When you’re living with hepatitis C, deciding if and when to pursue treatment is one of the biggest health care decisions you’ll ever have to make. Many medical factors must be considered alongside your personal goals and preferences. Whether you’ve just been diagnosed, have declined treatment in the past or have gone through previous therapy that was unsuccessful, the recent development of more effective hepatitis C drugs may warrant a discussion with your doctor. These newer regimens provide a cure for at least 80 percent of people with hepatitis C, according to an April 2015 report from the European Association for the Study of the Liver.
Options, Benefits and Risks
The purpose of hepatitis C treatment is not simply to rid you of the virus, but to improve your short- and long-term health. Potential benefits of clearing hepatitis C include:
- reduced risk for liver failure and liver cancer
- healing of hepatitis C-related liver damage
- fewer symptoms from immune system conditions caused by hepatitis C
- improved physical, emotional and social health
If you have little scarring in your liver and are generally feeling well, your doctor may agree to defer treatment for a while, if that is your preference, though you’ll still need to see your doctor regularly so your liver and overall health can be monitored. If your doctor recommends treatment and you agree, deciding what medication regimen is best for you depends largely on the strain — or genotype — of the hepatitis C virus you have. Hepatitis C treatment regimens should be discussed with your doctor because they vary in terms of their probability of success and potential side effects.
The Different Drugs Used to Treat Hepatitis C
May 2011 marked the beginning of new era of hope for people living with hepatitis C when the U.S. Food and Drug Administration approved the first direct-acting antiviral drugs to fight the illness. Unlike older therapies like interferon, direct-acting antiviral drugs block specific steps in the hepatitis C virus life cycle. As newer and better antiviral medicines continue to be introduced, hepatitis C treatment is more effective, less time-consuming and easier to tolerate. With the recent direct-acting antiviral revolution in hepatitis C treatment, most people with the illness can be cured of the disease — something that was beyond imagination for people living with hepatitis C as recently as 2010.
Early Protease Inhibitors: The Revolution Begins
The hepatitis C virus, or HCV, infects liver cells and hijacks their internal machinery to produce more viruses and infect other liver cells. In the process of making new viruses, large proteins are produced that must be cut into smaller pieces to complete the HCV life cycle. Drugs called protease inhibitors block this protein slicing, foiling the virus-copying process needed to sustain the infection.
The first two HCV direct-acting antivirals — or DAAs — approved in 2011 were protease inhibitors. When these protease inhibitors were added to what was then standard treatment of peginterferon (Pegasys, PegIntron) and ribavirin (Copegus, Rebetol, Ribasphere), cure rates rose significantly higher. On the heels of this success, new and better DAAs were introduced that have further revolutionized and improved treatment for hepatitis C.
Newer Protease Inhibitors: Progress Continues
In November 2013, the new HCV protease inhibitor simeprevir (Olysio) won FDA approval. Simeprevir blocks the HCV life cycle more efficiently than earlier protease inhibitors, making it more effective for hepatitis C treatment. Simeprevir is used in combination with other antiviral medications. Another new HCV protease inhibitor called paritaprevir was awarded FDA approval in December 2014 as part of a four-drug combination pack for hepatitis C.
Both simeprevir and paritaprevir are components of first-choice, multidrug treatment regimens for many people with hepatitis C — including some people whose previous treatment failed to clear the infection, according to guidelines from the Infectious Diseases Society of America and the American Association for the Study of Liver Diseases (better known as the IDSA-AASLD) guidelines.
Other DAAs: New Ways of Fighting HCV
In addition to manufacturing new proteins, HCV has to copy its genetic material to produce new viruses that continue the infection. HCV polymerase inhibitors are another type of DAA that blocks this critical step in the HCV life cycle. Two HCV polymerase inhibitors are currently approved for use in the U.S., sofosbuvir (Sovaldi) and dasabuvir. Two other FDA-approved DAAs — ledipasvir and ombitasvir — block the function of an important HCV protein called NS5A, which is essential for the production of new viruses.
All of these newer DAAs are used in combination with other antiviral medicines and are first-choice recommended treatments for hepatitis C, according to the IDSA-AASLD guidelines. A combination tablet containing sofosbuvir and ledipasvir (Harvoni) was approved for use in the U.S. in October 2014. A four-drug combination pack that includes ombitasvir, paritaprevir, ritonavir and dasabuvir (Viekira Pak) was approved in December 2014.
Ribavirin and Peginterferon: Ongoing Roles
At the start of new millennium, peginterferon plus ribavirin was the cutting-edge treatment for hepatitis C. Peginterferon boosts the immune system’s response to HCV infection, but does not directly interfere with the viral life cycle. Ribavirin is an antiviral medicine, but it does not block specific steps in the HCV life cycle the way DAAs do. Since the introduction of the DAAs, dual therapy with peginterferon plus ribavirin alone is no longer recommended in the IDSA-AASLD guidelines. However, in some situations, ribavirin alone or dual therapy with peginterferon plus ribavirin may be recommended in addition to treatment with a DAA.
People living with hepatitis C have never had more reasons to consider treatment. Cure rates with the newer DAA combination therapies typically exceed 80 percent and are well above 90 percent in some situations, according to a 2015 report from the European Association for the Study of the Liver. Many factors must be carefully considered in making the decisions about whether to begin hepatitis C treatment and which treatment is best for you. Talk with your doctor about the possible health-related benefits and risks of hepatitis C treatment.
- Journal of Hepatology: EASL Recommendations on Treatment of Hepatitis C 2015
- HCVGuidelines.org: When and in Whom to Initiate HCV Therapy
- Gastroenterology Clinics of North America: Noninvasive Tools to Assess Hepatic Fibrosis: Ready for Prime Time?
- Hepatitis C Online: Making a Decision on When to Initiate Treatment
- World Journal of Hepatology: Hepatitis C Virus Syndrome: A Constellation of Organ- and Non-Organ Specific Autoimmune Disorders, B-Cell Non-Hodgkin’s Lymphoma, and Cancer
- World Journal of Gastroenterology: Hepatitis C Virus and Metabolic Disorder Interactions Towards Liver Damage and Atherosclerosis