Treating hepatitis C virus infection

Hepatitis C virus (HCV) infection causes liver inflammation that can lead to liver problems, including cancer. People who have chronic hepatitis C need medication to treat it. These drugs can ease symptoms of HCV.

But even if an HCV infection hasn’t caused symptoms yet, it’s still important to treat it. This is because drugs can also lower the risk of complications from HCV, such as dangerous liver problems.

HCV has different genetic variations (genotypes). The medication prescribed for HCV depends on the genotype a person has. Genotype 1 is the most common type in the United States.

Here are the medications available to treat hepatitis C, plus some helpful information about what to expect with their treatment.

Ribavirin works by stopping viruses from replicating and spreading. It’s an oral medication that comes as a capsule, tablet, or solution and is available in several strengths. It’s used in combination with other drugs.

Brand names of ribavirin include:

  • Copegus
  • Moderiba
  • Rebetol
  • Ribasphere
  • Ribasphere RibaPak

Ribavirin 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.

Other side effects may include:

  • nausea and vomiting
  • changes in your ability to taste
  • memory loss
  • trouble concentrating
  • difficulty sleeping
  • muscle pain

Direct-acting antivirals (DAAs) are the standard of care for chronic HCV infection today. These drugs work by attacking HCV directly. This means they’re more targeted than older treatments such as interferons (see below). Also, they don’t affect as many systems in your body as interferons, so they may not cause as many side effects. All DAAs are oral drugs.

Side effects of DAAs can include:

  • anemia
  • diarrhea
  • fatigue
  • headaches
  • nausea
  • vomiting
  • slow heartbeat

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
  • simeprevir (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 or Technivie. Simeprevir is given with sofosbuvir or peginterferon alfa and ribavirin. And grazoprevir is used with elbasvir (Zepatier).

Protease inhibitors (NS5A inhibitors)

The action of these drugs isn’t fully understood. They may work by stopping the virus from copying itself. They may also help prevent drug resistance (when a drug no longer works to treat a condition).

These drugs are used to treat all HCV genotypes. They’re used alone or in combination with other medications. Examples of directed inhibitors include:

  • ledipasvir (a component of the combination drug Harvoni)
  • ombitasvir (a component of the combination drug Viekira Pak)
  • elbasvir (a component of the combination drug Zepatier)
  • daclatasvir (Daklinza)

Nucleotide/nucleoside and nonnucleoside polymerase inhibitors (NS5B inhibitors)

These drugs work by blocking a protein called NS5B. The hepatitis C virus needs this protein to replicate itself and survive. Examples of these drugs include:

  • sofosbuvir (Sovaldi)
  • dasabuvir

All DAAs are given as combinations. Some combinations are made into single pills to make taking the medication easier. Brand names of current combination therapies include:

  • Harvoni
  • Viekira Pak
  • Zepatier
  • Technivie
  • Epclusa
  • Vosevi
  • Mavyret

Harvoni, which contains ledipasvir and sofosbuvir, is used to treat HCV genotype 1. It was approved in 2014.

Approved in 2014, Viekira Pak is used to treat HCV genotype 1. It contains the drugs dasabuvir, ombitasvir, paritaprevir, and ritonavir.

As with Technivie (see below), the FDA warns that Viekira Pak may cause liver failure, which could lead to death. This risk is highest during the first month of treatment. Your risk may be higher if you already have liver scarring.

Zepatier contains elbasvir and grazoprevir. The FDA approved this drug in 2016 to treat HCV genotypes 1 and 4.

The FDA approved this drug in 2015 to treat HCV genotype 4. It must be taken with ribavirin. You can’t take this drug if you have cirrhosis (liver scarring).

The drugs in Technivie — ombitasvir, paritaprevir, and ritonavir — are also in Viekira Pak, so it works in a similar way to Viekira Pak. However, like Viekira Pak, Technivie carries FDA warnings for liver failure.

Epclusa, which contains sofosbuvir and velpatasvir, was approved in 2016. It can be used in combination with ribavirin in people with moderate to severe cirrhosis.

Epclusa was the first medication to treat all six genotypes of HCV.

The FDA approved Vosevi in 2017 for use in people with infection by any genotype of HCV. It contains the drugs sofosbuvir, velpatasvir, and voxilaprevir.

Vosevi is intended for use in people who’ve been treated before with sofosbuvir, which didn’t work to treat their HCV.

The FDA approved Mavyret in 2017 for use in the treatment of any genotype of HCV. It contains glecaprevir and pibrentasvir.

Mavyret is the first treatment that can be administered for only 8 weeks in people without cirrhosis. Most of the other combination drugs must be administered for a minimum of 12 weeks.

Interferons were the standard for HCV treatment for many years, but today, the newer treatments listed above are typically used instead. This is because interferons can cause a lot of side effects, and they’re not as effective for treating chronic HCV infection.

Interferon is a protein that your body makes. It helps your immune system fight viruses, including HCV. These drugs include:

  • peginterferon alfa-2a (Pegasys)
  • peginterferon alfa-2b (PegIntron, Sylatron)
  • interferon alfa-2b (Intron A)

Interferons were part of combination treatments for genotype 1 HCV, but could also be used for genotypes 2 and 3. The more common side effects of interferons include:

  • anxiety
  • dry mouth
  • excessive fatigue
  • headache
  • mood changes or depression
  • weight loss
  • worsening hepatitis symptoms

Other more serious side effects can happen over 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

HCV infection can cause unpleasant symptoms and lead to serious 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 HCV work in different ways and can cause unique side effects. Ask your doctor which medication might be a good fit for you. Together, you can find the most effective drug to treat your HCV with the fewest side effects.