Let’s Talk About Hepatitis C Medication
This serious viral infection is almost always curable with treatment. Here’s what you need to know about the new medications.
Since hepatitis C was first identified in 1989, much has remained the same: the viral infection is still often without symptoms until it becomes chronic and often leads to liver damage. One crucial thing has changed and that’s the medication used to treat it. The latest hep C drugs are highly effective, curing almost all cases in a matter of weeks, usually without side effects.
Our Pro Panel
We tapped some of the nation’s top experts in hepatitis C to bring you the most up-to-date information possible.
Nancy Reau, M.D.
Professor, Department of Internal Medicine, and Section Chief, Hepatology Associate Director of Organ Transplantation
Rush Medical College and Rush University Medical Center
Anurag Maheshwari, M.D.
The Center for Liver and Hepatobiliary Diseases at The Melissa L. Posner Institute for Digestive Health and Liver Disease at Mercy Hospital
Mindie H. Nguyen, M.D.
Professor of Medicine and Director for the Hepatology Fellowship in the Division of Gastroenterology and Hepatology and Liver Transplant Program
Stanford University Medical Center
The latest hep C medications are both effective and tolerable. In fact, 80% of patients report no side effects at all! Those who do have some reaction to the drugs say it’s mild.
The newest and most successful class of drugs for this disease are called direct-acting antivirals (DAA). They work by targeting proteins found in the virus, and generally work in 8-12 weeks. There are two commonly prescribed versions of DAA, Mavyret and Epclusa, and both include a mixture of several antiviral meds in one pill.
Treatment can rid your body of the virus, but it doesn’t make you immune to hep C. There is no vaccine, so if you engage in risky behaviors (like sharing needles), you can absolutely get it again.
Half the people with hepatitis C don't even know they're infected and symptoms for this condition can be elusive, allowing it to progress to advanced stages before symptoms appear. If hep C becomes chronic and starts affecting your liver, you may experience jaundiced skin, dark-colored urine, itchy skin, and fluid buildup in the abdomen.
What Is Hepatitis C Again?
Hepatitis C (HCV) is a liver infection caused by the hep C virus—and the disease is quite common. It’s the most common chronic blood-borne infection in the United States, with 3 to 4 million new infections occurring each year, according to FDA reports.
You can’t catch it from kissing, holding hands, or even if someone sneezes in your face. Hep C is passed on when infected blood gets into your bloodstream, which can happen in different ways, but typicals modes of transmission are:
Sharing needles or sharing straws to snort drugs
Working in healthcare (due to the risk of an accidental needle-stick)
Sharing razors, toothbrushes, or nail clippers with an infected person (due to the risk of coming in contact with their blood)
Getting a body pierce or tattoo in an unsterile environment
Getting a blood transfusion or organ transplant before the virus was discovered in 1989, or prior to 1992, when blood wasn’t as thoroughly screened
Being born to a mother who had hep C when she was pregnant
Some of these risks were more common years ago, before blood supply was routinely screened for the virus. For that reason, three out of four patients with chronic hepatitis C are baby boomers (born between 1945 and 1965), according to the Centers for Disease Control and Prevention (CDC). Many became infected before the virus was identified and protective measures were developed. Hep C can also be spread through sexual intercourse, but that risk is considered to be low.
While 30% of people who have hep C clear the infection through their own immune system, 70% don’t, and treatment is crucial. When it’s left to linger, hep C can lead to serious liver complications.
Thanks to some new(ish) state-of-the-art meds, hep C is 98% curable—and often in just a matter of months. There is a caveat: while hep C drugs can cure the infection, they aren’t vaccines (there is no vaccine yet for hep C), so they won’t reduce the risk of contracting the disease again. If you return to the same behaviors that lead to infection, the virus may come back.
What Are the Signs and Symptoms of Hepatitis C?
As conditions go, hep C is seriously sly—most people who have it don’t show symptoms. In fact, about half of people with HCV don't know they're infected, according to the Mayo Clinic, and some people can live with it for decades before being diagnosed. If there are symptoms, they’re pretty mild. Think fatigue, muscle aches—common ailments you wouldn’t automatically associate with hep C.
This is why the CDC recommends a hepatitis C screening: a simple blood test known as an HCV antibody test, for all adults aged 18 years and older at least once in their lifetime. Keep in mind, it’s not a standard test, so you have to ask for it. If that test is positive, you’ll likely be given a HCV RNA test to determine if you have an active infection.
Why is it so crucial to be diagnosed, if you don't have any symptoms? When hep C hangs out in the system untreated for years, it starts affecting the liver and becomes chronic. More than half of people who become infected with HCV will develop chronic infection, according to the CDC. When that happens, symptoms may include:
Fluid buildup in the abdomen
Swelling in the legs
Bleeding and bruising easily
Confusion and slurred speech
Spider-like blood vessels on your skin
Chronic HCV can lead to serious complications, including cirrhosis (scarring of the liver caused by years of damage, making it difficult for this organ to function properly), liver cancer, or liver failure. The liver performs a slew of vital functions, including:
Breaking down nutrients from food so they can be used as energy
Storing vitamins, minerals, and sugar to prevent nutrient shortages
Removing bacteria from the blood to prevent infection
When the liver is unable to deliver on even one of its important jobs, the damage wrought by hep C can be serious—which is why treatment is so crucial.
