From hcvadvocate.org September newsletter. A great site for lots of info!
HealthWise: Choosing Not to Treat Hepatitis C
Lucinda K.Porter, RN
Imagine this scene. Your medical provider recommends treatment for chronic
hepatitis C virus infection (HCV). You've had HCV for 30 years and your liver
is moderately scarred. You have genotype 1 so treatment will likely last for 48
weeks. You have read about the side effects of the medications and, after
careful consideration, you'd rather take your chances with hepatitis C than with
Regular Healthwise readers probably think I am going to try to persuade this
fictitious patient to reconsider. After all, if I didn't believe in treatment I
would not have tried it once, let alone twice. However, the decision to undergo
treatment is a complicated one, and what worked for me might not work for
So, this month, I am headed in a different direction. I explore the other
pathmaking the choice to not treat. I recommend ways to support your liver and
general health. This advice applies to nearly everyone, but particularly those
with liver disease.
There are many reasons for rejecting HCV treatment. Here are some:
* You are concerned that you might not be able to work.
* You are troubled by the potential side effects, particularly depression.
* You are bothered by the fact that the medication is given by
self-injection and concerned it may trigger a relapse from drug recovery.
* You distrust the pharmaceutical industry and their products.
* You are committed to natural or alternative medicine.
* You are afraid that treatment will be unendurable.
* You are paralyzed by indecision.
* You are scared that the medication will harm, maim or kill.
* You favor waiting for better HCV medications.
* You are unwilling to go through treatment without better odds of success.
* You feel well and don't want to give that up for a year.
* Your liver has little or no fibrosis and waiting makes sense.
* You think a sharp stick in the eye sounds like a better alternative.
Let's assume you discussed all of this with your medical provider and your mind
is made up. Now what?
First and foremost, minimize stress to your liver. Abstain from alcohol use.
If you aren't willing to quit, limit your drinking to no more than one standard
size drink a day. One standard drink is 12 ounces of regular beer, 8 to 9
ounces of malt liquor, 5 ounces of table wine, or 1.5 ounces of 80proof
spirits. If drugs or alcohol are a problem, get help.
Keep your weight under control. Nonalcoholic fatty liver disease (NAFLD) is
quickly becoming a serious health problem in this country. NAFLD is the most
common cause of elevated liver enzymes. Tragically, NAFLD is striking children
as well as adults. Complications from NAFLD include liver cancer and death.
Fortunately, NAFLD is treatable and potentially reversible. Weight loss is an
effective treatment for NAFLD. Exercise may help. Patients with NAFLD showed
improvement with as little as 60 minutes a week of low-to-moderate intensity
exercise. Patients who exercised but did not lose weight also had significant
improvements in fasting blood glucose, insulin resistance, and cholesterol and
Eat a low fat, high-fiber diet. Include fresh fruit, vegetables, and whole
grains. Avoid trans-fatty acids, saturated fats, corn syrup and excess salt.
Eat real foodrather than stuff out of a box.
Practice safe food habits. Avoid raw or undercooked shellfish. Raw or
undercooked oysters and clams may carry Vibrio vulnificusbacteria that cause a
number of serious clinical conditions. Uncooked shellfish may also harbor
Beware of poisonous mushrooms. They contain toxins that can destroy even the
Do not eat wild mushrooms unless you are 100% sure of what you consume.
Aim for 30 or more minutes of exercise every day. If you are confused about
exercise, here is a simple place to start. Put on comfortable walking shoes and
sunscreen. Step outside and walk 15 minutes or more. Then turn around. Make
this a daily goal. If 30 minutes is too much, start with something you can do.
A walk to the mailbox is better than no walk.
Protect your liver from other viruses. If you aren't already immune to
hepatitis A and B, get vaccinated. Make sure all immunizations are up to date,
including an annual flu shot.
Get regular check-ups. Your medical provider will recommend how often you
should be seen and what labs and other diagnostic tests need to be performed.
This all depends on the condition of your liver. Blood tests are usually done
every six or twelve months, more frequently if you have cirrhosis. Medical
appointments are usually scheduled annually, more often for patients with
advanced liver disease. If you have cirrhosis, your provider may order an
abdominal ultrasound every 6 months. Liver biopsies are usually recommended
every 3 to 5 years. If you already have cirrhosis, there is no need to biopsy
If you use herbs or dietary supplements, learn how to do this safely. Some
herbs are toxic to the liver. Large doses of any supplement are strongly
discouraged. More is not better. Vitamin A in high doses can cause liver
injury. Iron supplementation should only be taken under medical supervision.
Herbs should never be used by people with decompensated cirrhosis. For more
information about dietary supplements, visit www.hcvadvocate.org.
Act responsibly around blood and bodily fluids. This means not infecting
others, and avoiding infections from others. Wash your hands. Practice safer
sex. Cover all cuts or wounds. Do not share personal hygiene instruments, such
as razors, cuticle scissors, nail clippers, toothbrushes or other items that
might be exposed to blood. Properly discard all feminine hygiene products. Use
good judgment when getting tattoos or body piercings.
Strive for the best health possible. If you smoke, try to quit. If you don't
floss your teeth, make this a daily goal. Wear your seat belts. Look for every
opportunity for improvement. If you hear yourself groaning about this, consider
an attitude adjustment. We don't have to improve our healthwe can take
chances. Alternatively, we can take our future into our own hands and start
feeling better now.
Keep abreast of medical news. Science is making giant leaps. The Hepatitis C
Support Project provides the latest news on liver disease. You can subscribe to
regular updates or go to www.hcvadvocate.org. At this website, there is an
extensive list of HCV and other liver-related drugs that are in various stages
for more info on natural treatment of HCV.