Dos & Dont’s

Hep C Is Manageable—If You Know the Ins and Outs
by Larry Buhl

You’ve been diagnosed with Hepatitis C. Now what? First, don’t panic. Doctors agree a Hep C diagnosis is not a death sentence. But the virus does require some lifestyle changes and careful monitoring to avoid chronic liver disease.

There are a lot of misconceptions in the general public about hepatitis C. We spoke with Lisa Oldson, M.D., an internal medicine physician and medical director for the Analyte Physicians Group in Chicago. Dr. Oldson has counseled many patients with hepatitis C recently and suggests several things to do and not do if you find you’re infected.

DO see your primary care physician first. If you learn about your status through a series of STD tests, as many people do, you will probably be advised to go to your primary care physician, even though they usually won’t be the best people to treat HCV over the long haul, Oldson tells A&U. “You don’t necessarily need immediate treatment if you’ve just been diagnosed with hepatitis C. But you do need to be monitored continually for changes in your liver with blood work and either ultrasounds or MRIs of your liver. Your primary care doctor should have a network and know who is the most experienced local expert to treat the disease, and whose personality is the best fit. Because [treatment] is going to require an ongoing relationship.”

DON’T rely on homeopathic remedies. Actress Pamela Anderson has said she took homeopathic remedies to treat hepatitis C, which she was diagnosed with nearly ten years ago. High profile figures touting homeopathy as a potential cure makes many doctors uncomfortable, because they feel it may encourage people with hep C to eschew conventional treatment.

“I’m not opposed to alternative therapies and I know that Western medicine doesn’t have it all figured out,” Dr. Oldson says. “But in 2011 we shouldn’t be looking to herbs alone to cure hepatitis C. And there are some homeopathic remedies that could hurt your liver. Dr. Oldson once had a patient who had taken massive doses of herbs for non-hepatitis related ailments that had done massive damage to his liver.

“There are simply not enough studies and not enough information about these treatments. We need large, randomized, double-blind studies. The National Institutes of Health is starting to conduct more rigorous research into the benefits and downfalls of vitamin and herbal therapies, and thus far there is no evidence to support using herbal treatment for hepatitis C.”

DO wait for new drugs if you can. Dr. Oldson and other doctors agree that for people with advanced liver disease, time is of the essence and they should probably go on traditional therapy of interferon and ribavirin right away. But some infectious disease specialists are beginning to tell patients who don’t have advanced symptoms to wait. Interferon takes a toll on the body, and patients who find it debilitating may choose to discontinue treatment early. The new protease inhibitors promise fewer side effects and even better results and could be less than a year away.

DON’T be fooled by lack of symptoms or enzyme levels. Most people with hepatitis C never know they have it, and lack of symptoms doesn’t mean HCV hasn’t progressed. Likewise, enzyme level numbers can be deceiving. “Sometimes in more advanced disease, the enzyme numbers go down because so many liver cells have already been damaged,” Dr. Oldson says. What’s needed, she explains, is thorough, regular screening to find signs of progression.

DON’T infect others. Hepatitis C is carried by blood. The blood of one person with the hepatitis C virus must enter the bloodstream of another person. People at high risk are sharing injecting drug equipment. Hepatitis C can be infectious even in microscopic amounts of blood. If you’ve had a blood transfusion before screening techniques were in place in the early 1990s, you could be at risk as well. The risk of transmitting the virus through sex is low, unless there is an exchange of blood. Casual contact is not a risk.

If you DON’T have HCV or have never been tested. Dr. Oldson has some other things to consider for those who haven’t been tested. First she wants to dispel the common misconception that you can be vaccinated for hepatitis C. “You can be vaccinated for hepatitis A and B, and I encourage people to be vaccinated for A if they travel abroad and for B if they are having sex with multiple partners. But a lot of people assume if they’re vaccinated for one, that covers A, B, and C, and it’s not true.” Finally, if you’ve avoided blood exchange that could put you at risk for hepatitis C, treat your liver well by avoiding excessive alcohol and unhealthy food. The so-called liver detoxification herbs shouldn’t be necessary if one is already enjoying a healthy lifestyle.

Lary Buhl is a freelance journalist and screenwriter living in Los Angeles.

March 2011