Hepatitis C is a viral infection that affects the liver. It causes liver inflammation and can sometimes lead to severe liver damage. The hepatitis C virus is spread through contaminated blood and living with hepatitis C for a long time is only going to aggravate the damage to your liver. Early diagnosis and treatment of hepatitis C can help protect the liver. There are two types of hepatitis C, based on how long you have been infected by the virus. Acute hepatitis C and chronic hepatitis C. Treatment for hepatitis C depends on which type of hepatitis you have, and understanding the treatment options available to you will help you make informed decisions about your health.
Read on to learn more about acute versus chronic hepatitis and your treatment options.
Types of Hepatitis C
Hepatitis C is a liver infection that is caused by the hepatitis C virus. As the virus causes very few symptoms, many people remain unaware of even having being infected. Living with hepatitis C for a long time is going to increase the damage to your liver. This is why an early diagnosis and treatment helps protect the liver from severe damage and also preserves your quality of life.
There are many forms of the hepatitis C virus, and disease is typically divided into two types by doctors: acute hepatitis C and chronic hepatitis C.(1)
Acute hepatitis C is the early stage of the disease when you have only been infected for less than six months. Chronic hepatitis C is long term hepatitis. This means that the virus infected you at least six months. Nearly 85 percent of all people who have hepatitis C will go on to develop the chronic form of the infection.(2)
The treatment plan that your doctor designs for you will depend on the type of hepatitis C you have.
Acute Vs Chronic Hepatitis C & Your Treatment Options
Treating Acute Hepatitis C
If you are suffering from acute hepatitis C, then you do not need immediate treatment. In nearly 15 to 20 percent of cases of this disease, the infection clears up on its own without any treatment.(3)
You will still need close monitoring, though. Your doctor is going to administer an HCV (hepatitis C virus) RNA blood test in every four to eight weeks for at least six months. This blood test will indicate how much of the hepatitis C virus still remains in your bloodstream.(4)
During this time period, it is essential to keep in mind that you will still be capable of transmitting the virus to others through blood to blood contact and this is why you must avoid sharing or reusing needles. This also includes getting a tattoo or a piercing in an unregulated place, or even injecting drugs. You also need to ensure that you use a condom during sexual intercourse or any other type of barrier birth control method should be used so that you avoid transmission of the virus to your partner.
If within six months the virus clears up on its own, then you will not need any type of treatment. However, it is still essential that you take the necessary precautions to avoid getting infected by the virus once again in the future.(5)
Treating Chronic Hepatitis C
If you get a positive HCV RNA blood test after waiting for six months, then this means that you have chronic hepatitis C infection. You will need to begin treatment so as to prevent any damage to your liver by the virus.(6)
The primary treatment for chronic hepatitis C makes use of antiviral drugs to destroy the hepatitis C virus from your bloodstream. There are also many new types of antiviral drugs that are known to cure more than 90 percent of all people having chronic hepatitis C.(7)
Your doctor will decide to prescribe an antiviral medication or a combination of medicines depending on the level of liver damage you have, what treatments you have had in the past, and what genotype of hepatitis C you have. There are six genotypes of hepatitis C (ranging from genotype 1 to genotype 6) in total, and each genotype responds only to specific medications.(8)
The antiviral drugs that are approved by the US Food and Drug Administration (FDA) for the treatment of chronic hepatitis C along with the specific genotype of the infection they treat are as follows:
- Genotype 1: simeprevir (brand name: Olysio)
- Genotype 4: ritonavir/paritaprevir/ombitasvir (brand name: Technivie)
- Genotypes 1 and 3: daclatasvir/sofosbuvir (brand name: Daklinza)
- Genotypes 1 and 4: elbasvir/grazoprevir (brand name: Zepatier)
- Genotypes 1, 2, 5, 6: pibrentasvir/glecaprevir (brand name: Mavyret)
- Genotypes 1, 4, 5, 6: sofosbuvir/ledipasvir (brand name: Harvoni)
- Genotypes 1a and 1b: dasabuvir/ritonavir/paritaprevir/ombitasvir (brand name: Viekira Pak)
- All Genotypes: velpatasvir/sofosbuvir (brand name: Epclusa)
- All Genotypes: sofosbuvir (brand name: Sovaldi)
- All Genotypes: velpatasvir/sofosbuvir/voxilaprevir (brand name: Vosevi)
The antiviral drugs that are known to be the standard treatment for chronic hepatitis C include:
- Peginterferon alfa-2a (brand name: Pegasys)
- Peginterferon alfa-2b (brand name: Pegintron)
- Ribavarin (brand name: Copegus, Ribasphere, Rebetol)
However, these drugs take a long time to work and do not always cure the hepatitis infection. They also cause several side effects such as chills, fever, sore throat, and appetite loss.
