Hepatitis C: An In-Depth Guide

Choosing a drug combination for chronic hepatitis C

There are an increasing number of drug combinations approved in Canada to treat chronic hepatitis C (Hep C). With more options, there are more factors to consider when choosing a combination. Careful consideration of these factors will help a person make a decision with their doctor about which Hep C medications to take.

The Hep C drug factsheets have more information on each factor for specific drugs.

Factors to consider:

Genotype or strain of the Hep C virus

There are six different strains, or genotypes, of the Hep C virus. A doctor can do a test to find out which genotype a person has.

When a medication is approved for use, it is approved for the treatment of specific genotypes of the virus. Some medications only work against certain genotypes or work better against certain genotypes. Some newer medications are effective against all genotypes of the virus.

The section Treatment combinations has a list of which medications are approved in Canada by genotype.

Cure rates or sustained virological response (SVR) rate

Hep C medications can cure people from Hep C. A cure is also called a sustained virological response (SVR). 

Different drug combinations have different cure rates. The cure rates are determined from clinical trials that tested the medications.

Many of the currently available medications cured 95% or more of the people who took them in clinical trials.

More information about the cure rates for different combinations is available in the drug fact sheets. To see the drug fact sheets, check out Treatment Combinations.

Previous treatment experience

There are two categories of treatment experience:

  1. People who have never been treated for Hep C (treatment naïve).
  2. People who have tried treatment and were not cured (treatment experienced).

The category a person is in may affect their response to their next treatment combination. Some drug combinations are more effective for people with particular treatment experiences.

In general, people who have never been treated for hepatitis C are more likely to be cured from treatment. People who have tried treatment but were not cured may have a virus that is resistant to treatment, making it harder to be cured. However, there are effective new treatments for this group.

Length of treatment

In general, a treatment combination has to be taken for a fixed amount of time. Most treatments are taken for 12 weeks and a few are taken for as short as eight weeks or as long as six months.

Stage of liver damage

A doctor will assess the level of liver damage a person has as part of their initial tests. For more information on the type of tests, see Monitoring tests. The amount of liver damage a person has can impact decisions about which treatments are the best to take and when to start treatment.

In general, medications are more likely to cure people who have minimal liver damage compared to people who have more liver damage. This can mean that starting treatment earlier can lead to better outcomes. However, many new treatments also work well for people with moderate or advanced liver injury.

If a person’s liver is severely damaged, they may need to get a liver transplant prior to being treated for hepatitis C.

Other health conditions or other medications

If a person has other health conditions this might affect how likely they are to be cured of Hep C using a particular treatment combination. Or, a particular Hep C medication may not have been tested in people with specific health conditions, for example, people co-infected with Hep B and C.

It is important for a the doctor to know about all of the health issues a person has and any medications they are taking before starting treatment so they can determine if there is a potential for drug interactions between Hep C medications and other medications.

HIV co-infection

Many currently available Hep C treatments and experimental Hep C treatments have been tested in people who are co-infected with HIV and Hep C.

In clinical trials, when treated with drug combinations that included peg-interferon, people who co-infected with HIV and Hep C had lower cure rates than people who only had Hep C (mono-infected).

In clinical trials for the new interferon-free treatments, people co-infected with HIV and Hep C tend to be cured as often as people who only have Hep C.

New Hep C treatments may not be tested as quickly on people with HIV because they are usually tested in people who only have Hep C before they are tested in people co-infected with HIV. People co-infected with HIV may not be able to access new medications as quickly as people who are mono-infected.

Cost and coverage of medications

Hep C medications can be expensive. People often get the cost of their medications covered through different programs.

Some people have their Hep C medications covered by private health insurance.

Some Hep C medications are covered by provincial or territorial drug formularies. There may be conditions for accessing these programs and these conditions may change over time.

Speak to a nurse or doctor to find out more information about accessing programs that cover the cost of Hep C medications. There is also more information about these programs in Treatment coverage in your region.

Revised 2017.