Treatment for hepatitis C has changed dramatically in recent years. Piedmont Healthcare Hepatologist Raymond Rubin, MD, answers questions he hears often from his patients about treating – and curing – the disease. 1. Q: What’s the difference between the hepatitis C infection and the disease? A: Hepatitis C is the actual infectious agent that irritates the liver. If your immune system doesn’t clear it out, it can set up shop and develop into a chronic disease. 50-70% of the time, the hepatitis C infection is not cleared out by the immune system, so it turns into a long-standing disease that has the potential to cause serious complications. 2. Q: How has the hepatitis C treatment experience changed over the last few years? A: In the old days, when I was going to start someone on interferon and ribavirin, our practice would have a class every other week for the patients who were about to get started to show them, of course, how to give themselves an injection. But most of the session was devoted to side effect management. We would see these patients very frequently when they were on treatment. We would handle a lot of telephone calls and office visits with patients who were having all kinds of side effects. On the other hand, now, I have a brief review with patients of the potential side effects and I’ll tell them that about 20% of people who take this medication could experience headache, fatigue, insomnia, or some GI distress; serious side effects are exceptionally rare and needing to stop the medication is exceptionally rare. Other than that, there isn’t a ton of prep. I usually review with them how often they need to get their blood tested during the treatment, and also more importantly, how to tell that they’re cured once the treatment has stopped. 3. Q: What do you wish your patients knew about hepatitis C? A: First and foremost, if you’re a baby boomer, get tested for hepatitis C. Most people with hepatitis C don’t know they have it, and most of those people were born between 1945 and 1965. And hepatitis C rarely has symptoms, so you really won’t know you have it until you’re either tested, or you experience symptoms of severe liver disease. Testing and finding out early so you can treat it is a better way to go. I also wish my patients knew that hepatitis C can cause severe complications, like cirrhosis and end-stage liver disease. Now that it’s curable and the treatment is so much easier, it’s worth talking to your doctor about getting treated. Lastly, I want all my patients to know that hepatitis C is curable. It’s incredible. 4. Q: What’s the hardest part of treating hepatitis C for you? A: It's difficult to find all the patients with hepatitis C who haven't been tested yet, and it's challenging to get these expensive medications paid for by insurance. One really hard part of treating hepatitis C, honestly, is that there’s only one of me! Now that there’s a cure and the treatment is so much more tolerable, there’s no shortage of people getting treated. But the shortage is in people who know how to take care of these patients. Practitioners need to recognize that a subset of these patients either already have cirrhosis or may develop cirrhosis and it’s important to refer these patients to a hepatitis specialist, called a hepatologist. Those doctors are very savvy and know how to best treat hep C.