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Treatment options for hepatitis C have improved greatly in recent years. 

Amanda Gardner
April 12, 2017

Hepatitis C is a serious liver disease that can lead to liver cancer, liver failure, or even death. But luckily, not only is hepatitis C treatable, it can be cured. These days, people with hepatitis C have options when it comes to their treatment, including pills that are easier to take and much more effective than injections of the past.

The hepatitis C virus (HCV) is spread through contact with infected blood, such as from shared needles or syringes (you cannot get it from casual contact with an infected person). Up to 25% of people who get the virus have an acute, or short-lived, infection that is cleared by the body without treatment. The remaining 75% to 85% of cases—up to 4 million people in the U.S.—develop chronic hepatitis C, meaning the virus lingers for six months or longer. For people with chronic hepatitis C, getting treatment as soon as possible can help shorten the lifespan of the condition and hopefully clear the infection in a matter of weeks.

"With the regimens that are out there now, there can be just one pill with few side effects and cure rates over 95%, closing in on 98% to 99%," says Eugene Schiff, MD, professor of medicine and director of the Schiff Center for Liver Diseases at the University of Miami Miller School of Medicine.

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The number of drugs that treat hepatitis C have increased in recent years. The first treatment options for hepatitis C were a combination of pegylated interferon and ribavirin. However, they were accompanied by nasty side effects and were effective less than half the time, says Ryan Westergaard, MD, assistant professor of medicine at the University of Wisconsin School of Medicine and Public Health in Madison. Interferon also had to be injected.

Today's medications have fewer side effects and are better at combating the virus. Before deciding on a treatment, your doctor will take into account the genotype (strain) of your hepatitis C. Treatment for hepatitis C now relies on medicines called direct acting antivirals (DAAs), which stop the virus from reproducing. Examples of DAAs, which come in pill form, are Olysio (simeprevir); Sovaldi (sofosbuvir), which is used in combination with Olysio; Daklinza (daclatasvir); and Harvoni (a combination of ledipasvir and sofosbuvir). In 2016, the FDA approved Epclusa, a combination of sofosbuvir and another drug, velpatasvir, to treat all hepatitis C genotypes.

What's more, the newer treatments can usually clear the virus in a matter of weeks. The earlier they're started, the better, although even those who already have liver damage can benefit.

"It won't fix their liver, [but] it'll cure them of the virus that is doing ongoing liver damage," says Dr. Westergaard. "It's dousing the fire even though the house is still burning."

Lifestyle strategies are also important, especially in advanced stages of liver disease. This includes eating a healthy diet, exercising, and avoiding alcohol and illicit drugs which can further damage the liver.

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So with all these advances, why are so many people still developing hepatitis C? Experts say diagnosis continues to be an issue.

"People just aren't screening," says Dr. Schiff. "They're not being diagnosed, therefore they're not getting treated."

One reason for this is that hepatitis C can be a "silent" disease. While some people have symptoms like fever, fatigue, nausea, or jaundice (a yellowish tinge to the skin and whites of the eyes), many others don't have any symptoms at all.

Another challenge is cost. Even if you are screened and test positive for hepatitis C, many of the newer drugs are incredibly expensive—as much as $100,000 for one course of treatment. And insurance companies don't usually cover these medications unless you already have liver damage.

"The treatment has gotten really easy," says Dr. Westergaard. "We know what we can do to reduce the disease burden of hepatitis C, but we're not even close to making an impact just because of it costing so much money."