Is it necessary to take interferon for Stage One hepatitis C infection if I do not drink alcohol, consistently eat right and take a regimen of herbs that are good for the liver? I am afraid to start interferon therapy since I'm prone to depression and am also severely fatigued.

M.

Hepatitis C, the most common type of chronic viral hepatitis in the United States, is acquired through blood or body fluid contact. While the long-term effect of hepatitis C on the liver is variable, this infection becomes chronic in more than 70 percent of patients. Chronic hepatitis C causes inflammation in the liver, which over the course of many years -- at least 10 to 15 -- can lead to fibrosis and cirrhosis. Another dreaded complication of Hepatitis C is liver cancer (hepatoma), which usually develops in patients with established cirrhosis.

New advances have revolutionized the treatment for hepatitis C. Until recently, interferon was the main medication used to treat this infection. Given as an injection under the skin three times a week for six to 12 months, interferon was effective in eliminating the virus from the blood of up to 50 percent of patients. However, over half of these patients had recurrences of the virus after the treatment was stopped. In the last couple of years, new studies have shown that combining interferon with another antiviral drug, ribavirin, is much more effective in treating this infection, with long-term remission rates of close to 50 percent. This combination therapy is now considered the treatment of choice for hepatitis C.

Among the patients most likely to respond to the combination therapy are younger patients, female patients, those with low viral counts and those whose liver biopsies do not detect advanced fibrosis or cirrhosis. Response to therapy can also be influenced by the subtype of virus infecting the patient.

It is important to emphasize that alcohol consumption has been shown to advance the progression of the liver disease in hepatitis C. Thus, people with hepatitis C are strongly urged to abstain from alcohol. No specific herbs have been scientifically proven to be good for liver health. Actually, several Chinese herbs have been documented to lead to liver failure, even in healthy people without liver disease. Thus, I would recommend not taking any herbs unless your doctor has deemed them safe.

The difficult decision in your case relates to your depression. Interferon has been linked to worsening depression in patients who have this condition. There are even reports of patients committing suicide while on interferon. Although you may be a good candidate for interferon and ribavirin therapy because of the early stage of your hepatitis, your history of depression may make treatment risky. You should consult with your doctor, who can refer you to a hepatologist experienced in the treatment of hepatitis C for a complete evaluation.