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, which means your treatment is working.
You will continue to have regular blood tests to check for any detectable RNA, the genetic material of the hepatitis C virus. A sustained virologic response (SVR) occurs when your blood tests continue to show no detectable RNA in 12 weeks or more after treatment.
Why is SVR desirable? Because 99 percent of people who achieve SVR remain virus-free for life and may be considered cured.
When you have achieved SVR, you no longer have the virus in your system, so you don’t have to worry about transmitting the virus to anyone else. After SVR, your liver is no longer under attack. But if you’ve already sustained some liver damage, you may need further treatment.
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:
- SVR12. This is when your blood tests show a sustained virologic response (SVR), or no detectable amount of HCV, after 12 weeks of treatment. At this point, you’re considered cured of hepatitis C. The marker for cure used to be SVR24, or no detectable amount of HCV in your blood after 24 weeks of treatment. But with modern medications, SVR12 is now considered the cure marker.
- SVR24. This is when your tests show a sustained virologic response (SVR), or no detectable amount of HCV in your blood, after 24 weeks of treatment. This used to be the standard of cure, but with new modern medications, SVR12 is now most often considered the cure marker.
- Partial response. Your levels of HCV have gone down during treatment, but the virus is still detectable in your blood.
- Nonresponse or null response. There is little or no change in your HCV viral load as a result of treatment.
- Relapse. The virus was undetectable in your blood for a time, but it became detectable again. Its return can happen either during or after treatment. Your doctor will help you decide on further treatment options.
There are a number of ways to approach treatment. It will likely involve a combination of drugs, many of which are now combined into single pills. So you may have to take only one pill a day.
Your doctor will recommend a regimen based on your:
- age and overall health
- specific hepatitis genotype
- extent of liver damage, if any
- ability to follow treatment guidelines
- potential side effects
The introduction of direct-acting antiviral drugs (DAAs) in 2011 completely changed treatment of chronic hepatitis C.
Before then, treatment consisted primarily of injections of drugs called interferon and ribavirin, plus other medications in pill form. Treatment was most often not effective, and side effects, including depression, nausea, and anemia, were serious.
In 2014, a second wave of even more effective DAAs were introduced. These new antiviral drugs have become the mainstay of modern chronic hepatitis C treatment in the United States. They attack the virus directly and are far more effective than the earlier drugs.
The newer DAAs can be taken orally, often in a single pill daily. They have fewer side effects, increased cure rates, and reduced treatment time over some drug regimens of only five years ago.
Second-wave DAAs are also able to treat a wider range of the seven known hepatitis C genotypes, or genetic strains. Some of the new DAAs can treat all genotypes by combining different drugs in the pills to target different genotypes.
Some of the first-wave DAAs are still used in combination with interferon and roburin, but many of the second-wave DAAs are used by themselves.
The average cure rate, or SVR, of modern DAA regimens is now about 95 percent overall. This rate is often greater for people who have no cirrhosis, or scarring, of the liver and haven’t undergone previous hepatitis C treatment.
Since the addition of more effective DAAs since 2014, some of the first-wave DAAs became outdated, and their manufacturers took them off the market.
These include the drug Olysio (simeprevir), discontinued in May 2018, and the drugs Technivie (ombitasvir/paritaprevir/ritonavir) and Viekira Pak (ombitasvir/paritaprevir/ritonavir plus dasabuvir), which were discontinued on January 1, 2019.
All DAAs are combinations of drugs. Scientists have discovered that combining drugs that target the virus differently can increase the chance for cure. People undergoing treatment often take several different pills, although many treatments now involve a single pill combining various drugs. They usually take the medications for 12 to 24 weeks, or longer.
Your doctor will help you decide on your medication regimen, depending on your medical history and which hepatitis C genotype you have. No vaccine is available for hepatitis C as there is for hepatitis A and B.
Hepatitis C medications are often classified by the genotype of the virus that they are designed to treat. A genotype is a specific genetic strain of the virus that is created as the virus evolves.
There are currently seven known HCV genotypes, plus known subtypes within those genotypes.
Genotype 1 is the most common in the United States, affecting about 75 percent of Americans with HCV. Genotype 2 is the second most common, affecting 20 to 25 percent of Americans with HCV. People who contract genotypes 3 to 7 are most often outside the United States.
Some medications treat all or many of the HCV genotypes, but some drugs target just one genotype. Carefully matching your medications to the genotype of your HCV infection may help you achieve SVR.
Your doctor will test you to determine your genotype of HCV infection, which is called genotyping. Medication regimens and dosing schedules are different for the various genotypes.
Following is a list of some of the modern antiviral medications most commonly used to treat hepatitis C, arranged in alphabetical order. You may find more detailed information about available HCV medications here.
Information in the list below is taken from the FDA list of approved hepatitis C drugs. The brand name for each drug is followed by the generic names of its ingredients.
Manufacturers of these medications often give detailed information and claims of effectiveness for additional genotypes on their websites. Your doctor can help you evaluate this information. Some of it may be valid, while some of it may be exaggerated or out of context for you.
Be sure to discuss with your doctor which medications are right for you to help you get to SVR.
- Daklinza (daclatasvir). Usually combined with sofosbuvir (Sovaldi). It was approved in 2015 to treat genotype 3. Treatment is usually 12 weeks.
- Epclusa (sofosbuvir/velpatasvir). Approved in 2016, used for all genotypes. It’s used to treat people with or without cirrhosis. For people with advanced cirrhosis, it’s taken with ribavirin. Treatment length is 12 weeks.
- Harvoni (ledipasvir/sofosbuvir). A fixed-dose medication in combination with ledipasvir and sofosbuvir. It’s indicated for the treatment of genotype 1. Treatment is 8 to 24 weeks.
- Mavyret (glecaprevir/pibrentasvir). A combination drug approved by the FDA in 2017 to treat genotypes 1 to 6, without cirrhosis. It’s made up of two viral protein inhibitors. This means the drug works by preventing the virus from reproducing. Treatment ranges from 8 to 16 weeks.
- Sovaldi (sofosbuvir plus ribavirin). This drug, introduced in 2013, is often given credit for revolutionizing hepatitis C care by launching the era of DAAs. It changed hepatitis C from being a debilitating condition with few recoveries to a treatable disease often cured within three months. Its creator, Michael Sofia, in 2016 received the Lasker Award for revolutionizing hepatitis C care. It’s used to treat genotypes 1, 2, 3, and 4. Length of treatment is 12 to 16 weeks.
- Vosevi (sofosbuvir/velpatasvir/voxilaprevir). Approved in 2017 by the FDA to treat genotypes 1 to 6. It’s intended for people who’ve been previously treated with sofosbuvir but didn't achieve SVR. Treatment length is 12 weeks.
- Zepatier (elbasvir/grazoprevir). A combination pill containing elbasvir and grazoprevir. It’s taken with or without ribavirin for treatment of genotypes 1 or 4, either with or without cirrhosis. Treatment ranges from 12 to 16 weeks.
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 you aren’t going to try a different antiviral drug for whatever reason, 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 at 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. Over 3 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.