A diagnosis of HCV doesn't necessarily mean you need treatment. The National Institutes of Health recommends treatment for HCV if you have:

• A positive test result indicating hepatitis C virus circulating in your bloodstream

• A biopsy that indicates significant liver damage

• Elevated levels of a liver enzyme called alanine aminotransferase (ALT) in your blood

Choosing to treat your hepatitis C is one of the most significant decisions you will ever make. For many people, treatment helps reduce the amount of hepatitis C virus in the blood to a level where it can no longer be detected. Combination therapy using pegylated interferon and ribavirin can render the virus undetectable in up to 5 out of 10 persons with genotype 1 and in up to 8 out of 10 persons with genotypes 2 and 3. Often, treatment can have a positive effect on the liver—an impact that your doctor can see within a few weeks.

It may be tempting to put off treatment. The course of treatment can be difficult for many people, and it always seems easier to do nothing—to wait until a better, more convenient time in the future. But ask yourself these questions:

• Have there ever been better, more successful treatments available for hepatitis C?

• Will I ever be stronger, healthier, more ready to take on prescription treatment than I am right now?

• Is there a way to accurately predict how fast my hepatitis C will advance?
• What can happen if hepatitis C is not treated?

The answer to the first question is easy. There has never been better treatment available. We know more about hepatitis C than we ever have, and treatment has made truly significant progress.

The answer to the second question is up to you and your doctor. Make sure you ask the tough questions and get helpful guidance from your healthcare team. They may tell you what they have probably told many of their patients: that you'll never be stronger than you are right now—today.

The answer to the third question is difficult. You can have a liver biopsy to determine the damage that hepatitis C has done to your liver so far, but there is currently no way to accurately predict how fast your disease may advance. This is something that you should discuss with your healthcare provider.

The answer to the fourth question is straightforward. If left untreated, hepatitis C can result in liver damage, which can lead to serious conditions such as cirrhosis (in which healthy liver tissue is replaced by scar tissue) or liver cancer.

The standard of care for hepatitis C treatment is weekly injections of a drug called pegylated interferon alfa combined with twice-daily oral doses of ribavirin (Rebetol) — a broad-spectrum antiviral agent. Two pegylated interferon medications are available, peginterferon alfa-2b (Peg-Intron) and peginterferon alfa-2a (Pegasys).

The treatment is given by injection, and has a number of side effects including: flu-like symptoms, headaches, fever, fatigue, loss of appetite, nausea, vomiting, depression and thinning of hair. The treatment with interferon may also interfere with the production of white blood cells and platelets, while the combination therapy (Rebetron) can cause sudden, severe anemia and birth defects. Women should avoid pregnancy during and for 6 months following treatment. Generally, 50-60 percent of patients respond to treatment initially and continued response occurs in about 10-40 percent of patients. Treatment may be prolonged and given a second time to those who relapse after initial treatment.

A small number of people taking combined pegylated interferon and ribavirin may experience psychosis or suicidal behavior. For this reason, treatment with interferon isn't recommended if you have a history of uncontrolled major depression. You're also not a good candidate for this treatment if you have untreated thyroid disease, low blood cell counts or autoimmune disease, or if you drink alcohol or use drugs and are unwilling to stop or seek help with stopping.

The best treatment for people with end-stage liver disease is liver transplantation. However, the number of people awaiting transplants far exceeds the number of donated organs. But several new developments in transplantation may make it possible for more people to receive the organs they desperately need.