3 New Ways to Treat Hepatitis C

by Jennifer Tzeses Health Writer

Hepatitis C, a viral infection transmitted through blood, is a stealthy condition that often has no symptoms. Though 30% of people with hep C can clear the infection simply through their own immune system, for the 70% who don’t, medical treatment is necessary. Left to fester, hep C can eventually lead to consequences like cirrhosis (scarring of the liver) and liver cancer. This is why blood test screenings are so important. The Centers for Disease Control and Prevention recommends hepatitis C screening for all adults aged 18 years and older at least once in a lifetime.

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Today’s New Meds

With treatment, there’s a 98% cure rate for hep C, says Nancy Reau, M.D., professor of internal medicine in the Division of Digestive Diseases and Nutrition at Rush Medical College in Chicago. Unlike the aggressive weekly interferon injections of the past, today’s meds are often in tablet form, meant to be taken over a few weeks. More progress: 80% of patients report no side effects, says Anurag Maheshwari, M.D., a liver specialist for the Center for Liver and Hepatobiliary Diseases at Mercy Hospital in Baltimore. For those who do, they’re mild. The bottom line, says Dr. Maheshwari: “The earlier you treat hep C, the better the outcome.”

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The Most Common Meds

The standard treatment for hep C is a class of meds called direct-acting antivirals (DAA), which target and eradicate proteins found in the virus. The two most commonly prescribed are Mavyret and Epclusa, both of which include a cocktail of different drugs in one pill. Which one your doctor chooses is often a matter of the meds you’re already taking (some can cause interactions) and your insurance coverage. “The medications are fairly equivalent,” Dr. Maheshwari says.

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The Med: Mavyret

Approved by the FDA in 2017 for all genotypes of hep C (there are six), including patients with mild cirrhosis of the liver and those who’ve received liver or kidney transplants, Mavyret is a combo of two antivirals: glecaprevir and pibrentasvir, which work together to help stop the hep C virus from multiplying. Treatment typically requires three pills at one time, or one after the other, once a day with food for a duration of eight weeks.

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Side Effects of Mavyret

The most common adverse reactions in patients taking Mavyret include headaches, fatigue, and nausea. Mavyret is also not recommended for those with moderate or severe cirrhosis, and it can cause interactions with certain meds used to treat conditions like high cholesterol and seizures, affecting how they work. Always talk to your doctor about what you’re currently taking before starting any treatment.

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The Med: Epclusa

Epclusa became available in 2016 and is approved for those with and without cirrhosis. A combo of two antivirals, sofosbuvir and velpatasvir, the drug treats all six hep C genotypes. It’s a one-a-day pill taken for 12 weeks with or without food, and it works by reducing the amount of virus in your body, helping the immune system fight the infection and allowing the liver to recover.

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Side Effects of Epclusa

The most common side effects of Epclusa include headache and fatigue. However, it can also interact with certain medications, which may reduce the amount of Epclusa in the blood, weakening its efficacy. One of the biggest risks is for people taking the heart rhythm medication amiodarone, because sofosbuvir, a key ingredient in Epclusa, can cause life-threatening heart problems. Before starting treatment, make sure your doctor is fully aware of all meds you’re taking.

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A Third Option If You Need It

About 2% of people don’t respond to the first line treatments, and in this case, doctors will likely prescribe a more potent combination of antivirals, such as Vosevi. This powerful pill is a mix of three antiviral medications: sofosbuvir, velpatasvir, and voxilaprevir, and it has a slightly higher burden of side effects, including headache, fatigue, diarrhea, and nausea, Dr. Maheshwari says. Treatment is typically one pill taken once a day with food for 12 weeks; your doctor may keep you on it longer to clear the infection.

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Your Recovery ETA

The beauty of today’s treatments is that in just about three months, the majority of patients will be free of hep C. However, Dr. Reau says, “We don't label someone cured until they've remained virus-free for about three months after we stopped therapy.” Twelve weeks after treatment has ended, your doctor will likely order a blood test to measure how much viral genetic material (viral RNA) is in your blood; if none is visible, then you’re deemed cured.

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Avoid Another Infection

Keep in mind that while hep C drugs can cure your body of the infection, they won’t make you immune or reduce your risk for the disease. Remember: they are not vaccines. In fact, there is no vaccine for hep C yet. If you engage in the same behaviors that got you hep C in the first place (such as sharing a razor or toothbrush with someone who’s infected or getting a tattoo from an unsterilized needle), it will come back. So play it safe.

Jennifer Tzeses
Meet Our Writer
Jennifer Tzeses

Jennifer Tzeses is a writer and content strategist specializing in health, beauty, psychology and lifestyle. She's written for The Wall Street Journal, Mind Body Green, CNN, Architectural Digest, Barron's, Cosmopolitan, Harper's Bazaar, Psycom, Elle, Marie Claire, and more. Follow her on Instagram @jtzeses.