How is hepatitis C treated?

Hepatitis C virus is treated with all-oral medications. These pills, called antiviral medications , are usually taken once per day. These antiviral medications are extremely good at attacking the virus and preventing it from multiplying.

Antiviral medications were not the original treatment for hepatitis C. Before 2014, the only treatment for hepatitis C was called interferon and ribavirin, taken as weekly injections under the skin, plus pills. Interferon treatment caused many unpleasant side effects and was not usually successful. Then a new generation of medications became available. These antiviral treatments are extremely successful at curing the virus and have very minimal side effects.

Ribavirin (without interferon) is still sometimes prescribed to be taken along with the new antiviral medicines, but it has become more and more uncommon that ribavirin is needed at all. Ribavirin has some mild-moderate side effects. Ribavirin is a pill taken twice per day, as 2 or 3 pills in the morning plus 2 or 3 pills at night, depending on the patient's body weight. Most patients do not need ribavirin.

Why should people take antiviral medications for hepatitis C?

The purpose of taking antiviral medications for hepatitis C is to:

• remove (or clear) all the hepatitis C virus from your body permanently
• stop or slow down the damage to your liver
• reduce the risk of developing cirrhosis (advanced scarring of the liver)
• reduce the risk of developing liver cancer (hepatocellular carcinoma)
• reduce the risk of liver failure and the need for a liver transplant

What does it mean to have a successful treatment? What is a Sustained Virologic Response (SVR)?

In an untreated state, the hepatitis C virus infects the cells of the liver and then continuously lives there, making copies of itself that circulate in the bloodstream. Antiviral medications can destroy the ability of the virus to reproduce, so the amount of virus in the bloodstream then decreases. The amount of virus in the blood is measured by a viral load (also called HCV RNA).

Treatment is successful when the viral load drops to undetectable levels, which means the virus cannot be detected in the bloodstream at all. The viral load becomes undetectable during treatment and remains undetected after treatment has ended. If there is still no detectable virus in the blood 12 weeks after the end of the treatment, the treatment was successful. This is called a Sustained Virologic Response (SVR).

A patient who has achieved an SVR is considered to be cured of the hepatitis C virus.

What are the names of the medications for treating hepatitis C?

Since 2014, multiple different antiviral treatments for hepatitis C have been developed. With the many options now available, often there is more than one good choice for a patient. Some of the treatments are recommended as first-line options, some are second-line options, and others are used less commonly in light of all the available choices.

• Elbasvir/Grazoprevir (Zepatier)
• Glecaprevir/Pibrentasvir (Mavyret)
• Sofosbuvir/Ledipasvir (Harvoni)
• Sofosbuvir/Velpatasvir (Epclusa)

Second line hepatitis C medications:

• Sofosbuvir/Velpatasvir/Voxelaprevir (Vosevi)

How long is the treatment?

Treatment is usually 8-12 weeks long but can be as much as 16 weeks long in certain situations. Some patients with more damage to their liver may require 24 weeks of treatment, but this is uncommon. The duration depends on the medication, and specific HCV factors in particular patients.

How likely is it that the treatment will cure my hepatitis C virus?

Hepatitis C treatment regimens have extremely high success rates. There is roughly a 95 percent cure (SVR) rate overall.

Do all patients with hepatitis C need the treatment?

All patients with hepatitis C should be evaluated for treatment, including patients who:

• have cirrhosis
• use drugs
• drink alcohol
• are homeless
• have other medical problems

Patients who should be seen by a hepatitis C specialist for treatment are patients who:

• have been previously treated but the treatment failed
• have cirrhosis and have been ill from their cirrhosis
• have fluid in the abdomen
• have confusion
• have had bleeding in their gastrointestinal tract
• have had a transplant or may have a transplant in the future
• have coinfection with HIV
• have coinfection with hepatitis B

How quickly will the medications work?

The medications will usually cause a very big drop in the viral load within the first two weeks. Some patients will see their viral load become undetectable very early, such as by the fourth week. For other patients, it can take longer until their viral load becomes undetectable.

What can people do to help the medications work best?

• Take the medications every day
• Stay in touch with pharmacy to be sure that all refills are ready on time
• Take the medications exactly as prescribed (in terms of timing with food or other medicines)
• Do not skip doses
• Get all blood tests done on time
• Go to all visits with providers as recommended
• Tell the provider about all other medications that are being taken - including over-the-counter medicines, vitamins, herbs, and supplements
• Complete the entire course of medication

What does it mean to relapse?

Relapse means the medicine was able to lower the hepatitis C viral load to the undetectable level for a time, but then the viral load increased again. Re-treatment options should then be discussed with the provider.

How will my provider monitor me during the treatment?

Your provider will meet with you during treatment to review how well you are tolerating treatment and review laboratory results. Laboratory tests help keep tabs on your health, track the viral load, and determine your response to treatment. You will be given specific dates to go get your blood tested at the lab during and after the treatment.

Side effects of antiviral medications

Hepatitis C antivirals have very mild or no side effects. Some of the side effects may be:

• Nausea
• Fatigue
• Headache
• Disturbed sleep (insomnia)

What about patients with hepatitis C who also have hepatitis B?

Hepatitis B virus can flare in patients who are co-infected with hepatitis B and hepatitis C and are taking medication for hepatitis C. This has been reported as a potential risk for patients who are taking hepatitis C treatment and have underlying hepatitis B as well. The flare usually occurs within a few weeks after the patient starts taking medication for hepatitis C. Therefore, patients who have both hepatitis B and hepatitis C should be seen by a hepatitis expert before starting treatment of the hepatitis C; they may need to start taking hepatitis B treatment to avoid a hepatitis B flare.

Are there ways to cure hepatitis C other than with medications?

Patients sometimes ask whether there are ways to treat hepatitis C other than taking medicines. Currently, there are no vaccines to prevent hepatitis C. Once a person is infected, the only way to treat it is with prescribed antiviral medications.

Some patients worry that having hepatitis C means they will need a liver transplant. Only a very small fraction of people with hepatitis C require a liver transplant. By far, most people with hepatitis C never need a liver transplant. A transplant is performed only when damage to the liver is extremely advanced and the liver is unable to perform its basic functions. A transplant provides a new working liver, but a transplant does not get rid of the hepatitis C virus in the patient. Patients with a liver transplant still need antiviral medication to cure their virus.

Helpful tips while taking hepatitis C medications

• Always follow your health care providers' advice, particularly the instructions on taking your medicine.
• If you have to cancel an appointment, call your provider and schedule a new one as soon as possible.
• Take good care of yourself. Eat well, drink 8 to 10 glasses of water each day, and try to get a full night's sleep.
• Learn about the hepatitis C medications you are taking. This includes special risks and warnings.
• If taking ribavirin, use sunscreen, wear long sleeves and a hat, and limit sun exposure.
• Write down your doctor's name and phone number. Carry this information with you at all times.
• Write the names and amounts of the medicines you are taking. Carry this information with you at all times.

More information

For more about hepatitis C treatment, see our patient information , contact the Centers for Disease Control and Prevention (CDC) Hepatitis Toll-Free Information Line at 1-888-4 HEPCDC (1-888-443-7232), or visit the CDC website at http://www.cdc.gov/hepatitis/index.htm .