Q: Is infertility a side effect of peg interferon and ribavirin?

A: True infertility is not a side effect of peginterferon plus ribavirin therapy. However, I should mention that people on treatment and their partners should never try to conceive while on treatment because of the harmful side effects of ribavirin in particular on fetal development.

Q: Do doctors treat hepatitis C with the same meds they treat HIV with?

A: The medicines to treat hepatitis C are different than the medicines used to treat HIV.

Q: When I was first diagnosed with hepatitis C, they told me the treatment with interferon had to be injected several times a week. I'm scared of needles. Have there been any improvements on the interferon treatment so that it doesn't have to be injected?

A: Interferon has to be injected because it would be destroyed by the stomach and intestines if it were taken by mouth. While interferon still has to be injected, the newer pegylated interferon treatment is injected only once a week. I know the thought of sticking yourself with a needle can be very intimidating, but there are options. Perhaps a loved one can learn how to give you the injections; many people do this rather than have to stick themselves. Also, there are classes offered by a number of doctor's offices to help people overcome their fear of the injections before starting treatment. In the end, if you're otherwise ready to start treatment, there are ways to overcome the injection issue.

Q: I've been taking pegylated interferon and ribavirin for 6 months. My viral count went from 1.5 million to 7,000 and my doctor told me that I'm a nonresponder. She advised me to stop the treatment. Is this right?

A: Doctor use the drop in viral load at 12 weeks (3 months into therapy) to predict whether a person is likely to clear the hepatitis C virus on interferon-based treatment. You don't say by how much your viral load dropped within that first 12 weeks, so I can't directly respond to your question. Doctors look for at least a 100-fold drop at that 12 week time point. (In your case, that would be a drop from 1.5 million to 15,000.) If you're uncertain about why your doctor is recommending that you stop treatment at this point, ask her. She will explain her thinking and the reasons why she is making the recommendation to stop treatment.

Q: My husband is in the 9th month of combo treatment. His starting viral load was 6 million. By the 8th month, it was down to 80 thousand. His viral load is now up to 250,000. Is there any point in completing the last 3 months of this treatment?

A: A response to combination therapy (interferon plus ribavirin) is defined as at least a 100-fold drop in viral load by week 12 of treatment. In your husband's case the would mean his viral load would have to drop from 6,000,000 down to 60,000. It sounds as if his viral load never dropped to that level. If the viral load has bounced back up, especially considering your husband has already completed 9 months of treatment, it is highly unlikely he will have a sustained clearance of the hepatitis C virus. I encourage you to talk with your husband's doctor; together you may decided that since therapy will not lead to viral clearance, it's time to stop.

Q: How do I know that the treatment I am receiving is working. My viral load reduced from 1.6 million to 675,000 after two weeks on interferon and ribavirin? Is this a normal response?

A: Response to interferon/ribavirin therapy is defined as at least a hundred-fold drop in viral load by week 12 of treatment. In your case, the drop from 1.6 million to 675,000 is not a hundred-fold drop. If these two test represent your pretreatment viral load and a 12-week viral load, this would be considered in inadequate response to justify the continuation of treatment as the probability of successful clearance of the virus would be very, very low.

Since I do not know if this is your situation, I urge you to discuss your test results with your doctor and ask him/her this very important question you have posed.

Q: After relapsing following 48 weeks of combination interferon/ribavirin treatment, how often should I be reevaluated and are there any other treatments available?

A: I am sorry to hear that you experienced a relapse after going through the full 48 weeks of combination therapy; I am sure that was a great disappointment for you after working so hard to stay on treatment.

Since you still have the hepatitis C virus, you need to continue to have regular medical care. Depending on your current liver health and other medical conditions, you should probably be seen at least every 6 months, perhaps more often if you have severe liver disease or other conditions that may complicate your situation.

Your treatment options depend on what type of therapy you had initially, particularly if you had regular interferon or pegylated interferon. If you had regular interferon, you may be a candidate for combination therapy with pegylated interferon. This is something you will need to discuss with your doctor.

Q: I am considering going on interferon and ribavirin. I thought I had to be on the treatment for a year, but I saw on the Internet that now treatment is down to 6 months! What's the catch?

A: How long a person stays on treatment is not a "one-size-fits-all" situation. Your doctor will take into consideration factors such as:

- your genotype

- your pretreatment viral load

- your viral response to treatment

- whether you are on a clinical trial protocol

Research indicates that some people that meet very specific criteria may be successfully treated with shorter (or longer) durations of therapy that the usual 48 or 24 weeks most people hear about at the standards. Only your doctor, who knows all of the relevant information about your specific circumstance, can advise you about what the likely length of treatment will be for you.