Figuring out if you should begin treatment for chronic hepatitis C virus (HCV) infection and determining when you should start are complicated issues. The timing of HCV treatment and the medications prescribed are influenced by various factors, such as your current health, your doctor’s recommendations, and your insurance coverage. Some HCV medications can cause side effects, so people with hepatitis C must weigh the risks of therapy against the benefits in deciding if and when to start treatment.

The American Academy for the Study of Liver Diseases (AASLD) and the Infectious Disease Society of America (IDSA) recommend HCV treatment for nearly all chronically infected people 18 years of age or older who are willing to be treated and to adhere to treatment requirements. HCV-positive individuals with cirrhosis (stage 4 liver disease) or severe fibrosis (stage 3) are candidates for immediate treatment.

A patient should be offered treatment, regardless of the presence or absence of symptoms, the route of HCV infection, the genotype of HCV, or the HCV viral load, if the following criteria are met:

  1. Detectable HCV;
  2. Assessment of degree of liver damage (fibrosis); either by liver biopsy or noninvasive testing; and
  3. Compensated liver disease (laboratory signs and symptoms suggesting that the liver is still functioning).
Treatment is not recommended and should not be offered in certain situations. These include:
  1. Known allergies to the drugs used to treat HCV
  2. A non-liver-related terminal illness with a life expectancy of less than a year
There are additional precautions when using peginterferon and/or ribavirin. These drugs should be used cautiously or not offered in certain situations. These include:
  1. Major uncontrolled depression (which can be exacerbated by HCV treatment)
  2. Solid organ transplant (e.g., kidney, heart or lung)
  3. Autoimmune hepatitis or other autoimmune condition (which can be exacerbated by HCV treatment)
  4. Untreated thyroid disease
  5. Pregnant, unable or unwilling to practice effective birth control
  6. Severe accompanying diseases, such as very high blood pressure, heart failure, significant coronary disease, poorly controlled diabetes or chronic obstructive disease/emphysema
Above all, deciding if and when to start treatment should be individualized. Meaning that, regardless of what “official” guidelines do or don’t say, it is up to you and your health care provider to figure out what’s best for you, based on your own thoughts, concerns and capabilities.