The hepatitis C virus (HCV) is a bloodborne virus that causes inflammation of the liver. This inflammation can lead to permanent liver damage.
Hepatitis C is contracted only through direct contact with the blood of a person infected with HCV. Possible routes of infection include:
- sharing needles used for injected drugs
- using unsterilized needles for tattoos, body piercing, or acupuncture
- accidental needle stick or blood contact in a healthcare setting
- being born to a mother infected with HCV
- sexual contact with a person infected with HCV
Blood screening to detect hepatitis C has been routinely used in the United States since 1992. For this reason, new cases of infection due to contaminated blood transfusions or organ transplants are very rare in the U.S.
Still, chronic hepatitis C affects 3.5 million people in the United States alone, and about 71 million worldwide. It’s a serious disease that can cause long-term health problems, including liver damage, liver failure, or even death. Yet significant advances in hepatitis C treatments have led to higher cure rates, fewer side effects, and shorter treatment times.
Some people with hepatitis C don’t need any treatment. In these cases, the body’s immune system is able to knock out an acute hepatitis C infection. Many people with hepatitis C, however, need medical intervention to cure the infection and prevent long-term complications.
Treatments for hepatitis C include various combinations of antiviral medications. These need to be taken for at least several weeks, and up to 24 weeks. The goal of drug treatment is to:
- rid the body of the hepatitis C virus (having no virus detected at least 12 weeks after treatment is completed)
- slow down or prevent inflammation and damage to the liver
- prevent or reduce the odds of developing cirrhosis or liver cancer
Until 2010, the drugs most commonly used for hepatitis C treatment were forms of interferon and the antiviral drug ribavirin. Interferon treatments are given by injection, and ribavirin is given as a pill.
Interferon is a naturally occurring protein that the body makes to fight viruses and bacteria. Interferon and ribavirin treatments were typically given for 24 or 48 weeks and were not very effective — 40 to 50 percent of people saw their HCV infection clear following treatment. Certain HCV genotypes fared even better, clearing the virus in up to 80 percent of patients. Many people had unsuccessful therapy and would continue to live with HCV infection.
When interferon is given by injection, it can cause very unpleasant side effects, making it intolerable for many people. Some of the more common adverse reactions to interferon therapy include:
- rash and other skin issues
- persistent cough and shortness of breath
- flu-like symptoms (fever, muscle aches, and headache)
- nausea, vomiting, and diarrhea
- anxiety and mood changes
- thyroid changes
- vision disorders
- autoimmune disease
The first oral non-interferon drug regimen
Sofosbuvir (Sovaldi) is a direct-acting antiviral agent (DAA) that was approved by the U.S. Food and Drug Administration in 2013. DAAs can target the hepatitis C virus in every stage of its lifecycle. This is very different from injectable interferon, which worked by activating the body’s immune system.
Sofosbuvir can be used without interferon, can be taken orally, has fewer side effects, and can cure many people with hepatitis C in just 12 weeks.
Sofosbuvir was part of the first non-interferon combination treatment for people with the most common types of hepatitis C (genotypes 1, 2, 3, and 4). Sovaldi is expensive but it can be very effective for many people with hepatitis C. Some researchers claim that up to 90 percent of HCV patients can be cured.
In the last five years, many new treatment options for hepatitis C have been approved. These include:
- NS5A inhibitors: daclatasvir, elbasvir, ledipasvir, ombitasvir, pibrentasvir, velpatasvir
- NS5B (polymerase) inhibitors: dasabuvir, sofosbuvir
- HCV protease inhibitors: asunaprevir, boceprevir, glecaprevir, grazoprevir, paritaprevir, simeprevir, telaprevir, voxilaprevir
- Combination therapies: Epclusa, Harvoni, Mavyret, Technive, Viekira Pak, Vosevi, Zepatier
These new drugs and combination therapies work mainly by stopping the hepatitis C virus from replicating (reproducing) in your body. This is thought to cause the decline and elimination of infected liver cells.
Many of these newer drugs can provide more effective and efficient treatment with fewer side effects, and can cure the disease much faster than previous methods.
A liver transplant is generally an option of last resort for people with HCV or other types of liver disease. However, a liver transplant may be needed if you have irreversible end-stage liver damage. A donor liver may be either a whole organ from a deceased donor or a portion of the organ from a living donor.
Unfortunately, a transplant does not equal a cure in people with hepatitis C. Recurrence of HCV after transplant is inevitable, unless antiviral medications are used. Another possibility after transplant is rejection of the donor organ by the recipient’s body. In some cases, further transplantation may be suggested.
If you have chronic hepatitis C, discuss available treatment options with your doctors. With recent advances, you may find a drug combination or therapy regimen that works faster and better for you.