The decision for treatment should be individualized for each case. There are many aspects that need to be taken in consideration before treatment is initiated such as presence of other illnesses, drug interactions, patient readiness to start the treatment, older age, the stage of the hepatitis C,  the availability of new therapies, etc.

Treatment should be considered for patients who wish to cure the infection and have evidence of active Hepatitis C without any contraindication to current available therapies.

At your first evaluation your doctor might order extensive blood work that includes Hepatitis C viral load, Hepatitis C Genotype, liver function tests, complete cell blood count and, it is often required, blood work to rule out concomitant infections or some other illnesses that might change the treatment approach.

Liver function tests (LFT’s), which include liver enzymes, are groups of clinical biochemistry laboratory blood assays designed to give information about the state of a patient's liver. These tests can be used to (1) detect the presence of liver disease, (2) distinguish among different types of liver disorders, (3) gauge the extent of known liver damage, and (4) follow the response to treatment.

ALT and AST are enzymes present in hepatocytes (liver cells). When a liver cell (hepatocyte) is damaged, it leaks these enzymes into the blood, where they can be measured. ALT and AST levels rise frequently on patients with chronic viral hepatitis, and other conditions, such as alcohol use. A normal level should be interpreted with carefulness because it does not always correlate with a healthy liver.

Your viral load is the amount of specific viruses that you have, in a given volume of your blood (usually 1 milliliter = 1 cubic centimeter). More precisely, it means that the amount of Hepatitis C genetic material found in your blood corresponds to as many Hepatitis C viruses as the given number says.

Viral load varies between infected individuals and varies from time to time in the same individual.  Your viral load becomes useful for your doctor to follow and monitor the response to Hepatitis C treatment.

The hepatitis C genotype is a type or "strain" of Hepatitis C virus. There are 6 genotypes of Hepatitis C around the world. In the United States, 3 genotypes are common: Genotype 1, 2, and 3. The genotype of Hepatitis C does not change over time. It needs to be tested only once. Approximately 75% of Americans with hepatitis C have genotype 1 whereas genotype 2 and 3 share the reminder 25 %.

Knowing the genotype of hepatitis C for each patient is very important information because Hepatitis C treatment works differently for different genotypes. In general, genotype 1 is much more "resistant" to current Hepatitis C treatments and genotypes 2 and 3 are much more "sensitive" to treatment.

A liver biopsy is a procedure that involves obtaining a small piece of liver tissue, which is then analyzed in the laboratory. A Liver biopsy may be recommended to diagnose a problem or determine the severity of liver disease. As a general rule, a liver biopsy is recommended only when the results would affect your treatment or management. In certain liver diseases, such as chronic Hepatitis B or C a biopsy can provide important information about how severely the liver is damaged.

Most liver biopsies are done in a hospital or in a specialized center. You may have an IV line placed into a vein so that fluid and medicine can be given if needed. You may be given medicines to minimize discomfort and anxiety. Because your cooperation is needed during a liver biopsy procedure, you will not be put to sleep.

The doctor will put some local anesthesia at the site of the needle to minimize discomfort. The biopsy itself only takes a few seconds as the biopsy needle is passed quickly in and out of the liver. A small bandage will be applied to the biopsy site; stitches are not needed

A liver biopsy is a very safe procedure when performed by an experienced doctor. The most common complications include pain, low blood pressure, and bleeding, however, most of these complications are minor and can be treated. Very rarely other complications can occur such as infection and accidental puncture to nearby organs. To further minimize the occurrence of complications your doctor may obtain the biopsy with the assistance of an ultrasound or CT Scan

Cirrhosis is the term used to describe a diseased liver that has been severely scarred, usually due to many years of continuous injury. The most common causes of cirrhosis include longstanding alcohol abuse and hepatitis B or hepatitis C. Although cirrhosis cannot be cured, there are a number of things you can do to prevent the disease from worsening.

Many herbal products claim that they may help to detoxify the liver, and in patients with significant liver inflammation it is possible that some of these agents may be marginally effective in decreasing liver inflammation, but they do not cure the virus.  Many herbal products claim to "cure" or improve hepatitis C; none of these claims have been proven true. In addition, some herbal medications can seriously injure the liver.

There are several options for people whose virus does not respond or whose infection comes back after the first round of treatment. The best option depends on what medications you took before, how well you tolerated the previous treatment, your current liver function, and other factors. Options include watching and waiting, trying a different treatment regimen, or enrolling in a clinical trial where an experimental drug is being used in addition to standard of care therapy.