Hepatitis C infection (Hep C) is a lifelong condition for most people. Only about 15 to 25 percent of people overcome hepatitis C without treatment, according to the Centers for Disease Control and Prevention. For everyone else, the infection becomes chronic.

Many people don’t seek treatment for chronic hepatitis C infection because they don’t know they’re infected. It’s only later, when hepatitis C leads to serious health issues, that many people seek medical attention.

Doctors often want to take a proactive approach to hepatitis C management, but your treatment options depend on many factors. Medication can help prevent some of the more challenging effects of the infection. Early intervention may also keep people healthy longer.

As someone who has received a hepatitis C diagnosis, you may not know what to ask your doctor. Here are some ways to start the conversation.

What are the latest treatments for hep C?

There are more treatments for hepatitis C infection available now than ever before. Up until just a few years ago, people living with hepatitis C only had two medication options: pegylated interferon and ribavirin.

Now, there are several medications that your doctor may prescribe. Your eligibility for each medication depends on the type of hepatitis C virus you have — there are six different genotypes of hepatitis C.

Some medications are not recommended if there is evidence of liver damage, such as cirrhosis, which refers to scarring of the liver. A co-infection with HIV also impacts medication options.

Newer drugs, available as far back as 2011, include protease inhibitors, polymerase inhibitors, and direct-acting antivirals. Each type works a bit differently to block a biological process that the hepatitis C virus needs to thrive.

The latest drugs available for hepatitis C have high success rates when it comes to curing the condition. There are only two medications that have FDA approval to treat all six hep C genotypes: Mavyret (glecaprevir/pibrentasvir) and Epclusa (sofosbuvir/velpatasvir).

There are other medications that only have approval to treat certain genotypes of hep C. For example:

  • Harvoni (ledipasvir/sofosbuvir) is approved for genotypes 1, 4, 5, and 6.
  • Daklinza (daclatasvir) is approved for genotypes 1, 2, and 3.
  • Technivie (ombitasvir/paritaprevir/ritonavir) is approved for genotype 4.
  • Zepatier (elbasvir/grazoprevir) is approved for genotypes 1 and 4.

According to the American Liver Foundation, these medications all had high cure rates in clinical trials. The FDA maintains a list of approved hepatitis C treatments.

In conversations with your doctor, you can discuss the full range of treatment options. Some of these are combination drugs. Not every medication may be effective for you, even if it’s for the right genotype.

Are there factors that affect the likelihood of medication effectiveness?

It’s important to take medication as directed. You can explain any concerns you have about how and when you take the drug. Your doctor may have support options available or may recommend a different treatment plan.

Not every drug is right for every person. Some medications are not for people with liver scarring, people with HIV, or people who have had a liver transplant. Your past treatments, viral load, and overall health are also factors.

What are the side effects of treatment?

According to the Mayo Clinic, many people stop therapy because of side effects. Since hepatitis C can lead to liver damage, cirrhosis, and liver cancer if not treated, it’s vital to stick with a treatment plan.

Newer drugs have fewer severe side effects than pegylated interferon and ribavirin. Nevertheless, you may feel differently while taking hepatitis C medication. Your doctor can answer your questions about these possible side effects:

  • fatigue
  • headaches, muscle aches, and fever
  • cough, shortness of breath, and lung infections
  • depression, mood swings, and confusion
  • itchy, dry skin or skin rash
  • insomnia
  • nausea, vomiting, and diarrhea
  • appetite loss and weight loss

Serious side effects can occur with pegylated interferon and ribavirin treatment. If you’re taking these medications, you should be monitored for these serious side effects:

  • anemia (low red blood cell count)
  • thrombocytopenia (low level of blood cell clotting)
  • light sensitivity in the eyes
  • trouble breathing because of lung tissue inflammation
  • suicidal thoughts
  • thyroid disease
  • autoimmune disease flares

You can ask your doctor about the side effects of any medication. They may be able to suggest a different medication option or a way to manage the side effects. For example, diet changes may help with poor appetite, nausea, and diarrhea. Sensitive skin soaps such as Cetaphil may work well on dry skin.

Why choose one medication over another?

Newer treatment options are easier to take and have fewer side effects. The latest medications for hepatitis C are taken by mouth, in pill form. Treatment generally lasts between eight weeks to six months, depending on the medication. Overall, new drugs cure the hepatitis C infection in 90 to 100 percent of people, according to the FDA.

In contrast, the older interferon treatments last between six months and one year. Treatment is administered by injection and often causes flu-like side effects. In addition, interferon only cures the hepatitis C infection in about 40 to 50 percent of people.

Those statistics may make the choice seem easy. But only you and your doctor fully understand the state of your health. It’s important to find the drug that’s the best match for you.

Can I use natural remedies?

You may want to discuss herbal therapies with your doctor. Some of these may interfere with hepatitis C medications and make them less effective. Natural products, such as shark cartilage, valerian, skullcap, kava, and comfrey can cause liver damage.

That doesn’t mean you can’t take any over-the-counter supplements. But it’s important to talk about these products with your doctor first. They may be able to recommend other ways for you to manage medication side effects.

Who can I talk to during treatment?

Since hepatitis C treatment plans last several weeks, you should regularly attend medical appointments. Your doctor may also have a list of local groups where you can find emotional support. There may also be other resources such as community nurses and walk-in clinics. With this information, you will know where to go for help between appointments.

Another option is to explore the online hepatitis C community, where people share their experiences with hepatitis C. For example, the Inspire hepatitis C group allows people to connect, share stories, discuss treatment, and more.

The takeaway

Hepatitis C is an infection that needs active treatment. If you have the hepatitis C virus, you may have several different medication options. Your doctor can advise you on the best choice for your condition and circumstances.

There are more effective treatment options available now than ever before. The vast majority of people can be cured of hepatitis C with the right treatment.

Deciding which treatment plan to follow is an important process. Each medication has possible side effects. Try to be open with your doctor about your concerns. Through open communication you can get the information you need to support your health.