The goal of hepatitis C therapy is to clear your blood of the hepatitis C virus (HCV). During treatment, your doctor will monitor the level of virus in your blood (viral load). When the virus can no longer be detected, it’s called a virologic response and it means your treatment is working.
If the virus continues to be undetectable six months after treatment is complete, it’s called a sustained virologic response (SVR). Why is this desirable? Because 99 percent of people who achieve SVR remain virus-free for life and may be considered cured.
Because you no longer have the virus in your system, you don’t have to worry about infecting anyone else. And your liver is no longer under attack. But if you’ve already sustained some liver damage, you may need further treatment.
Your blood will forever contain hepatitis C antibodies. That doesn’t mean you can’t be reinfected, though. You should still take preventive measures to avoid exposure to the many strains of HCV.
Periodic blood tests will assess the effectiveness of therapy. The terms used to describe virologic responses can be a little confusing.
Here’s a list of common terms and their meanings:
- Rapid virologic response (RVR): After 4 weeks of treatment, the virus is undetectable in your blood.
- Extended RVR (eRVR): The virus is undetectable at 4 weeks and 12 weeks of treatment. This is sometimes called SVR12.
- Early virologic response (EVR): After 12 weeks of treatment, there’s a significant reduction in viral load, but it may still be detectable.
- Breakthrough response: Your viral load was undetectable for a time, but it’s up again, even though you’re still in treatment.
- Partial responder: The viral load went down some during treatment, but has remained detectable.
- Null responder: There was little to no change in viral load during treatment.
- End-of-treatment response (ETR): The virus is undetectable at the end of treatment.
- Relapser: Your viral load was undetectable for a period, but came back after you completed treatment.
RVR, eRVR, and EVR are encouraging signs that you may reach SVR. SVR means the virus remains undetectable 24 weeks after you completed treatment. That’s why it’s sometimes referred to as SVR24.
There are a number of ways to approach treatment. It will likely involve a combination of drugs.
Your doctor will recommend a regimen based on:
- age and overall health
- specific hepatitis genotype
- extent of liver damage, if any
- ability to follow treatment guidelines
- potential side effects
Following are some medications used to treat hepatitis C and help you get to SVR. The generic name for each drug is followed by its brand name in parentheses. All statistics are reported by the American Liver Foundation.
Ask your doctor about the pros and cons of each of these medications.
Daclatasvir (Daklinza): In clinical trials, 98 percent of treatment-naive patients with no cirrhosis achieved SVR, and 58 percent with cirrhosis achieved SVR. Of treatment-experienced patients, 92 percent of those with no cirrhosis achieved SVR, and 69 percent with cirrhosis achieved SVR.
Daclatasvir is approved for use with sofosbuvir, with or without ribavirin, in people who have genotypes 1 and 3. That includes people with HIV or advanced cirrhosis, and those who’ve had a recurrence after a liver transplant.
Ombitasvir/paritaprevir/ritonavir tablets plus dasabuvir (Viekira Pak): Clinical trials resulted in a 97 percent SVR rate among treatment-naive and treatment-experienced people, including those with compensated cirrhosis.
Ledipasvir plus sofosbuvir (Harvoni): In clinical trials, about 94 percent of people reached SVR12. It’s approved for use in people with decompensated cirrhosis, including those who’ve had a liver transplant. It can also be used in people with coexisting HIV.
Ombitasvir/paritaprevir/ritonavir (Technivie) with ribavirin: Clinical trials showed that 100 percent of people with genotype 4 and no cirrhosis reached SVR.
Elbasvir/grazoprevir (Zepatier): Studies show a cure rate of 94 to 97 percent in people with HCV genotype 1 and 97 to 100 percent in people with genotype 4.
Sofosbuvir/velpatasvir (Epclusa): In clinical trials, 98 percent of people with decompensated cirrhosis achieved SVR12. People with decompensated cirrhosis who took Epclusa with ribavirin had a cure rate of 94 percent. Those who took Epclusa alone for 24 weeks had a cure rate of 86 percent.
Sofosbuvir (Sovaldi): This can be used with or without ribavirin or in combination with daclatasvir.
Simeprevir (Olysio): This can be used in combination with sofosbuvir.
Success with any of these treatments depends on strict adherence to treatment guidelines.
Not everyone reaches SVR. Severe side effects may cause you to stop treatment early. But some people simply don’t respond, and it’s not always clear why. Your doctor may recommend that you try a different combination of drugs.
Even if you don’t get to SVR, these treatments may help slow the virus and be beneficial for your liver.
If, for whatever reason, you aren’t going to try a different antiviral drug, you won’t necessarily need more viral load testing. But you still have an infection that needs attention. This means regular blood count and liver function tests. By working closely with your doctor, you can quickly address any problems that arise.
If you’ve tried several therapies without success, you might want to consider applying for a clinical trial. These trials sometimes allow you to try new drugs that are still in the testing stage. Clinical trials tend to have strict criteria, but your doctor should be able to provide more information.
Even if you don’t have many symptoms right now, hepatitis C is a chronic illness. So it’s important to take care of your overall health, paying particular attention to your liver. Make your health your top priority.
- Maintain a good relationship with your doctor. Report new symptoms right away, including anxiety and depression. Check with your doctor before taking new medicines or supplements, as some can be harmful to your liver. Your doctor can also keep you informed of the latest advances in treatment.
- Eat a balanced diet. If you’re having trouble with this, ask your doctor to recommend a nutritionist to guide you in the right direction.
- Get regular exercise. If the gym isn’t for you, even a daily walk is helpful. It might be easier if you get a workout buddy.
- Get a full night’s sleep. Burning the candle on both ends takes a major toll on your body.
- Don’t drink. Alcohol is harmful to your liver, so it’s best to avoid it.
- Don’t smoke. Avoid tobacco products because they’re detrimental to your overall health.
Living with a chronic condition can be trying at times. Even close family and friends may be unaware of your concerns. Or they may not know what to say. So take it upon yourself to open up the channels of communication. Ask for emotional support and practical help when you need it.
And remember, you’re far from alone. About 3.2 million people in the United States are living with chronic hepatitis C.
Consider joining an online or in-person support group so you can connect with others who understand what you’re going through. Support groups can help you navigate information and resources that can make a meaningful difference in your life.
They can also result in lasting, mutually beneficial relationships. You may start out seeking support and soon find yourself in a position to help others.