Can Hep C Really Be Cured Now?
For 95% of people with hepatitis C, the exciting answer is yes. What’s more, second-round treatments are highly effective at curing the remaining 5%.
Until about a decade ago, receiving a diagnosis of hepatitis C was fraught with uncertainty—and often a whole lot of worry. This dangerous and often silent viral infection causes inflammation of the liver that can lead to cirrhosis, scarring, liver cancer, and death. But thanks to exciting innovations in targeted treatment regimens that have come to market within the past five to eight years, the vast majority of cases of hep C (as it’s so often called) can now be cured—yes, you read that right!—meaning that lives are being saved.
This is not to say the disease should be taken lightly—Hep C today can still be fatal. In 2018, more than 15,000 people died from it in the U.S., according to the Centers for Disease Control and Prevention (CDC)—and that’s likely a low estimate, because many people do not get screened for the disease. (The CDC recommends that all adults get tested for hep C at least once in their lifetimes.) Still, with powerfully effective new treatments comes virtually undetectable viral loads, less liver damage, and better management of the condition. For many folks, it means a hep C-free future.
Keep reading to learn about how far we’ve come with treatment options, and why a cure is within reach for many with this disease.
How People Catch Hep C
The CDC reports that hepatitis C most commonly spreads by coming into contact with the blood of someone who’s infected. This can happen through the sharing of drug injection equipment like needles and syringes (the most common cause of new infections today); sex with an infected person; and getting tattoos or body piercings at unlicensed facilities that don’t take good infection-control precautions such as using new, sealed, sterilized needles for each customer.
Because many people with hep C don’t look or feel sick, they can go for a long period of time without knowing they’re infected, potentially spreading the infection to others, even as the disease does more damage to their bodies.
Treatment Progress Over Time
Until very recently, therapies for hep C—a virus that was first discovered in 1989—were not all that effective and came with serious, sometimes debilitating side effects. A brief history of hep C treatments can help explain why:
Early 1990s: The first treatment option was recombinant interferon-alfa (IFNa). About a third of people treated with interferons responded to these treatments, but this approach didn’t attack the hep C virus directly. And because the body breaks down laboratory-produced interferon quickly, for most people, the virus rebounded.
Late ‘90s Through 2000s: Over the next few years, the combination of a new antiviral drug called ribavirin with a more high-powered interferon, called pegylated interferon alpha (PegINFa), brought cure rates for hep C to more than 50%, according to a history of hepatitis C treatment published in Clinical Liver Disease. Good news, sure—but it still meant that nearly half of people with hep C could not be cured. And for many people, the serious side effects outweighed the benefits. They included flu-like symptoms, weight loss, fatigue, anemia, skin problems, insomnia, depression and even suicidal thoughts. And treatment took 48 weeks. You can probably imagine that it was very difficult to endure symptoms like these for nearly a year with only about a 50-50 chance of being cured.
2011: The big breakthrough came with the introduction of the first in a group of drugs called direct-acting antiviral agents (DAAs). Unlike previous treatments, these drugs were designed to target the virus specifically. “We moved from having response rates that were in the 40% to 50% range up to 75%, which was really remarkable at the time,” Norah Terrault, M.D., professor of medicine and the Neil Kaplowitz chair in liver diseases at the Keck School of Medicine of the University of California-San Francisco.
These treatments were quite complicated. “We still needed to use them with interferons, there were a whole lot of side effects, and patients still had to stay on treatment for a long time,” Dr. Terrrault says. They also didn’t work on everyone, likely because the hep C virus actually has six major genetic types, labeled 1 through 6.
Still, the door to directly attacking the hepatitis C virus had been unlocked. Over the next decade, a rapid progression of new drugs and drug combinations came through it. By 2017, there were DAA drugs available for all hep C genetic types, with cure rates of 95% or more, far fewer side effects, and shorter treatment times, some as short as just eight to 12 weeks.
Streamlining Available Treatment Breakthroughs
For a while, as flurries of new DAA drugs came out, choosing the right drug for the right patient could be very complicated. Some of them worked on certain genotypes and not on others. Some of them were approved for patients who had more advanced liver disease and some were not. Some could be used only in patients who had not undergone previous treatment.
“Today, there are three basic drugs that can be effective for the vast majority of hepatitis C patients,” says Imtiaz Alam, M.D., medical director of the Austin Hepatitis Center in Austin, TX, and a clinical associate professor of medicine at Texas A & M University. These drugs, he says, are all what’s known as pan-genotypic, meaning that they work for all of the six different hepatitis C genotypes and their subtypes.
The first, Epclusa (sofosbuvir/velpatasvir), was approved in 2017. It’s a pill taken once daily for 12 weeks. You can take this drug whether or not you have liver cirrhosis, but if your liver disease is advanced (also called “decompensated cirrhosis”), it must be combined with ribavirin, Dr. Alam explains. “The cure rate for this drug is about 98%,” he says.
