Overview of Hepatitis C
The hepatitis C virus (HCV) is what causes hepatitis C. It is a blood borne virus, meaning it spreads by blood-to-blood contact and causes inflammation of the liver. Over a period of time, this inflammation of the liver can cause permanent damage to the liver.
Hepatitis C can be contracted only by coming into direct contact with the blood of an infected person. Some of the possible routes of hepatitis C infection include:
- Being born to a mother who is infected with HCV
- Sharing needles for injecting drugs
- Using unsterilized needles for body piercings, acupuncture, or tattoos
- Accidentally coming in contact with a needle stick or blood in a healthcare setup
- Sexual contact with a person who has been infected with HCV
The most common diagnostic test for screening hepatitis C is blood screening, and it is routinely used throughout the world since the 1990s. Due to regular testing being done in many developed countries, there have been very few cases of infection from contaminated blood transfusions or organ transplants.
Nevertheless, chronic hepatitis C is known to affect over 3 million people in the United States alone(1), and nearly 71 million across the world.(2) Hepatitis C is a serious disease that is known to cause many types of long term health problems, including liver failure, liver damage, or even death. However, there have been many new advances made in the treatment of hepatitis C that has increased the cure rates of the disease, and at the same time lowered the appearance of side effects and also shortened treatment times.
Treatment of Hepatitis C
Some people who have contracted HCV do not need to undergo any treatment. In such cases, the body’s immune system itself is able to clear out this acute hepatitis C infection. However, many people who contract HCV are unable to fight off the virus within the first six months from being infected by the virus. In such cases, medical intervention is required to cure the infection and also for preventing long-term complications.
Treatment options for hepatitis C include many different combinations of antiviral drugs. These medications need to be consumed for a couple of weeks, the maximum time period being up to 24 weeks. The goal of treatment with antivirals include:
- Prevent or slow down inflammation and damage to the liver
- Reduce or prevent the chances of developing liver cancer or cirrhosis
- Help rid the body of the hepatitis C virus – within 12 weeks after completing the treatment, if no virus is detected in the bloodstream, the treatment is considered to be successful
Traditional Treatments Used for Hepatitis C
Until the year 2010, the most common drugs that were used for treating hepatitis C infection were in the forms of the antiviral drug ribavirin and interferon. Interferon treatments were administered by injection, while ribavirin was administered to be taken orally as a pill.(3)
Interferon is a naturally occurring protein that your body manufactures for fighting off viruses and bacteria.(4) Ribavirin and interferon treatments were usually prescribed for a period of 24 to 48 weeks and were not proving to be too successful in treating the infection. In fact, only around 40 to 50 percent of patients actually witnessed their HCV infection clear up after being treated with ribavirin and interferon.(5)
Nevertheless, there were some HCV genotypes that showed better results with this treatment, and nearly 80 percent of patients witnessed effective results and saw their HCV infection clear up. But, for most HCV genotypes, patients ended up having no success and continued to live with hepatitis C.
Furthermore, when interferon is administered into the body through injection, it is known to cause some extremely unpleasant side effects, even making it intolerable for many patients. Some of the most common side effects of interferon therapy include:
- Persistent cough
- Shortness of breath
- Skin rash and other skin issues
- Flu-like symptoms – fever, headache, and muscle aches
- Mood changes
- Anxiety and depression
- Autoimmune disease
- Vision disorders
- Thyroid disorders or thyroid changes
Things started changing with the introduction of the first oral non-interferon drug. In 2013, the US Food and Drug Administration (FDA) approved sofosbuvir (brand name: Solvaldi), which is a direct-acting antiviral agent (DAA). DAAs are known to target the hepatitis C virus in each and every stage of its life cycle, increasing the chances of killing the virus. This is quite different from the manner in which injectable interferon was functioning – it worked by activating the body’s natural immune system and waited for the virus to be killed.
- Sofosbuvir is now used without interferon, and it is taken orally, has lesser side effects, and can cure the hepatitis C infection within just 12 weeks.
