Between 130 and 150 million people worldwide, including an estimated 2.7 to 3.9 million Americans, have chronic hepatitis C. The virus spreads mainly through intravenous drug use. Untreated hepatitis C can lead to serious liver problems, including cirrhosis and cancer.
The good news is that the virus can go into remission with the right treatment. Doctors refer to remission as a sustained virological response (SVR).
SVR means the hepatitis C virus can’t be detected in your blood 12 weeks after your last dose of treatment. After this, it’s very likely that the virus has gone permanently. The U.S. Department of Veterans Affairs reports that 99 percent of people who’ve achieved an SVR remain virus-free.
These people also:
- experience improvement in liver inflammation
- have decreased or regressed fibrosis
- are twice as likely to have lower inflammation scores
- have reduced their risk for mortality, liver failure, and liver cancer
- have reduced their chance of developing other medical conditions
Depending on the liver damage, you will need follow-up appointments and blood tests every six or 12 months. The hepatitis C antibody will be permanently positive, but this doesn’t mean you’re reinfected.
For some people, hepatitis C can also clear up on its own. This is called spontaneous remission. Infants and young women in particular may have a chance of the virus clearing itself out of their bodies. This is less likely among older patients.
Drug treatments can help your chances of beating the hepatitis C virus into remission. Your treatment plan will depend on:
- Genotype: Your hepatitis C genotype or “blueprint” of the virus is based on your RNA sequence. There are six genotypes. About 75 percent of the people in the United States have genotype 1.
- Liver damage: Existing liver damage, whether mild or severe, can determine your medication.
- Previous treatment: Which medications you’ve already taken will also influence next steps.
- Other health conditions: A coinfection may rule out certain drugs.
After looking at these factors, your healthcare provider will prescribe a course of medications for you to take for 12 or 24 weeks. You may need to take these medications longer. Drugs for hepatitis C may include:
- daclatasvir (Daklinza) with sofosbuvir (Sovaldi)
- sofosbuvir with velpatasvir (Epclusa)
- ledipasvir/sofosbuvir (Harvoni)
- simeprevir (Olysio)
- boceprevir (Victrelis)
- ribavirin (Ribatab)
You may hear some of the newer drugs referred to as direct-acting antiviral (DAA) medications. These target virus replication at specific steps of hepatitis C’s life cycle.
Your doctor may prescribe other combinations of these drugs. You can keep up to date with hepatitis C treatments by asking your doctor or visiting HEP C123. Always follow through and finish your treatment. Doing so increases your chance of remission.
Several factors can help predict your response to therapy. These include:
- Race: In comparison to other races, African-Americans historically respond poorer to therapy.
- IL28B genotype: Having this genotype can also lower your response rate to therapy.
- Age: Increasing age lowers the change of achieving SVR, but not significantly so.
- Fibrosis: Advanced scarring of the tissue is associated with a 10 to 20 percent lower response rate.
Previously, genotype and RNA levels of the hepatitis C virus also helped predict your response to therapy. But with modern medications in the DAA era, they play less of a role. DAA therapy has also reduced the likelihood of treatment failure. However, a specific genotype of the hepatitis C virus, genotype 3, still remains the most challenging to treat.
It’s possible for the virus to return through reinfection or relapse. A recent review of risks for hepatitis C relapse or reinfection puts the rate for sustained SVR at 90 percent.
Reinfection rates can be up to 8 percent and higher, depending on the risk factor.
Relapse rates depend on factors such as genotype, drug regimen, and if you have any other existing conditions. For example, the relapse rate for Harvoni is reported to be between 1 and 6 percent. Harvoni is used mostly for people with genotype 1, but more studies are needed on this.
The chance of reinfection depends on your risk. The analysis identified risk factors for reinfection as:
- using or have used injectable drugs
- men who have sex with men
- coinfections, especially ones that compromise your immune system
You are at a low risk for reinfection if you have no recognized risk factors. High risk means you have at least one identified risk factor for reinfection. Your risk is higher as well if you also have HIV, regardless of risk factors.
The risk for recurrence of hepatitis C within five years is:
|Risk group||Chance of recurrence in five years|
You can be reinfected, or experience a new infection from someone else who has hepatitis C. However, you’re very likely now living without hepatitis C in your life. You can consider yourself in remission or hepatitis C negative.
Always follow the treatment your doctor prescribes. This increases your chances for remission. Talk to your doctor if you’re experiencing discomfort or side effects from your medication. Ask for support if you’re experiencing feelings of depression. Your doctor may have patient advocate resources to get you through your treatment and to your goal of being free of hepatitis C.