Is hepatitis C virus (HCV) really curable?
Yes. When hepatitis C treatment is working, the virus will become undetectable in the blood within four to 12 weeks and will remain that way throughout treatment.
People are considered cured of HCV when they have achieved a continuation of this undetectable status for 12 to 24 weeks after completing therapy. This is known as a sustained virologic response (SVR). The chances of HCV returning after 24 weeks of remaining clear of the virus are nearly zero.
What is the recommended treatment for HCV?
Whether this is your first time being treated for hepatitis C, or you have been treated before, a variety of new medications are available, including:
- Sovaldi (always prescribed with another HCV drug such as ribavirin or Olysio)
- Viekira Pak
- Olysio (always prescribed with another HCV drug, usually Sovaldi)
Harvoni is two drugs formulated into one daily pill, whereas Viekira Pak is a combination of pills. In some cases, these medications may be prescribed with ribavirin.
Peginterferon, an injectable medication with many side effects, is rarely used in the United States any longer. However, it may be prescribed in certain cases, such as for patients with the uncommon genotype 5.
Which HCV medication will my doctor prescribe for me?
Your doctor will prescribe medication and a treatment length based on your health history and laboratory tests. The prescribed treatment is based on:
- Your HCV genotype (the genetic structure of the virus)
- Your viral load (how much virus is in your blood)
- Your past treatment experience
- If you have cirrhosis
- If you are a liver transplant recipient or on the transplant waiting list
- Your ability to tolerate the prescribed treatment
- In some cases, HCV treatment may be limited by your health insurance plan or drug formulary.
What are the side effects of HCV treatment?
Although hepatitis C treatment has come a long way, all medications have side effects and risks. When they occur, the side effects are usually mild.
Here are some common side effects for frequently prescribed HCV meds:
Harvoni is fairly easy to tolerate because it is rarely used with ribavirin. The most common side effects are diarrhea, fatigue, headache, insomnia and nausea.
Copegus, Moderiba, Rebetol, Ribasphere (ribavirin)
When ribavirin is prescribed, it is always taken with one or more other HCV medications. Ribavirin has more side effects than the newer HCV drugs. The most common are anemia (low red blood cells), difficulty concentrating, fatigue, increased heart rate, insomnia, irritability, itchy skin, lightheadedness, loss of appetite, moodiness, nausea, rash, upset stomach and weakness. Ribavirin may cause fetal death or abnormalities, so if pregnancy is a possibility, read the strong warnings that accompany the prescription information.
Olysio is prescribed with one or more other HCV medications, particularly Sovaldi. In addition to nausea, Olysio frequently causes skin problems, such as itching, rash and a potentially serious reaction to the sun known as photosensitivity.
Pegasys and PegIntron (peginterferon or PEG)
Newer drugs have largely replaced PEG, but it is still used occasionally. With over 40 potential side effects, PEG is the HCV medication with the highest risk. Common side effects are: depression, dry mouth, fatigue, flu-like symptoms (chills, fever, joint and muscle aches), gastrointestinal disorders (abdominal pain, decreased appetite, diarrhea, nausea), hair loss, headache, injection site reaction, insomnia, neutropenia (low white cells), pain (back, joint, muscle), and thrombocytopenia (low platelets).
Sovaldi’s side effects are mild. However, since Sovaldi is always prescribed with other medications such as ribavirin or Olysio, the list of side effects expands to include any associated with those drugs. Without ribavirin or Olysio, fatigue, headache and nausea are the most common side effects of Sovaldi.
Viekira Pak (ombitasvir/paritaprevir/ritonavir, dasabuvir)
Viekira Pak may be prescribed with or without ribavirin. Without ribavirin, the most common side effects of Viekira Pak are insomnia, itching, nausea, photosensitivity and rashes. Viekira Pak may increase liver-related lab tests such as ALT and bilirubin.
Will insurance pay for HCV treatment?
Hepatitis C treatment is covered under most insurance plans, including Medicare and Medicaid. However, HCV drugs are costly, and treatment is often denied for various reasons. Patients who have mild liver disease are commonly denied treatment. Despite this, patients are often able to win approval after they have appealed the insurer’s denial of coverage.
Obtaining insurance approval is half the battle; the other half is being able to afford your drug co-pay. Even with insurance, the drug co-pays can be thousands of dollars. Fortunately, patient assistance programs are usually able to reduce these out-of-pocket costs to affordable amounts.
Where can I find help for paying for HCV treatment?
Whether navigating insurance red tape or getting help paying for HCV medications, patient advocacy and assistance programs have helped countless patients obtain affordable HCV treatment. There are many helpful organizations, such as:
- Help-4-Hep, 877.Help4Hep (877.435.7443), help4hep.org
- Patient Access Network Foundation, 866.316.PANF (866.316.7263), panfoundation.org
- Patient Advocate Foundation’s Hepatitis C CareLine, 800.532.5274, hepatitisc.pafcareline.org
What are the complications of HCV?
The main complications of HCV are cirrhosis (severe liver scarring), hepatocellular carcinoma (liver cancer) and death. People with hep C are at risk for medical problems that are outside of the liver. These are called extrahepatic manifestations, and they include certain skin and kidney diseases, lymphoma, and autoimmune conditions.
If cured, will HCV treatment reduce the risk of complications?
People who are cured of HCV before they have cirrhosis will usually have reversal of liver disease. Their risks for complications are much like those who never had hep C. Extrahepatic manifestations may resolve if they were caused by hep C. People whose HCV is cured after they already have cirrhosis may benefit from treatment, but they still need to be monitored for complications such as liver cancer.
Can I get hepatitis C again after I am cured?
Yes. Unlike most viruses, the hepatitis C antibody does not protect against reinfection. Avoiding blood contact is the best prevention against acquiring hepatitis C.