The second, Mavyret (glecaprevir/pibrentasvir) was also approved in 2017 and has one of the shortest treatment times: just eight weeks. It’s also a once-daily pill that works on all six genotypes, with a response rate of about 98%. One limitation: unlike Epclusa, it cannot be used in people who have advanced liver disease. In rare cases, the Food and Drug Administration (FDA) warns, it can cause severe liver injury in these patients.
“These two drugs are the primary regimens that we now recommend,” says Dr. Terrault. “There are some differences between the two, but they are both highly effective and can be used for all genotypes.”
In August of 2020, the American Association for the Study of Liver Diseases (AASLD) and the Infectious Disease Society of America (IDSA) put out a set of simplified guidelines recommending these drugs as the first line of therapy for most hep C patients. “There are still some patients who need a different approach to treatment, including people who have chronic kidney disease or coinfection with HIV or hepatitis B. But the majority of hepatitis C patients can be cured using one of these two treatments,” Dr. Terrault says.
More great news: Most people don’t experience serious side effects with any of these drugs, with headache and fatigue being the most common issues reported, says Dr. Alam. People who have to take ribavirin with Epclusa because of advanced liver disease also report the typical ribavirin side effects, which also include anemia, nausea, and diarrhea.
What’s more, the new simplified recommendations mean that most of those people also don’t necessarily have to see a specialist; instead, they can get treated and cured of their hepatitis C by a primary care provider or other non-specialist.
Treating the Remaining 5%
If a treatment is 95% successful, though, that still means that as many as 5% of people who take it won’t be cured. Fortunately, there are other options. If your hepatitis C was not cured by taking a first-line therapy like Epclusa, Dr. Terrault says, you should see a hep C specialist. That doctor will likely recommend a triple therapy called Vosevi (sofosbuvir, velpatasvir, and voxilaprevir). Also taken as a daily pill for 12 weeks, it’s about 95% effective—yes, even if previous treatments did not work for you.
A Life-Saving Cure Really Is Here
It’s no exaggeration to say that thousands of lives have been saved by these new treatments. A study published in July 2020 in JAMA Network Open found that the risk of death from hepatitis C was nearly cut in half for patients who took DAAs, even among people who weren’t as high-risk because they didn’t yet have advanced liver disease.
“This means that we can say that we’re pretty confident we’re going to be able to cure you, if not with the first round of treatment then with a second round,” Dr. Terrault says. “The majority of people with hepatitis C can now be cured with single course of treatment that takes just eight to 12 weeks.”
It’s important to understand, though, that while they may be cures, the new treatments for hep C are not vaccines. This means that you can get the disease more than once. “If you are treated and cured, if you are exposed to the virus again you can be reinfected,” Dr. Terrault warns. Fortunately, reinfection rates after the virus has cleared through treatment are fairly low. In a study published in the journal Clinical Infectious Diseases, 18 of 257 patients (7%) who successfully cleared the virus after treatment were reinfected, with the highest reinfection rates found in people who continued to inject drugs.
Equally important? You have to take them exactly as prescribed. “That means taking them every day without fail,” she says. “Some supplements and over-the-counter medications can also interfere with their effectiveness, so be sure to talk to your doctor about anything else you’re taking. This is the time to be pro-active. Everyone with hepatitis C can have access to a cure.”
- Facts About Hepatitis C: Centers for Disease Control and Prevention (CDC). (2020). “Hepatitis C Questions and Answers for the Public.” cdc.gov/hepatitis/hcv/cfaq.htm
- Hepatitis C Treatment History: Clinical Liver Disease: A Multimedia Review Journal. (2012). “A brief history of the treatment of viral hepatitis C.” aasldpubs.onlinelibrary.wiley.com/doi/full/10.1002/cld.1
- First Hep C DAAs: Canadian Journal of Gastroenterology. (2012). “Review of boceprevir and telaprevir for the treatment of chronic hepatitis C.” ncbi.nlm.nih.gov/pmc/articles/PMC3354889/
- Side Effects of DAAs: AIDSMAP. (2012). “Telaprevir and boceprevir show high rate of serious side-effects in hepatitis C patients with urgent need of treatment.”aidsmap.com/news/apr-2012/telaprevir-and-boceprevir-show-high-rate-serious-side-effects-hepatitis-c-patients
- Impact of DAAs on Survival: JAMA Network Open. (2020). “Association of Direct-Acting Antiviral Treatment With Mortality Among Medicare Beneficiaries With Hepatitis C.” jamanetwork.com/journals/jamanetworkopen/fullarticle/2768395
- New Guidelines for DAA Treatment: AASLDL/IDSA. (2020). “Simplified HCV Treatment Algorithm for Treatment-Naive Adults With Compensated Cirrhosis.” hcvguidelines.org/treatment-naive/simplified-treatment-compensated-cirrhosis
- Mavyret: Food and Drug Administration (FDA). (2019). “FDA warns about rare occurrence of serious liver injury with use of hepatitis C medicines Mavyret, Zepatier, and Vosevi in some patients with advanced liver disease.” fda.gov/drugs/drug-safety-and-availability/fda-warns-about-rare-occurrence-serious-liver-injury-use-hepatitis-c-medicines-mavyret-zepatier-and