Current Treatments for Hepatitis C

Newer Antiviral Drugs Boast More Than 90% Cure Rates

Harvoni (ledipasvir + sofosbuvir). Courtesy Gilead Sciences

When you consider that the hepatitis C virus (HCV) was only first identified in 1989 and that it was largely considered incurable until the latter part of the 20th century, the advances in therapy have been nothing short of astonishing.

It was only in December 2013, in fact, that the game changed completely with the release of Sovaldi, a direct acting antiviral (DAA) that offered fewer side effects, shorter treatment duration, and a cure rate of as high as 99 percent in some populations.

So effective have the drugs been that treatment today has now been extended to both people with acute and chronic HCV infection, as well as those with advanced liver disease.

By better understanding the goals of hepatitis C therapy—including how the drugs are selected and used—you can make a more informed choice as to the course of action most appropriate for you.

Goals of Hepatitis C Therapy

As a rule of thumb, earlier treatment of hepatitis C relates to better outcomes, not only in terms of clearing the virus but in preventing any long-term damage to the liver and associated organs.

The goals of hepatitis C therapy, therefore, are two-fold:

During the course of therapy, lab tests are regularly performed to assess the level of virus in a person’s blood.

Also known as the HCV viral load, these tests can help doctors predict the likely outcome (or prognosis) of treatment.

An undetectable viral load is considered the optimal response, with 24 weeks of SVR effectively considered a "cure."

Pathologists typically define treatment response as follows:

RVRRapid viral responseAn undetectable viral load after four weeks of treatmentGenerally more likely to achieve SVR
eRVRExtended rapid viral responseAn undetectable viral load at week 12, following the initial RVRGenerally more likely to achieve SVR
EVREarly viral responseAn undetectable viral load or a 99 percent reduction in viral load by week 12Failure to achieve EVR by week 12 correlates to a less than 4 percent chance of achieving SVR
ETREnd of treatment responseAn undetectable viral load achieved by the end of week 12Not helpful in predicting treatment outcomes
Partial responder Able to achieve EVR but unable to sustain an undetectable viral load 24 weeks after therapy completionConsidered treatment failure
Null responder Unable to achieve EVR by week 12Treatment is typically terminated if EVR is not achieved by week 12
SVRSustained viral responseAble to sustain undetectable viral load for 12 weeks (SVR-12) and 24 weeks (SVR-24) following completion of therapySVR-24 can be considered a "cure," while patients with SVR-12 are usually able to achieve SVR-24

Today, more than 99 percent of those who achieve SVR-24 will remain virus-free for at least five years. Of those, nearly half will experience a resolution of cirrhosis within a year, while most will see significant reversals in liver scarring (fibrosis).

When to Start Treatment

Evidence strongly supports treatment for all persons with hepatitis C, aged 18 years or older. The only exceptions are those with life expectancy of less than 12 months due to non-liver-related causes.

However, as treatment may not be available to all patients (due either to cost or insurance limitations), priority must be given to those with the most urgent need. These include individuals with advanced fibrosis, compensated cirrhosis, liver transplants, or severe non-liver-related complications of HCV infection.

Consideration is also typically given to persons at high risk of hepatitis C-related complications, including those with moderate fibrosis, HIV co-infection, hepatitis B co-infection, type 2 diabetes, and other co-occurring liver diseases.

It is worth noting, however, that persons with early access to treatment can benefit enormously, not only by minimizing liver damage but by prolonging the duration of the SVR. Research has shown that individuals treated in the earliest stages of fibrosis (as measured by the METAVIR score) have a 92 percent chance of remaining virus-free for at least 15 years. 

Before embarking on any course of treatment, it is important that you assess both your willingness and ability to adhere to therapy. If you foresee any problems—including work or personal issues, alcohol/drug use, or fears about the medications themselves—be sure to discuss these with your doctor before starting treatment. Support services may be available to better help overcome these issues.

Approved Hepatitis C Medications

Hepatitis C therapy consists of one or more drug agents, which are typically prescribed in a 12-week course. In some cases, the duration of therapy may extend to 24 or even 48 weeks, most often in persons with cirrhosis or those have previously failed therapy.

In addition to the prescribed DAA, two other drugs may be used as part of a combination therapy:

  • peginterferon, a man-made version of interferon, which acts by signalling the body to the presence of disease-causing agents like HCV
  • ribavirin, an oral drug known to interfere with viral replication

Peginterferon, delivered by injection, is typically prescribed with ribavirin. Ribavirin, by contrast, is often used on its own in combination with a primary DAA drug. 

Drug selection is based on the genetic type (genotype) of virus the person is infected with, as well as an assessment of the individual's health status and previous treatment history.

There are currently eight DAA drugs approved by the U.S. Food and Drug Administration:

DrugApproved forPrescribedDosingDuration
Epclusa (sofosbuvir + valpatasvir)genotypes 1, 2, 3, 4, 5, and 6 with or without cirrhosiswith our without ribavirin, depending on genotype and treatment historyone tablet daily with without food12-16 weeks
Zepatier (elbasvir + grazoprevir)genotypes 1 and 4 with or without cirrhosiswith our without ribavirin, depending on genotype and treatment historyone tablet daily with without food12-16 weeks
Daklinza (daclatasvir)genotypes 3 without cirrhosiswith Sovaldione tablet daily with food12 weeks
Technivie (ombitasvir + paritaprevir + ritonavir)genotypes 4 without cirrhosiswith ribavirintwo tablets daily with food12 weeks
Viekira Pak (ombitasvir + paritaprevir + ritonavir, co-packaged with dasabuvir)genotypes 1 with or without cirrhosiswith or without ribavirin, as indicatedtwo tablets of ombitasavir + paritaprevir + ritonavir taken once daily with food, plus one tablet of dasavuvir taken twice daily with food12-24 weeks
Harvoni (sofosbuvir + ledispasvir)genotype 1 with or without cirrhosison its ownone tablet daily with or without food12-24 weeks
Sovaldi (sofosbuvir)genotypes 1, 2, 3, and 4 with or without cirrhosisin combination with ribavirin, Olysio, peginterferon + ribavirin, or Olysio + ribavirin, as indicatedone tablet daily with or without food12-24 weeks
Olysio (simeprevir)genotype 1 with or without cirrhosisin combination with Sovaldi or peginterferon + ribavirin, as indicatedone capsule daily with food24-48 weeks

Specialist consultation should be sought for individuals being retreated for hepatitis C after a previous treatment failure. Retreatment decisions should be based on an assessment of the types and combination of drugs previously used, as well as an evaluation of the person's liver.

In some cases, genetic resistance testing, which can monitor the development of HCV drug resistance, may be helpful in drug selection, particularly in persons with genotype 1 infection who have previously been exposed to DAAs. 


American Association for the Study of Liver Diseases (AASLD) and the Infectious Diseases Society of America (IDSA). "HCV Guidance: Recommendations for Testing, Managing, and Treating Hepatitis C." Updated July 6, 2016.

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