Hepatitis C: what treatments work?

Patient information from the BMJ Group 

Hepatitis C: what treatments work? 

Hepatitis C is an infection that can harm your liver. Many people don't know they have it, because there are often no symptoms for many years.Treatments can get rid of the virus. 

What happens when you have hepatitis C? 

The virus that causes hepatitis C is carried in human blood.You can catch it if blood from someone with the virus gets into your bloodstream and the virus is carried to your liver. Some people's bodies fight off the virus naturally, without any treatment. 

This happens for between 15 and 45 in every 100 people who are infected with the virus. But many people aren't able to fight off the virus on their own. If you have had the infection for more than six months, doctors say you have chronic hepatitis C. 

Some people live for many years with chronic hepatitis C, without having any health problems. But it can cause scarring in your liver and stop your liver working properly. 

If your liver isn't working properly, all the jobs that it does are affected. These include breaking down waste products in your body, fighting infection, and breaking food down into a form your cells can use for energy. 

Up to 20 in every 100 people who have chronic hepatitis C eventually get scarring in their liver (cirrhosis) if they don't have treatment. Over time, cirrhosis can cause life-threatening problems, including liver cancer. 

Should I have treatment - and when? 

Treatment for hepatitis C takes several months, and it can have some unpleasant side effects. So it can sometimes be difficult to decide if, and when, to have treatment. Here are some of the things you need to think about.You can talk them over with your doctor to decide what is best for you. 

Were you infected recently? 

If you have recently been infected with hepatitis C, you and your doctor may decide to hold off on treatment to see whether your body is able to fight off the infection on its own. You will need to have regular tests to check on the virus. If you have had the infection for six months or longer, it is unlikely that your body will get rid of the virus without treatment. 

How old are you? 

If you are younger than 18 or older than 60, the benefits of treatment may not be as clear as they would be for someone at a different age. For example, not much research has looked at the effects of hepatitis C medicines in children. And someone who is older might have other health issues that could make treatment more difficult, or harmful.These are issues you should discuss with your doctor. 

Is your liver damaged? 

If you have hepatitis C, but you don't have any signs of liver damage, your doctor may say you don't need treatment now. But you might get liver damage in the future.You need to keep in touch with your doctor and have regular tests. 

If you have mild liver damage, there's a better chance that treatment will work than if your liver damage is more serious.You need to weigh up the chance that liver damage may get worse, against the side effects of treatment. 

If you have serious liver damage, your doctor will probably suggest that you have treatment as soon as you can. 

Will you be able to cope with the side effects? 

You may get unpleasant side effects during treatment, which can be difficult to cope with. However, this is less likely with newer medicines for hepatitis C (see below). It's important that you fully understand the possible side effects, so you can weigh these against the possible benefits of treatment.

What treatments work? 

Medicines can help you get rid of the hepatitis C virus. This may stop any liver damage from getting worse and prevent future damage. 

Types of medicines 

Interferon used to be the main medicine for hepatitis C. However, there are several newer treatments that often work better than interferon, cause fewer side effects, and require a shorter length of treatment. 

Another advantage of the newer treatments is that you take them as tablets or capsules. Interferon requires an injection. 

The newer medicines include: 

• Dasabuvir 

• Ledipasvir 

• Ombitasvir 

• Paritaprevir 

• Ritonavir 

• Simeprevir 

• Sofosbuvir

You take these medicines once or twice a day.You might take more than one of these drugs at a time, or combine them with older medicines called peginterferon (a type of interferon) and ribavirin. People also sometimes have treatment just with peginterferon combined with ribavirin.

Treatment usually lasts between 12 and 24 weeks. However, if you have peginterferon and ribavirin on their own, treatment lasts for 48 weeks. 

What treatments your doctor recommends depends on a few things. 

What type of hepatitis C virus do you have? 

There are six types of hepatitis C virus.They are called genotypes, and they are numbered 1 to 6. What genotype you have affects which medicines are most likely to work for you. Most people with hepatitis C in Western Europe have genotype 1, 2, or 3.You will have a blood test before you have treatment to find out which genotype you have. 

Do you have certain medical conditions? 

If you are pregnant, taking some of these medicines may harm your baby. Talk to your doctor about your options.You may want to wait until after you've had your baby to start treatment. 

If you have kidney disease, heart disease, or bad liver damage, you may not be able to take ribavirin. That's because it can make these conditions worse. 

Have you been treated for hepatitis C before? 

Treatment for hepatitis C doesn't always work. And, sometimes, it works for a while and then the virus flares up again. If you have had treatment for hepatitis C before, you can have treatment again. However, you may be offered different medicines. 

What medicines are available where you live? 

The newer medicines for hepatitis C have not yet all been approved in some countries. You can talk to your doctor about what treatments are available where you live. 

Medicine side effects 

The newer treatments for hepatitis C can cause side effects, but these are usually not serious. Side effects can include tiredness, problems sleeping, a rash, itching, headaches, diarrhoea, and nausea. 

The older hepatitis C medicines - peginterferon and ribavirin - have several side effects, which can be difficult to cope with. 

Common side effects of peginterferon include tiredness, aches and pains, nausea, losing weight, feeling irritable and depressed, and losing your hair (but it grows back). 

Common side effects of ribavirin are tiredness, feeling irritable, skin rashes, a stuffy nose, and coughing. These medicines can also cause more serious problems. 

They include anaemia (you have too few red blood cells), problems with your thyroid gland; serious infections; a problem where your body makes hardly any white blood cells; a problem where your body makes hardly any platelets, which help your blood to clot; and severe depression. 

While you are taking these treatments, you will have regular blood tests to check for some of these problems.

Follow-up 

The only way to see if treatment is working is to have blood tests to check for the virus. If your test is positive, you still have the virus in your blood. If your test is negative, you have no sign of the virus in your blood. 

Most people have blood tests for the virus after four and 12 weeks of treatment. People with genotype 3 have an additional test after 24 weeks. If there is no sign the medicines are working, your doctor will probably advise you to stop taking them. 

The virus can come back after treatment is over. To be certain that the treatment has worked, doctors test for the virus again six months after you finish treatment. If there is no sign of the virus, doctors say you have a sustained virological response (SVR for short). 

Among people with the most common genotypes (1, 2, and 3), those with genotype 1 used to have a much lower chance of getting rid of the virus through treatment than people with genotype 2 or 3. However, the newer treatments have changed this. Now, the vast majority of people have no sign of the virus six months after they finish treatment

© BMJ Publishing Group Limited 2015. All rights reserved. Last published: Mar 04, 2015

 

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