All Your Hepatitis C Treatment Questions, Answered
First comes a diagnosis... then what? When you’re living with hepatitis C, a liver infection caused by the hepatitis C virus (HCV), the answer is probably “a lot of questions.” The most important thing to know is that more than nine out of 10 of hep C cases are cured. The go-to treatments are oral medications called direct-acting antivirals (DAA) that target and destroy specific proteins in the virus, says Arjmand Mufti, M.D., assistant professor in the department of internal medicine at UT Southwestern Medical Center in Dallas, TX. As for your bazillion other questions, read on!
What Type of Doctor Treats Hepatitis C?
If routine bloodwork or a hepatitis C screening reveals you may have HCV, your primary care doc will refer you to a specialist who can assess you, order the proper meds, and guide you through treatment, says Geoffrey D. Block, M.D., medical director of liver transplant at the University of Arizona College of Medicine in Tucson. That’s likely to be an infectious disease doctor, gastroenterologist (a specialist focused on the digestive system), or hepatologist (a specialist in disorders of the liver, pancreas, and gallbladder).
Which Treatment Is Best for Me?
Hep C has multiple treatment options—your specialist will work with you to choose the best one (or combo) for your situation. Factors include whether you have cirrhosis (scarring of the liver), other medications you take, and if you’ve been treated for hepatitis C before, says Saira Aijaz Khaderi, M.D., an assistant professor of abdominal surgery at Baylor College of Medicine in Houston, TX. Your doc may also consider which strain or genotype you have, though many DAAs now work to fight them all.
Can I Still Take My Other Medications?
Some meds don’t mix well with hep C drugs. For example, statins for high cholesterol and medications for acid reflux disease are known to exacerbate hep C drug side effects, says Dr. Khaderi. Anticonvulsants, blood thinners, and certain heart meds may also have negative interactions. Talk with your doc about the meds you’re currently taking. You may need to stop or change your dosage during hep C treatment, or your physician might be able to use a different hep C therapy that doesn’t have adverse interactions.
How Long Does Treatment Last?
Most hepatitis C treatments are taken orally for eight to 12 weeks, says Dr. Mufti. In some cases, you may need to take medication for 16 weeks, but that’s rare. The most likely reasons for extended treatment are if you’ve been treated for hepatitis C unsuccessfully before and/or if there is already significant scarring on your liver. The good news: Even in cases that require longer treatment, the cure rate is still very high, says Dr. Mufti.
Will I Be Cured Once I Finish Treatment?
The overwhelming majority of people who are treated for hepatitis C are cured. “When hepatitis C treatment is successful, it doesn’t come back—it’s a cure,” Dr. Khaderi says. This will be confirmed via a blood test done 12 weeks after your last dose of treatment. If it comes back negative for the virus, you’re done! “The medications we have available work so well that doctors expect to cure pretty much every patient they treat, even if it requires a combination of treatments,” adds Dr. Mufti.
What Are the Side Effects of Treatment?
Back in the dark ages, protein-based injections called interferons and the antiviral drug ribavirin came with such debilitating side effects that many patients struggled to make it through a full course of treatment. But hep C drugs have drastically improved in recent years. While DAAs aren’t completely free of side effects, they’re tolerable, says Dr. Mufti. “Headache, fatigue, diarrhea, nausea, and insomnia are the most common things we see,” he says. You may also feel more run down than before treatment, but it shouldn’t interfere with daily life.
How Much Does Treatment Cost?
Perhaps not surprisingly, there isn’t one universal answer. According to a 2016 study published in Infectious Agents and Cancer, a 12-week course of hep C treatment in the United States could cost anywhere from $54,000 to $147,000. (We know, ouch!) But like most drugs, your out-of-pocket cost will depend on whether you’re insured and if your insurance company covers the treatment. Even without insurance, rebates and discounts from pharmaceutical companies mean patients rarely pay the sticker price for treatment, Dr. Mufti says.
How Can I Get Help Paying for Treatment?
For any specialized treatment, insurance companies often require proof that one drug (i.e. the more expensive med) is necessary over another, and it’s common for coverage approvals to be delayed. Your best strategy is to talk with your doctor about how they can help advocate for you to get a drug approved. Some pharmaceutical brands also offer special pricing for those who are uninsured or whose insurance refuses to cover a drug. The bottom line: Speak up and ask questions—it’s your life, after all.
What if Treatment Doesn’t Work?
That’s not likely—cure rates of hepatitis C are 95% or higher depending on the specific drug, says Dr. Mufti. But in some cases, people can build up resistances to past treatment or simply be harder to treat for unknown reasons. “Even in very challenging cases, we have other options to try,” he says. Whether that means trying a new treatment that acts slightly differently or combining two or three drugs for a multi-directional attack, there are a lot of approaches available—and eventually, one will work.
Will Treatment Make Me Immune?
Unfortunately, no. Even if you’re successfully cleared of HCV, that doesn’t make you immune in the future. You have the same chance of getting re-infected as anyone else. That’s why it’s really important to talk to your doctor about ways to lower your risk and seek out testing if you think you may have been re-exposed. Remember: It’s always better to get tested and catch hepatitis C early so that you can be treated before the virus has a chance to wreak havoc on your liver. Once the damage is done, it can’t be reversed.
What if I Need a Liver Transplant?
Hep C medications are often delayed for people with liver failure until after a liver transplant because patients are too sick to go through treatment. Another reason to wait on treatment: Staying hepatitis C-positive may improve your chances of getting a new liver. Liver specialists have witnessed an influx of hep C-positive, but otherwise healthy, livers in organ banks lately, like a result of the opioid epidemic. “There’s less competition for a hepatitis C-positive organ, so you can likely get a transplant faster,” says Dr. Khaderi.
If My Treatment Was Successful, Am I Done?
It depends. If you don’t have cirrhosis or other liver damage, once you’ve been cleared of HCV, your specialist probably won’t need to see you again. If you do have cirrhosis, regular check-ins (about every six months) are important. In some cases, cirrhosis can still progress, Dr. Khaderi says, and it increases your risk of liver cancer so your doctor will need to monitor you. On the flip side, because relapses happen so rarely—“less than one or two in 1,000 patients,” Dr. Mufti says—once the virus is gone and you’re complication-free, you’re good to go.
Effectiveness of DAAs: U.S. Food & Drug Administration. (2017). “Hepatitis C Treatments Give Patients More Options.” fda.gov/consumers/consumer-updates/hepatitis-c-treatments-give-patients-more-options
Medication Interactions: American Association for the Study of Liver Diseases and the Infectious Diseases Society of America. (2019). “Monitoring Patients Who Are Starting HCV Treatment, Are on Treatment, or Have Completed Therapy.” hcvguidelines.org/evaluate/monitoring#monitoring-table-ddi
Average Cost of Treatment: Infectious Agents and Cancer. (2016). “Price and affordability of direct-acting antiviral regimens for hepatitis C virus in the United States.” ncbi.nlm.nih.gov/pmc/articles/PMC4867525/#!po=29.1667
Cost Concerns of DAAs: University of Washington. (2018). “Cost and Access to Direct-Acting Antiviral Agents.” hepatitisc.uw.edu
Treatment Options and Outcomes: American Liver Foundation. “Treating Hepatitis C.” liverfoundation.org/for-patients/about-the-liver/diseases-of-the-liver/hepatitis-c/treating-hepatitis-c/#potential-outcomes-of-treatment