Hepatitis C management: What to know

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The World Health Organization (WHO) recommends that all adults have access to hepatitis testing.

The body can sometimes clear a new infection on its own. When it does not, and the infection becomes chronic, a person needs treatment.

In 2011, doctors began using a group of drugs called direct-acting antivirals (DAAs). These drugs kill the virus in the body, making it possible to cure hepatitis C while also preventing its transmission to others. Standard therapy regimens can last from 12–24 weeks, depending on factors such as:

• the virus genotype
• response to treatment
• whether cirrhosis is present

DAAs transformed hepatitis C from a chronic disease that required ongoing management to a curable infection.

Benefits of DAAs

Compared with older treatment regimens, DAAs are associated with the following benefits:

• higher cure rates
• fewer adverse events
• fewer psychiatric events
• easier administration
• shorter duration courses

DAAs for hepatitis C

DAA therapy may use a combination of drugs to target different parts of the hepatitis C virus. These drugs include:

• elbasvir/grazoprevir (Zepatier)
• glecaprevir/pibrentasvir (Mavyret)
• ledipasvir/sofosbuvir (Harvoni)
• sofosbuvir/velpatasvir (Epclusa)

Learn more about DAA therapy for hepatitis C here.

Doctors have identified many different genotypes of hepatitis C. Each genotype has a slightly different genetic code that affects how the virus behaves in the body and responds to treatment.

A blood test can determine the type of hepatitis C a person has.

Among Americans with hepatitis C, roughly 75% have genotype 1, while 20–25% have genotype 2 or 3. A smaller number of people have genotypes 4, 5, or 6. Some people can have more than one genotype of hepatitis C.

Genotype 3 may be less responsive to treatment. It also tends to progress faster, increasing the risk of cirrhosis and liver cancer. This means people with genotype 3 who delay treatment or do not know they have the infection may be more vulnerable to developing serious complications.

A number of drugs designed to treat multiple genotypes are currently undergoing clinical trials. These drugs would eliminate the need to determine which type of hepatitis C a person has.

The Centers for Disease Control and Prevention (CDC) estimate that hepatitis C treatment cures more than 90% of HCV infections.

To determine whether HCV is cured, doctors will look for sustained virological response (SVR). SVR refers to an undetectable level of HCV. Research has shown that among those who achieve SVR at 12 weeks following DAA therapy, more than 99% go on to achieve a long lasting response, and hepatitis C remains undetectable.

Also, successful treatment of chronic hepatitis can have the following benefits:

• lower prevalence of liver fibrosis
• lower risk of liver failure
• lower risk of developing hepatocellular carcinoma
• better chances of survival

In a small number of patients, antiviral drugs might fail to cure hepatitis C.

People with hepatitis C that is difficult to cure may have better results with multiple antiviral drug regimens or longer treatment courses.

The authors of a 2020 paper estimate that DAA therapy cures HCV in more than 95% of people who undergo retreatment. However, they emphasize that there is no clinical trial-proven treatment regimen for people with difficult-to-cure HCV.

In a study, the researchers had success treating a patient with difficult-to-cure HCV for 24 weeks with three antiviral drugs: sofosbuvir, glecaprevir/pibrentasvir, and ribavirin.

In 2018, Black Americans were almost twice as likely to die of hepatitis as white Americans. Racism plays an important role in this phenomenon.

Research from 2017 found that Black Americans are no more likely than other groups to be ineligible for HCV treatment. Yet, doctors are more likely to deny them treatment based on eligibility requirements.

Thanks to DAA drugs, hepatitis C is now almost always curable. But according to the CDC, about 40% of Americans with hepatitis C do not know they have an infection. This can prevent or delay treatment, increasing the risk of complications.

The complications of hepatitis C can include:

• end-stage liver disease
• liver cirrhosis
• liver cancer
• chronic pain
• death from liver disease

A person can also pass hepatitis C on to others if they do not treat chronic infections.

Between 1.5% and 2% of people who give birth in the United States have hepatitis C.

It is possible to pass the infection on to the fetus during pregnancy or to the baby during or after birth. However, the odds of transmission are low with the right management.

Direct-acting antiviral drugs are not currently approved for use in pregnancy. The Society for Maternal-Fetal Medicine recommends the following strategies for managing hepatitis C during pregnancy:

• Pregnant people with hepatitis should avoid drinking alcohol.
• Pregnant people should only use DAA drugs as part of a clinical trial.
• Doctors should offer DAA drugs in the postpartum period.
• Healthcare professionals should avoid invasive procedures, such as internal fetal monitoring, unless medically justified, since doing so increases the risk of hepatitis C transmission.
• Healthcare professionals should not discourage breastfeeding.
• Healthcare professionals should not routinely perform cesarean sections solely because a pregnant person has hepatitis C.

Some other treatment methods for hepatitis C, besides DAA therapy, may include:

• Liver transplant: A liver transplant can treat cirrhosis of the liver due to hepatitis C. However, it will not treat hepatitis C itself. Following a transplant, most people with hepatitis C can develop the infection in their newly transplanted liver. So it is important to use antiviral drugs in people with HCV who need a liver transplant.

• Supportive care: A person may need supportive care to help them manage some complications of hepatitis C, even when DAA therapy is successful in treating the underlying virus. This is because untreated hepatitis C can severely damage the liver and other organs. Delaying treatment increases the risk of this damage. A person may need treatments for kidney failure, liver cirrhosis, liver cancer, or anemia. They may also need ongoing monitoring for complications of hepatitis C.

• Vaccinations: There is no effective vaccine for hepatitis C. A person may be able to lower their risk by adopting prevention strategies, such as not sharing needles with others. Ongoing research, guided by advanced technology, is looking into developing an effective hepatitis C vaccine.

Learn more about the hepatitis C vaccine progress here.

Lifestyle changes are not part of the standard treatment regimen for hepatitis C.

However, a healthy lifestyle may improve liver health and reduce the risk of cardiovascular complications. For example, a 2021 study found improved cardiometabolic health and improved quality of life among people with hepatitis C who exercise.

Some lifestyle changes to consider include:

• avoiding alcohol, since it can damage the liver
• talking with a doctor about a liver-healthy diet
• seeking care to manage any chronic medical conditions
• taking DAA drugs exactly as a doctor prescribes them
• avoiding using illegal or unnecessary drugs or medications
• not sharing needles with other people

Management of hepatitis C involves seeking treatment as early as possible to reduce the risk of serious hepatitis C complications. With treatment, hepatitis C is curable in most individuals. This substantially reduces the risk of liver disease and liver failure.

Not everyone with hepatitis C develops symptoms. So people who have a high risk of hepatitis C should ask a doctor about testing. And anyone who is pregnant or has chronic illness symptoms or a history of intravenous drug use should also consider hepatitis C testing.