Treating hepatitis C virus infection
Hepatitis C virus (HCV) infection causes liver inflammation that can lead to liver problems, including cancer. If you have hepatitis C, you’ll need medication to treat it. These drugs can ease bothersome symptoms. But if your HCV infection hasn’t caused symptoms yet, it’s still important to treat the infection. This is because drugs can also lower your chance of complications from hepatitis C, such as dangerous liver issues.
HCV has different genotypes. Genotype 1 is the most common type in the United States. Your doctor will give you a drug that treats the type of HCV you have based on genotype. Here are the medications available to treat hepatitis C, plus some helpful information about what to expect with their treatment.
Interferon is a protein that your body makes. It helps your immune system fight viruses, including HCV. These drugs can prevent complications. They include:
- peginterferon alfa-2a (Pegasys)
- peginterferon alfa-2b (PegIntron, Sylatron)
- interferon alfa-2b (Intron A)
All of these drugs are injected by a healthcare provider. You don’t give them to yourself. They’re parts of combination treatment for genotype 1 HCV. They can also be used for genotypes 2 and 3.
The peginterferons are made of interferon combined with another compound that makes the drug last longer in your body. This combination also helps reduce side effects. The more common side effects of interferons include:
- dry mouth
- excessive fatigue
- mood changes or depression
- weight loss
- worsening hepatitis symptoms
Other more serious side effects can happen in time. These side effects may include:
- autoimmune diseases (when your body attacks itself)
- reduced red blood cell levels (can lead to anemia)
- reduced white blood cell levels (can lead to infections)
- high blood pressure (can lead to a stroke or heart attack)
- reduced thyroid function
- changes in vision
- liver disease
- lung disease
- inflammation of your bowel or pancreas
- allergic reaction
- slowed growth in children
This drug works by stopping viruses from replicating and spreading.
Ribavirin is used in combination with an interferon to treat infection with HCV genotype 1, 2 or 3. In some cases, it may be used with an interferon and a protease inhibitor. This is called triple therapy.
Ribavirin is an oral drug. It comes as a capsule, tablet, or solution and is available in several strengths. Brand names of ribavirin include:
- Ribasphere RibaPak
This drug may cause birth defects if a woman takes it during pregnancy. It can also cause birth defects if a man fathers a child during his treatment with this drug.
Direct-acting antivirals (DAAs)
These drugs work by attacking the hepatitis C virus directly. This means that they are more targeted. They don’t affect as many systems in your body, so they may not cause as many side effects. All DAAs are oral drugs.
Side effects of DAAs can include:
Protease inhibitor antiviral medications (NS3/4A inhibitors)
Protease inhibitors work by preventing the spread of infection. They stop viruses from multiplying in the body. Protease inhibitors for hepatitis C include:
- paritaprevir (for genotype 1)
- simepravir (Olysio) (for genotypes 1 and 4)
- grazoprevir (for genotypes 1 and 4)
All of these medications are used in combination with other HCV drugs. Paritaprevir is only available as part of the combination drug Viekira Pak. Simepravir is given with sofosbuvir or peginterferon alfa and ribavirin. And grazoprevir is used with elbasavir (Zepatier).
Directed inhibitors (NS5A inhibitors)
The action of these drugs is not fully understood. They may work by stopping the virus from copying itself. They may also help prevent drug resistance. These drugs are used to treat HCV genotypes 1, 4, 5, and 6. They are used alone or in combination with other medications.
These drugs include:
- ladispavir (a component in the combination drug Harvoni)
- ombitasvir (a component in the combination drug Viekira Pak)
- elbasavir (a component in the combination drug in Zepatier)
- daclatasvir (Daklinza)
Polymerase inhibitors (NS5B Inhibitors) and combination drugs
These drugs work by blocking a protein called NS5B. The hepatitis C virus needs this protein to replicate itself and survive.
Sofosbuvir (Sovaldi) can be used to treat HCV genotypes 1, 2, 3, and 4. It’s used in combination with other drugs. It may also be used to treat people with both hepatitis C and HIV.
Ledipasvir/sofosbuvir (Harvoni) is used to treat chronic infection with HCV genotype 1 in adults. Ledipasvir blocks the formation of a protein that helps the virus copy itself.
Viekira Pak is a combination drug used to treat HCV genotype 1. It includes the drugs dasabuvir, ombitasvir, paritaprevir, and ritonavir. Dasabuvir prevents the building blocks of the virus from coming together. Ombitasvir blocks the formation of a protein that helps the virus copy itself. Paritaprevir helps stop the building of small pieces that make up the virus. Ritonavir helps increase the effectiveness of paritaprevir by making it last longer in your body.
The FDA warns that Viekira Pak may cause liver failure. You may need a liver transplant. These liver problems may be fatal (cause death). This risk is highest during the first month of treatment. Your risk may be higher if you already have liver scarring. Your doctor will check your liver function during your treatment if you take this drug.
New hepatitis C drug treatments
Many new treatments for hepatitis C have recently become available. All of the newer drugs cause side effects similar to other hepatitis C drugs. These side effects include:
- upset stomach or nausea
Newer treatments have worked much better to treat the disease, however. Some treatments even cure HCV infection. And more new treatments are still being made.
This is a new combination treatment for HCV infection. The FDA approved it to treat HCV genotypes 1 and 4 in 2016. Elbasvir and grazoprevir work by stopping the virus from copying and building itself. Grazoprevir also prevents the virus from building up in your body. As another benefit, this new drug is about half the cost of earlier hepatitis C combination drugs.
People with moderate to severe liver problems may not be able to take this drug. Elbasvir/grazoprevir can make liver problems worse. Your doctor will check your liver function during treatment if you take this drug.
The drugs in Technivie are also in Viekira Pak. Like Viekira Pak, this drug carries FDA warnings for liver failure, need for liver transplant, and risk of death. Your doctor will check your liver function during treatment if you take this drug.
Treatment with this drug looks promising. When combined with ribavirin, this drug can cure up to 100% of people with HCV genotype 4 who don’t have cirrhosis.
This new drug is approved to treat HCV genotype 3. It’s often taken with sofosbuvir. Results with this drug combination have been good. Clinical trials found that it cured over 90% of people without liver scarring. The same study found that in people with liver scarring, no virus was present in more than half the people treated with this combination.
If this drug is taken with amiodarone, it may cause bradycardia (slowed heart rate). Amiodarone is a drug used to treat irregular heart rhythm.
Talk with your doctor
HCV infection can cause unpleasant symptoms and lead to health complications. Your treatment for the condition will depend on your health, the HCV genotype you have, and other factors. Different types of drugs used to treat hepatitis C work in different ways and can cause unique side effects. Ask your doctor which medication would be a good fit for you. Together, you can find the most effective drug to treat your hepatitis C.