Hepatitis C is a liver infection caused by the hepatitis C virus (HCV). Since most people are unaware that they’ve been infected, it’s hard to know how prevalent this disease is. The Centers for Disease Control and Prevention (CDC) estimates that 2.4 million Americans are living with HCV.
The infection can range from a mild illness that lasts a few weeks to a chronic, lifelong condition. If left untreated, HCV can cause liver damage, cirrhosis or liver cancer. Thanks to a handful of new drugs, the prognosis is better than ever with cure rates at an all-time high.
Signs and Symptoms of Hepatitis C
A surprising number of people who are infected with HCV never develop symptoms. Those who do start showing signs anywhere from two to 12 weeks after exposure.
Fever, extreme fatigue, dark urine and grayish stools are common. The eyes and skin take on a yellowish hue when jaundice sets in. Some patients lose their appetite. Abdominal pain, nausea, vomiting, and joint pain are occasional complaints.
Since 1992, the U.S. has conducted widespread screening of the blood supply. It is rare if not impossible these days to contract HCV through a blood transfusion or organ transplant.
The most common way that people get infected today is by sharing needles or syringes during drug use. Needlestick injuries in a hospital or health care settings put workers and patients at risk. Unregulated tattooing, a common occurance in prisons, is also dangerous. Occasionally, the virus is transmitted sexually or through sharing personal items, like razors, that have come in contact with infected blood. HCV can be passed to a fetus in pregnancy.
According to the CDC, 70 to 85 percent of people who are infected will develop a chronic case of hepatitis C, so anyone who was possibly exposed should see a doctor. Hepatitis C is diagnosed through blood testing.
The Top Five Treatment Options for Hepatitis C
Scientists aren’t sure why, but about 15 to 25 percent of people who have HCV spontaneously clear it from their bodies. They do not develop a chronic infection or require treatment.
For the others, the only available treatment used to be a combination of four medications called interferon, ribavirin, boceprevir, and telaprevir. Interferon shots were extremely painful, and the drugs triggered side effects similar to those of chemo. Only around half of patients who underwent this treatment were cured.
Now, antiviral medications are used, and they get better all the time. According to Hep, a magazine devoted to hepatitis-related issues, the new drugs cure hepatitis C in around 90 to 95 percent of patients.
Here are the main objectives of treatment
- To slow the progress of liver inflammation and clear the virus from the bloodstream
- To prevent liver scarring, which is known as cirrhosis, and reduce the risk of liver cancer
- To prevent reinfection
Treatment is far from one-size-fits-all, and many factors influence doctors’ decisions about it. They consider how much of the virus is in the system — this is known as the viral load. Acute cases are short term and not as serious as chronic, ongoing cases of six months or more. Bed rest, a healthy diet, hydration and alcohol avoidance might clear up the infection.
There are at least six strains, or genotypes, of HCV. They are distinctly different and call for different medications.
Other considerations include the severity of liver damage, separate health issues and response to previous treatments.
Five of the best treatments are described below. All are direct-acting anti-viral drugs that work in slightly different ways. In general, DAAs interfere with proteins to prevent HCV from making copies of itself. That prevents the virus from growing and spreading.
Zepatier (elbasvir and grazoprevir)
The combination drug Zepatier is recommended for patients with HCV genotype 1 — the most common genotype — and genotype 4. It is sometimes given with ribavirin.
The dosage is one pill per day for 12 to 16 weeks. Mild side effects include fatigue, headache and nausea. When Zepatier is combined with ribavirin, some patients also experience low red blood counts, shortness of breath, itching or rash.
Harvoni (ledipasvir and sofosbuvir)
The anti-viral Harvoni is best for patients with genotypes 1, 4, 5 and 6. Like Zepatier, it prevents the virus from reproducing itself.
Length of treatment is typically 12 weeks at one oral dose per day.
When Harvoni is taken alone, common side effects are fatigue and headache. Some patients experience weakness and cough when ribavirin is also prescribed.
Viekira Pak
Viekira Pak treatment is a regimen of four different drugs taken in specific doses. Viekira XR is a once-daily, extended release version. The four antiviral agents are ombitasvir, paritaprevir, ritonavir and dasabuvir. This treatment is most effective for genotype 1, but it is not ideal for people with underlying liver disease.
Depending on the formulation, length of treatment is either 12 or 24 weeks.
When taken alone, Viekira Pak sometimes causes nausea, insomnia and itching. If it’s coupled with ribavirin, weakness and rash may also occur.
Olysio (simeprevir) given with Sovaldi (sofosbuvir)
Olysio and Sovaldi are taken together for genotype 1. Both DAAs are taken orally once a day to end HCV’s life cycle in liver cells. They are sometimes given with ribavirin.
Treatment takes anywhere from 12 to 24 weeks. Side effects may include fatigue, headache, nausea, itching, insomnia and sensitivity to light. Dizziness and diarrhea may occur with longer regimens.
Daclatasvir (Daklinza) given with Sovaldi (sofosbuvir)
This combination is appropriate for genotypes 1 and 3. The drugs are taken together once a day, and they are sometimes given with ribavirin.
Treatment takes 12 weeks, and some patients experience a headache and fatigue.
Sovaldi is sometimes given with ribavirin to treat genotypes 2, 3 and 4. Drugs that treat all strains of HCV include Epclusa, Mavyret, and Vosevi.
The importance of taking the drugs exactly as prescribed can’t be overstated; taking every single dose is vital to success. The website of the American Liver Foundation provides tips for managing side effects.
During the course of treatment, patients must keep their doctor appointments. Blood testing reveals the current viral load. When all traces of the virus are removed, the patient is said to have sustained virologic response (SVR)
SVR is just a fancy term for cured, but patients are always glad to hear it.