The treatment of hepatitis C primarily involves the use of direct-acting antivirals (DAAs) to eradicate the virus, preventing progression to liver fibrosis, cirrhosis, and even liver cancer. This treatment regimen is suitable for all genotypes, has a short duration, and boasts high cure rates, making it the internationally recognized standard therapy.
The goal of treatment is to achieve "sustained virologic response" (SVR), meaning no detectable viral RNA in the blood 12 weeks after completing therapy. This approach has replaced traditional interferon therapy, significantly reducing side effects and increasing patient acceptance.
DAAs operate through various mechanisms: NS3/4A protease inhibitors block viral protein cleavage, NS5B polymerase inhibitors halt RNA replication, and NS5A inhibitors interfere with viral assembly. Common drug combinations include Sofosbuvir, Ledipasvir, and others.
Suitable for all patients with chronic hepatitis C, including those with cirrhosis, HIV co-infection, or kidney disease. Also used for early treatment of acute hepatitis C and prevention of viral re-infection post-liver transplantation.
Special populations such as the elderly or those with other metabolic diseases require assessment and tailored adjustments by physicians. This therapy is not suitable for undiagnosed other hepatitis virus infections (e.g., HBV co-infection requires concurrent anti-HBV therapy).
The main mode of administration is oral medication, typically once or twice daily, usually in fixed doses without adjustment. The complete treatment cycle generally lasts 8-12 weeks, but patients with cirrhosis may require extension to 12 weeks.
Dosage calculations are primarily based on genotype and liver function status: patients with Child-Pugh A cirrhosis can use standard doses, while those with severe liver impairment should avoid specific drugs such as Cimegovir.
Advantages include:
This therapy can reverse some liver fibrosis and reduce the risk of liver cancer. Clinical trials show that after completing treatment, 30-50% of patients with cirrhosis show improvement in Child-Pugh classification.
Common mild side effects include dizziness (10-15%), fatigue (about 20%), and mild diarrhea. A small number of patients may experience insomnia or joint pain, which usually resolve within weeks after treatment.
Serious but rare risks include: QT prolongation on electrocardiogram (requires regular monitoring), worsening liver failure (especially in patients with decompensated cirrhosis). Immediate medical attention is necessary if jaundice worsens or consciousness becomes confused.
Contraindications include hypersensitivity to drug components, severe decompensated cirrhosis (Child-Pugh C), and certain drug interactions. Alcohol consumption is strictly prohibited during treatment, as it may exacerbate liver damage.
DAAs may interact with antiepileptic drugs (e.g., phenytoin), reducing their efficacy, requiring dose adjustments. When combined with anticoagulants like warfarin, INR levels should be monitored. Protease inhibitors should not be used concurrently with certain antibiotics such as telithromycin.
Organ transplant recipients on immunosuppressants should be under specialist supervision. All medications should undergo comprehensive drug interaction assessment prior to use.
Large clinical trials show a cure rate of 97% in patients without cirrhosis and over 90% in those with cirrhosis. Genotype 3 patients may require ribavirin addition to enhance efficacy.
Five-year follow-up studies indicate that patients with Delta virus co-infection maintain an 85% sustained virologic response when using specific drug combinations. Liver biopsies show a 60% reduction in fibrosis stage post-treatment.
If intolerant to DAAs or treatment fails, older regimens such as interferon plus ribavirin can be considered, though they have severe side effects and cure rates of only 60-70%. Genotype 4 patients may still be eligible for pegylated interferon under certain conditions.
Newly developed drugs like novel NS3/4A inhibitors are in clinical trials, but current standard remains existing DAAs.
During treatment, alcohol should be avoided as it can worsen liver damage. If taking other medications or supplements, inform your doctor in advance, as some ingredients may affect drug metabolism. A high-protein, low-fat diet is recommended, along with regular meals to alleviate possible gastrointestinal discomfort.
What common side effects might antiviral hepatitis C drugs cause? How can they be alleviated?Common side effects include fatigue, musculoskeletal pain, and dizziness, usually occurring early in treatment. Mild symptoms can be relieved with adequate rest and warm compresses; severe symptoms should prompt dose adjustment or auxiliary medication as advised by a doctor. Regular reporting of symptoms to the healthcare team is essential.
Can vigorous exercise or long working hours be performed during treatment?During the initial phase, strenuous activities should be avoided as fatigue may exacerbate side effects. Light aerobic exercises like walking are recommended, along with sufficient sleep. If work involves physical labor, consult with your doctor to adjust work intensity to avoid overburdening the liver.
How long after completing treatment should follow-up tests be conducted?Blood tests should be performed at 12 and 24 weeks post-treatment to confirm viral clearance. If SVR is achieved, it generally indicates cure; however, patients with severe cirrhosis may require follow-up every 6 to 12 months with liver function tests and ultrasound examinations.
What factors influence the cure rate of hepatitis C treatment?The success rate depends on viral genotype, degree of cirrhosis, and patient age. The new DAAs can achieve cure rates over 95% for most genotypes, but severe cirrhosis or non-adherence to medication may reduce efficacy. Regular follow-up is crucial to ensure treatment success.
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