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Hepatitis C treatment

Effective treatments are available for hepatitis C. This field is evolving rapidly and standards of care are changing. The newest drugs can cure most people with hepatitis C, including people who also have HIV. If you are newly diagnosed with hepatitis C, it is important to consider the pros and cons of starting hepatitis C treatment now, or waiting until later.

The current standard treatment with interferon is slowly being replaced by direct-acting antiviral medications that attack hepatitis C virus at various steps of its lifecycle, similar to the ways different types of HIV treatment work against HIV. But unlike HIV treatment, treatment for hepatitis C can lead to a permanent cure and does not need to continue indefinitely. While interferon-based treatment usually lasts six months to one year, new drugs can cure hepatitis C in as little as 12 weeks.

Traditionally, hepatitis C treatment was mainly recommended for people with signs that their liver disease is progressing. Unfortunately, however, it is not possible to predict in advance who will experience liver disease progression or how fast it will occur. With the availability of more effective and better-tolerated drugs, more people may be recommended to start treatment at earlier stages of disease.

Because hepatitis C treatment involving interferon has unpleasant side-effects and is hard to take, many people with hepatitis C and their doctors have been waiting for interferon-free combinations of direct-acting antivirals. The first such regimens are now available and several more are expected to be approved in the coming years. However, not all people with hepatitis C will be eligible to receive interferon-free treatment. Recommendations are likely to evolve quite rapidly as new information becomes available on the effectiveness and affordability of interferon-free treatment at various stages of liver disease.

In the meantime, it can be difficult to decide whether to take hepatitis C treatment now or wait. People with advanced liver damage may need to start treatment urgently using the drugs that are available now. Treatment is much more effective if you start it while you are still in the acute stage of HCV infection, so if you are diagnosed in the acute stage, you may choose to start treatment right away. If you have chronic hepatitis C and mild or moderate liver disease, you may be able to – and choose to – wait for better options. You will need to weigh up a number of factors with your doctor when making a choice about whether to wait or start treatment now:

  • Can you wait until more drugs become available or is there a risk that your liver disease might worsen, and so become more difficult to treat?
  • What is the value to you of being cured of hepatitis C now, rather than waiting? How long are you prepared to wait?
  • How confident are you that newer drugs will be available if your liver disease becomes worse?
  • What do you feel about the possibility that taking hepatitis C treatment now may not cure the infection?
  • Do you feel ready to start a course of interferon-based treatment in the near future?

Clinical trials of experimental drugs are one way to get early access to promising new treatments in development.

Factors that affect treatment success

A number of different factors can help predict how well hepatitis C treatment is likely to work for you.

Before treatment is started, it is important to have a test to determine what strain, or genotype, of hepatitis C you have, as this can predict your response to treatment.

There are at least seven HCV genotypes. Genotype 1 is the most common in the UK, Europe and the US. Unfortunately, this type responds least well to interferon-based treatment. Researchers have recently discovered that within genotype 1, subtype 1a is harder to treat than 1b. HCV genotype 2 responds best to interferon-based treatment, followed by genotype 3. Genotype 4 is less well studied but also appears harder to treat.

In addition to hepatitis C genotype and viral load, factors such as your age, sex, degree of liver damage and presence of cirrhosis also help predict if treatment is likely to work. A human genetic variation known as IL28B predicts who will respond best to interferon. People of African descent generally have lower response rates to interferon than white people because they have a less favourable form of this gene.

Treatment is much more effective if you start it while you are still in the acute stage of HCV infection, rather than when you have developed chronic HCV infection. If you do develop chronic infection, you are more likely to achieve a cure if you are being treated for the first time (known as being ‘treatment naive') than if you are being re-treated after prior unsuccessful therapy (known as being ‘treatment experienced’). Treatment-experienced people can be further divided into three groups:

  • those who relapsed after finishing therapy – that is, your HCV viral load became detectable again after being undetectable.
  • ‘partial responders’ – that is, your viral load dropped, but was still detectable at the end of your treatment (also called ‘non-responders’).
  • people who didn’t respond to treatment – that is, you showed little or no viral load reduction (known as 'null responders').

HIV & hepatitis

Published April 2015

Last reviewed April 2015

Next review April 2018

Contact NAM to find out more about the scientific research and information used to produce this booklet.

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This content was checked for accuracy at the time it was written. It may have been superseded by more recent developments. NAM recommends checking whether this is the most current information when making decisions that may affect your health.
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