- Solvaldi became the first non-interferon combination therapy for patients who had the most commonly occurring genotype of hepatitis C (genotypes 1, 2, 3, and 4).
- However, Solvaldi is more expensive than the older drugs, but at the same time, it has proved to be highly effective for most patients with hepatitis C.
In fact, according to data from the US Centers for Disease Control and Prevention (CDC)(6), more than 90 percent of HCV patients can be cured with the use of sofosbuvir.
Advances in Hepatitis C Treatments
In the last five years, there have been many advances in the treatment options for hepatitis C. Many new treatment options were successfully tested and got approved by the US FDA. Here are some of the latest treatments that have been introduced in the last five years for treating hepatitis C:
- NS5B (Polymerase) Inhibitors: Sofosbuvir, dasabuvir
- NS5A Inhibitors: Elbasvir, daclatasvir, ombitasvir, ledipasvir, pibrentasvir, velpatasvir
- HCV Protease Inhibitors: Boceprevir, asunaprevir, grazoprevir, paritaprevir, glecaprevir, telaprevir, simeprevir, voxilaprevir
- Combination Therapies: Mavyret, Epclusa, Harvoni, Vlekira Pak, Technive, Vosevi, Zepatier
All these new medications and combination therapies are known to function by stopping the HCV from reproducing (replicating) inside the body. This is believed to be the reason behind the decline and elimination of the infected liver cells.
Many of these newly developed medications can provide more efficient and effective treatment and also have fewer side effects. They are further being hailed as they cure the disease must faster than the earlier traditional methods that were being used.
Option of Liver Transplant
At the end of the day, if nothing else seems to be working, then a liver transplant is considered to be the last resort for patients who are infected with HCV or who have other types of liver disease. A liver transplant might also be needed if due to hepatitis C, you have developed irreversible end-stage liver damage. In a liver transplant, the donor liver may either be a whole liver taken from a deceased organ donor, or it can just be a portion of the organ taken from a living donor.
Unfortunately for people who have hepatitis C, a liver transplant does not mean that the infection will get cured. Recurrence of HCV even after a transplant is inevitable, until unless your doctor puts you on antiviral drugs. Another possibility is that after the transplant, your body rejects the donor organ. In some cases, even further transplantation might be recommended.
If you suffer from chronic hepatitis C, you should discuss all the available treatment options with your doctors. With the many recent advances in hepatitis C therapies, it has become easy to find a therapy regime, or drug combination that works the fastest and is the best option for your condition.
- Cdc.gov. (2019). Hepatitis C Questions and Answers for the Public | CDC. [online] Available at: https://www.cdc.gov/hepatitis/hcv/cfaq.htm [Accessed 21 Aug. 2019].
- Who.int. (2019). Hepatitis C. [online] Available at: https://www.who.int/en/news-room/fact-sheets/detail/hepatitis-c [Accessed 21 Aug. 2019].
- Hepatitis C Trust. (2019). Ribavirin. [online] Available at: http://www.hepctrust.org.uk/information/treatment/current-treatments/ribavirin [Accessed 21 Aug. 2019].
- Rong, L. and Perelson, A.S., 2010. Treatment of hepatitis C virus infection with interferon and small molecule direct antivirals: viral kinetics and modeling. Critical Reviews™ in Immunology, 30(2).
- U.S. Food and Drug Administration. (2019). Hepatitis C Treatments Give Patients More Options. [online] Available at: https://www.fda.gov/consumers/consumer-updates/hepatitis-c-treatments-give-patients-more-options [Accessed 21 Aug. 2019].
- Cdc.gov. (2019). Hepatitis C Questions and Answers for Health Professionals | CDC. [online] Available at: https://www.cdc.gov/hepatitis/hcv/hcvfaq.htm [Accessed 21 Aug. 2019].
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- Difference Between Protease Inhibitors & Antiviral Drugs for Hepatitis C Treatment
- Is Autoimmune Hepatitis Considered a Disability?
- Acute Vs Chronic Hepatitis C & Your Treatment Options