Those with hepatitis C should be monitored by a physician, but given the current state of available treatments, active treatment is not recommended for all people. Available medications can have intense side effects, so they are not recommended for those in whom there is no clear and obvious benefit.

Treatment is recommended for those with hepatitis C who’re rapidly progressing toward cirrhosis. These people generally have elevated ALT levels and a liver biopsy that shows fibrosis and at least moderate levels of inflammation and liver tissue death.

Because the virus often enters a person’s body without producing symptoms, it can be difficult to detect those with acute disease. However, if it is possible to detect the infection during the first six months, medication is recommended because it may help clear the virus from the person?s system before the infection becomes chronic.

For others, the decision to pursue treatment should be made on an individual basis. After assembling test results, the doctor and patient should discuss the benefits and risks of treatment and decide on the best course of action. In those with elevated ALT levels but less severe changes to the liver tissue, it may be best to monitor the disease’s progress with regular ALT tests and a liver biopsy every 3 to 5 years. For those over 60 or under 18, firm data on the best course of treatment is not yet available. For those who are HIV-positive, treatment is only recommended if the HIV infection is stable and the person functions well in daily life. HIV can often accelerate the course of hepatitis C.

Treatment is not recommended for those with advanced cirrhosis. In those cases, treatment is often ineffective and the side effects are difficult to endure. These people should be considered candidates for liver transplants. People with consistently normal ALT levels and little liver damage should also abstain from medication, as response rates are variable and benefits unproven. Because of the medications? side affects, treatment is not recommended for those with a history of major depression, cytopenias (low blood cell or platelet counts), hyperthyroidism or major autoimmune disease, or if they have undergone a kidney transplant.

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