In the past, treatments for hepatitis C were often intolerable due to side effects. Today, we have new, much easier treatments that can actually cure the disease. Piedmont Healthcare Hepatologist Raymond Rubin, MD, explains why now is the time to get treated. If you contract the hepatitis C infection and your immune system doesn’t clear it out on its own, the virus can set up shop and develop into a chronic disease. This happens about 50 to 70% of the time. If you don’t receive medication to treat the disease, it’s possible that it can do severe damage to your liver and sometimes other organs. In the last few years, we have developed a treatment that cures hepatitis C. It may seem surprising, then, to learn that many people living with the hepatitis C virus aren’t currently treating it. There are two reasons for that. Most Americans with hepatitis C don’t know they have it. Most experts estimate that somewhere between 3 and 6 million Americans have hepatitis C, and out of that number, 1.5 to 3 million people don’t know it. Hepatitis C often doesn’t really show symptoms until it’s progressed to severe liver disease. That’s why people who are at risk of contracting hepatitis C, especially baby boomers, should talk to their doctors about getting tested. Starting treatment as early as possible can prevent damage to your liver. Symptoms might be prevalent right there when you first get the infection, but that doesn’t happen that often. Symptoms may become quite predominant late in the disease if someone develops cirrhosis, a condition in which healthy liver tissue is replaced with scar tissue, preventing the liver from functioning correctly. Typical symptoms that should make you think about treating your disease would be unexplained fatigue, unexplained itching all over your body, and yellow jaundice, which means the whites of the eyes turn yellow and skin may turn yellow; those are all signs of liver disease. If you’re throwing up bloody or black material or passing bloody or black stools, contact your doctor immediately. These are signs of very advanced liver disease and you’ll need to start treating your condition. In the past, the treatment seemed worse than the disease. The second reason that people aren’t treating their hepatitis C? Until recently, treatment was often extremely difficult to get through. Before 2013, all of our hep C treatments were based on a backbone of interferon. Interferon is a substance your body ordinarily makes. When we administered it for the treatment of hepatitis C, we gave patients a lot more of the concentrated form. The problem with interferon is it had terrible side effects that were difficult to tolerate, and many patients wouldn’t be able to complete the treatment process. I never injected interferon into myself, but I saw what it did to otherwise perfectly healthy people and they just couldn’t bear it. It wasn’t that they were being neglectful. It was such an awful experience they couldn’t get through it. But the amazing news is that, as of 2013, we have new, easily tolerated treatments available that can actually cure the disease! If you’re one of those people who suffered from side effects of interferon, it’s time to ask your doctor about the new treatments. These treatments have very little side effects and can completely remove the virus from your blood. A complicating factor to this new cure is that it’s quite expensive. Hepatitis C specialists around the country are still trying to figure out who should be treated with the new options, especially because not everyone with the hepatitis C virus is destined to develop cirrhosis and the complications of advanced-stage liver disease. Probably only about 20% of people with hepatitis C will go down that path. For now, we’re trying to focus these new drugs on patients who have moderate to severe damage to their liver already. Now, there are definitely people out there who are advocates of treating everybody with hepatitis C, to wipe it off the map. And if you’re the individual patient, even if you don’t have advanced liver disease, you may not want to coexist with this infection that, in some people, also has the ability to infect organs other than the liver. You may just want it out of you, no matter what. So there are a lot of spirited arguments right now asking, should we treat absolutely everybody that has the virus in their blood? Or do we focus only on those with the most advanced disease right now, until we can get the pricing down? The original recommendations from the American Association for the Study of Liver Diseases that came out just about a year ago said that we should prioritize treatment for the sickest patients, including those with bad scarring, those with cirrhosis, those who’ve had a liver transplant already, and those who have a lot of outside-the-liver side effects. However, here we are, 15 months later, and even the Association is now advocating treating all patients who are diagnosed. So how do you know it’s time to start treating your hepatitis C if you’re not experiencing symptoms of liver disease? My advice would be to talk to your doctor about your individual situation. He or she will be able to find the best path forward for you.