapy, and that recent tests have shown no significant improvement. This situation can be quite distressing, especially when one is hopeful for a positive outcome. Let’s delve into the treatment options available when interferon therapy does not yield the desired results.

Firstly, it’s important to clarify what is meant by "no effect" in the context of Hepatitis C treatment. Typically, the effectiveness of interferon therapy is assessed through a few key indicators, including the reduction of liver enzymes (ALT and AST), the presence of HCV RNA (the virus's genetic material) in the blood, and the overall improvement in liver function. If your father's viral load remains high or if liver enzymes do not show a significant decrease after a few months of treatment, it may indicate that the therapy is not effective for him.
In clinical practice, if a patient does not achieve a sustained virologic response (SVR) after completing a course of interferon therapy, it is often considered a treatment failure. SVR is defined as the absence of detectable HCV RNA in the blood 12 weeks after completing therapy. If your father is only three months into treatment, it may be premature to declare the treatment a failure, but the lack of improvement is concerning.

If interferon therapy is deemed ineffective, there are alternative treatment options available. The most significant advancement in the treatment of Hepatitis C has been the development of direct-acting antiviral agents (DAAs). These medications target specific steps in the HCV lifecycle and have shown high rates of efficacy, often exceeding 90% in curing the infection. DAAs are generally well-tolerated and have fewer side effects compared to interferon-based therapies.

Some of the commonly used DAAs include sofosbuvir, ledipasvir, velpatasvir, and glecaprevir/pibrentasvir. The choice of DAA regimen depends on several factors, including the specific genotype of the virus, the presence of liver fibrosis or cirrhosis, and any previous treatment history. It is crucial to consult with a hepatologist or a specialist in infectious diseases who can provide guidance on the most appropriate treatment plan based on your father's specific circumstances.

Regarding the suggestion of pursuing traditional Chinese medicine (TCM), while some patients seek complementary therapies, it is essential to approach this with caution. The efficacy of TCM for treating Hepatitis C is not well-established in scientific literature, and the costs associated with such treatments can be substantial. It is advisable to discuss any alternative treatment options with your father's healthcare provider to ensure they do not interfere with ongoing antiviral therapies.

In summary, if interferon therapy is not yielding results, it is crucial to explore alternative treatments, particularly the newer DAAs, which have revolutionized Hepatitis C management. Additionally, maintaining open communication with your father's healthcare team is vital to navigate this challenging situation and to ensure that he receives the best possible care.

I hope this information provides clarity and direction for you and your family during this difficult time. Please feel free to reach out with any further questions or concerns.

Best regards.

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