Treatment (NHS)

Hepatitis C can often be treated successfully by taking medicines for several weeks.

If the infection is diagnosed in the early stages, known as acute hepatitis, treatment may not need to begin straight away. Instead, you may have another blood test after a few months to see if your body fights off the virus.

If the infection continues for several months, known as chronic hepatitis, treatment will usually be recommended.

Your treatment plan

Treatment for hepatitis C involves:

  • making lifestyle changes to help prevent further damage to your liver and reduce the risk of spreading the infection
  • taking one or more medications to fight the virus You'll normally need to take medication for 8 to 48 weeks. The length of time will depend on the exact medicines you're taking and which version (strain) of the hepatitis C virus you have. Your doctor will advise you about this. There are 6 main strains of the virus. In the UK, the most common strains are known as genotype 1 and genotype 3. During treatment, you should have blood tests to check if your medication is working. Treatment may be stopped if the tests show it is having little effect.

Lifestyle measures

There are some things you can do to help limit any damage to your liver and prevent the infection spreading to others. These can include:

  • eating a healthy and balanced diet
  • exercising regularly
  • cutting out alcohol or limiting your intake
  • stopping smoking
  • keeping personal items, such as toothbrushes or razors, for your own use not sharing any needles or syringes with others

Hepatitis C medications

Until relatively recently, treatment for chronic hepatitis C usually involved taking:

  • pegylated interferon – a medication that encourages the immune system to attack the virus
  • ribavirin – an antiviral medication that stops the virus reproducing

These were frequently just taken together, but now there are new hepatitis C medications that have been shown to make treatment more effective.

In many cases, a combination of these newer medications may be taken without needing to take pegylated interferon and ribavirin as well.

Read more about all these medications below.

Pegylated interferon and ribavirin

Pegylated interferon is usually taken as a weekly injection. You can be trained to inject yourself at home. It usually needs to be taken for up to 48 weeks, depending on your circumstances.

Ribavirin is available as capsules, tablets or an oral solution. It's normally taken twice a day with food. It needs to be taken alongside pegylated interferon for up to 48 weeks.

For more information, see the National Institute for Health and Care Excellence (NICE) guidelines on peginterferon alfa and ribavirin for the treatment of chronic hepatitis C.

Newer medications

There are also a number of newer medicines now used to treat hepatitis C. Some of these are taken alongside pegylated interferon and ribavirin but, in most cases, they can be taken on their own or in combination with other new medicines. These medications include:

  • simeprevir
  • sofosbuvir
  • daclatasvir
  • a combination of ledipasvir and sofosbuvir
  • a combination of ombitasvir, paritaprevir and ritonavir, taken with or without dasabuvir
  • a combination of sofosbuvir and velpatasvir
  • a combination of sofosbuvir, velpatasvir and voxilaprevir
  • a combination of glecaprevir and pibrentasvir

These medications are taken as tablets once or twice a day for between 8 and 48 weeks, depending on the exact medicine you're taking, your hepatitis C genotype and the severity of your condition.

These medicines are generally used to treat people with either genotype 1 or genotype 4 hepatitis C, although sometimes they're also used to treat people with other genotypes.

Research into even more effective medications is ongoing.

How effective is treatment?

The effectiveness of treatment for hepatitis C can depend on the strain of the virus you have.

Genotype 1 used to be more challenging to treat and, until quite recently, less than half of people treated would be cured.

However, with the newer medications now available, the chances of a cure are much higher. Combinations of tablets now have a cure rate of more than 90%.

If the virus is successfully cleared with treatment, it's important to be aware that you're not immune to the infection. This means, for example, that you could become infected again if you continue to inject drugs after treatment.

If treatment doesn't work, it may be repeated, extended or tried using a different combination of medicines.

Side effects of treatment

Side effects of combination therapy involving interferon are quite common. The new tablet treatments have far fewer side effects and most people feel unaffected by them. If your treatment involves interferon, side effects can include:

  • flu-like symptoms, such as a headache, extreme tiredness (fatigue) and a high temperature (fever)
  • a reduced number of red blood cells (anaemia), which can make you feel tired and out of breath
  • a rash
  • depression
  • itchy skin
  • feeling and being sick
  • constipation or diarrhoea
  • problems sleeping (insomnia)
  • loss of appetite and weight loss

Hepatitis C medications can have unpredictable reactions when taken with other medicines or remedies. Always check with your specialist, GP or pharmacist before taking other types of medication.

Any side effects may improve with time as your body gets used to the medications. Tell your care team if any side effect is becoming particularly troublesome.

Coping with side effects can be challenging, but you should continue to take your medication as instructed. Missing doses may reduce the chances of you being cured.

Treatment during pregnancy

The medications used to treat hepatitis C, particularly ribavirin, can be harmful to unborn babies and aren't normally used during pregnancy.

If you're pregnant when diagnosed with the infection, treatment will usually be delayed until you have given birth.

Otherwise, you'll be advised to use contraception throughout your treatment and may need to have regular pregnancy tests.

If you're a man taking ribavirin, you shouldn't have sex with a pregnant women unless you use a condom.

If your partner isn't pregnant, you should ensure contraception is used during the course of your treatment. Your partner may need to have regular pregnancy tests.

Deciding against treatment

Some people with chronic hepatitis C decide against treatment. This may be because they:

  • don't have any symptoms
  • are willing to live with the risk of cirrhosis at a later date
  • don't feel the potential benefits of treatment outweigh the side effects some can cause

Your care team can give you advice about this, but the final decision about treatment will be yours.

If you decide not to have treatment but then change your mind, you can ask to be treated at any point.

via National Health Service UK