How Do You Treat Hepatitis C?
Treatment for hep C has come a long way. Patients used to require weekly interferon injections (accompanied by their harsh side effects) that required a course of six months to a year. Now, meds are in the form of a tablet that’s taken over just a few weeks. Better yet, 80% of patients taking hep C meds report no side effects. Those who do experience them say they’re extremely mild and can be managed with OTC medications.
The beauty of today’s treatments is that they can cure even chronic hep C cases that have been around for decades. Though these meds can eliminate the virus from a patient’s system, they can’t cure damage already done to the liver or reverse liver cancer—those more serious complications will often require a separate course of treatment.
Which Medications Are Used to Treat Hep C?
In the last several years, treatment for hepatitis C has changed dramatically, thanks to a class of drugs known as direct-acting antivirals (DAA). These meds target and eliminate proteins found in the virus. They’re much gentler on the body than the more intrusive treatments of the past. Patients have fewer side effects and shorter treatment times—some in just eight weeks.
The two most common medications prescribed are Mavyret (glecaprevir and pibrentasvir) and Epclusa (sofosbuvir and velpatasvir), both of which include a cocktail of several antiviral meds in one pill. While they’re equally effective in curing the virus, the one your doctor chooses may depend on other meds you’re taking (some can cause drug interactions) or on your insurance company.
Mavyret is a potent combination of two antivirals: glecaprevir and pibrentasvir, which work like a power team to reduce the amount of hepatitis C virus in your body and stop it from multiplying, so your immune system can fight back hard against the infection.
It was approved by the FDA in 2017 for all six genotypes of hep C, including patients with mild cirrhosis of the liver and those who’ve received liver or kidney transplants. Treatment requires three pills, one after the other, once a day with food for eight weeks.
Risks and Side Effects
Side effects of Mavyret, if any, are minor—headaches, fatigue, and nausea—and manageable. Keep in mind, Mavyret is not recommended for those with moderate or severe cirrhosis.
The biggest risks with Mavyret are drug interactions, which can happen if you’re on meds used to treat conditions like high cholesterol and seizures, affecting how they work. Make sure you have an honest talk with your doc about all the meds you’re taking before starting treatment.
A blend of two antivirals, sofosbuvir and velpatasvir, Epclusa became available in 2016. It’s approved for those with and without liver cirrhosis and treats all six hep C genotypes. It requires a one-a-day pill taken for 12, weeks with or without food, and works by reducing the amount of virus in the body, so your immune system can fight the infection and give your liver a chance to recover.
Risks and Side Effects
People on Epclusa experience very mild side effects, if any, including headaches and fatigue. Like Mavyret, it can cause drug interactions that may lessen the amount of Epclusa in the blood, leading to reduced efficacy.
One of the biggest risks is for people taking the heart rhythm medication Amiodarone, because sofosbuvir, a key ingredient in Epclusa, can cause serious heart problems. Before starting treatment, make sure your doctor is fully aware of all meds you’re taking.
What Happens if Hep C Meds Don’t Work?
In rare cases (2% of patients), the body won’t respond to either medication. If this happens, your doctor may prescribe a more potent combination of antivirals such as those found in Vosevi.
This medication blends three anti-viral meds: sofosbuvir, velpatasvir, and voxilaprevir. Because it’s more powerful, it may have a higher burden of side effects like headache, fatigue, diarrhea, and nausea.
Dosage entails one pill taken once a day with food for 12 weeks. Your doctor may also keep you on the meds longer to clear the infection.
How Effective Is Hepatitis C Medication?
Today’s treatments are incredibly effective. According to the FDA, they have a 90-to-100% cure rate in just two to three months. A few months after your prescribed course of treatment is finished, your doctor will order a blood test to measure how much viral genetic material (viral RNA) is in your blood. If none is visible, then you’re considered cured. Note: These medications aren’t vaccines (there isn’t a vaccine for hep C yet), so if you engage in risky behaviors, the condition could come back. It's in your hands to life your life fully, safely!
- Hep C Treatment Options: Gastroenterology & Hepatology. (2017). “New Therapies for Hepatitis C Virus Infection.” ncbi.nlm.nih.gov/pmc/articles/PMC5390323/
- Advances in Hep C Treatment: Pharmacy & Therapeutics.(2017). “Hepatitis C in a New Era: A Review of Current Therapies.” ncbi.nlm.nih.gov/pmc/articles/PMC5398625/
- Hepatitis C Facts & Figures: Mayo Clinic. (n.d.). “Diagnosis and Treatment.” mayoclinic.org/diseases-conditions/hepatitis-c/diagnosis-treatment/drc-20354284
- Hep C Management: American Liver Foundation. (n.d.). “Treating Hepatitis C.” liverfoundation.org/for-patients/about-the-liver/diseases-of-the-liver/hepatitis-c/treating-hepatitis-c/
- Hep C Stats: Centers for Disease Control and Prevention. (n.d.). “Overview and Statistics.” cdc.gov/hepatitis/hcv/cfaq.htm#overview