Ribavarin and peginterferon alfa are being used less and less often as the new antiviral drugs are more effective and also cause lesser side effects. However, when used in combination with peginterferon alfa, ribavirin, and sofosbuvir are still used as the standard treatment for people who have hepatitis C genotypes 1 and 4.(9) (10)
While under treatment for chronic hepatitis C, you will need to take the medications for 8 to 12 weeks and during the treatment period, you will be given regular blood tests that will measure the amount of hepatitis C virus still remaining in your bloodstream.
The goal of chronic hepatitis C treatment is to ultimately finish off any trace of the virus from your bloodstream at least within 12 weeks after you stop the treatment. This is known as a sustained virologic response (SVR).(11) Once there is no trace of the virus in the bloodstream, then it means that the treatment was successful.
If the first treatment fails to work, your doctor will move towards prescribing a different medication that may provide better results.
Treating Chronic Hepatitis C with Liver Transplant
Liver transplant is another treatment that is used only in severe cases of liver damage due to the hepatitis virus. Hepatitis C causes damage to the liver and also leads to scarring. If you have been living with hepatitis C for many years, your liver could well be damaged to the point where it is no longer functioning. At this point, you might not have any other option left except for a liver transplant.
A liver transplant removes the old liver and replaces it with a new and healthy liver. Usually, the new liver comes from a donor who has died, but in some cases, it is also possible to get a liver from a living donor.
Getting a new liver will help you feel better, but it is not going to cure your hepatitis C. In order to continue to work towards treating the virus and undergoing treatment to achieve SVR, you will still need to keep on taking the antiviral drug that is corresponding to the disease genotype that you have.
Today there are many new antiviral drugs and treatments to help cure people who have hepatitis C. If you already have hepatitis C or if you are at a higher risk of the infection, then you should see your doctor. They will test you to determine if you are infected by the virus and then determine which type of hepatitis C you have – either acute or chronic hepatitis C. If you require treatment for hepatitis C, then your doctor will prepare a treatment plan for managing and curing your hepatitis C until there is no trace of the virus in the bloodstream.
- Araujo, A.C., Astrakhantseva, I.V., Fields, H.A. and Kamili, S., 2011. Distinguishing acute from chronic hepatitis C virus (HCV) infection based on antibody reactivities to specific HCV structural and nonstructural proteins. Journal of clinical microbiology, 49(1), pp.54-57.
- Cdc.gov. (2019). Hepatitis C Questions and Answers for the Public | CDC. [online] Available at: https://www.cdc.gov/hepatitis/hcv/cfaq.htm#B2 [Accessed 20 Aug. 2019].
Maheshwari, A., Ray, S. and Thuluvath, P.J., 2008. Acute hepatitis C. The Lancet, 372(9635), pp.321-332.
- Hepatitis.va.gov. (2019). Hepatitis C RNA Qualitative Testing: Test of Hepatitis C – Viral Hepatitis and Liver Disease. [online] Available at: https://www.hepatitis.va.gov/patient/hcv/diagnosis/labtests-RNA-quantitative-testing.asp [Accessed 20 Aug. 2019].
- Orland, J.R., Wright, T.L. and Cooper, S., 2001. Acute hepatitis C. Hepatology, 33(2), pp.321-327.
- Hepatitis C Trust. (2019). Chronic phase of hepatitis C. [online] Available at: http://www.hepctrust.org.uk/information/impact-hepatitis-c-liver/progression-hepatitis-c/chronic-phase-hepatitis-c [Accessed 20 Aug. 2019].
- Cdc.gov. (2019). Hepatitis C Questions and Answers for the Public | CDC. [online] Available at: https://www.cdc.gov/hepatitis/hcv/cfaq.htm#F1 [Accessed 20 Aug. 2019].
- Thong, V.D., Akkarathamrongsin, S., Poovorawan, K., Tangkijvanich, P. and Poovorawan, Y., 2014. Hepatitis C virus genotype 6: virology, epidemiology, genetic variation and clinical implication. World Journal of Gastroenterology: WJG, 20(11), p.2927.
- Fried, M.W., Shiffman, M.L., Reddy, K.R., Smith, C., Marinos, G., Gonçales Jr, F.L., Häussinger, D., Diago, M., Carosi, G., Dhumeaux, D. and Craxi, A., 2002. Peginterferon alfa-2a plus ribavirin for chronic hepatitis C virus infection. New England Journal of Medicine, 347(13), pp.975-982.
- McHutchison, J.G., Gordon, S.C., Schiff, E.R., Shiffman, M.L., Lee, W.M., Rustgi, V.K., Goodman, Z.D., Ling, M.H., Cort, S. and Albrecht, J.K., 1998. Interferon alfa-2b alone or in combination with ribavirin as initial treatment for chronic hepatitis C. New England Journal of Medicine, 339(21), pp.1485-1492.
- Kau, A., Vermehren, J. and Sarrazin, C., 2008. Treatment predictors of a sustained virologic response in hepatitis B and C. Journal of hepatology, 49(4), pp.634-651.
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