Chronic hepatitis C treatment combinations | CATIE - Canada's source for HIV and hepatitis C information

Hepatitis C: An In-Depth Guide

Chronic hepatitis C treatment combinations

Hepatitis C (Hep C) treatments are called direct-acting antivirals or DAAs. DAAs work by blocking the ability of the virus to replicate. Hep C treatments are combinations of two or more different types of DAAs. Different types of DAAs attack viral replication in different ways. Some Hep C treatments include a drug called ribavirin, which is taken with DAAs.

Treatment generally means taking pills for 8 to 12 weeks. For most people, the treatment causes few problems. If they cause side effects, they are usually mild.

The Hepatitis C Drugs Approved in Canada for Adults chart provides summary information on treatment combinations that are approved by Health Canada for people with Hep C. The Hep C drug factsheets have more information on specific drugs and treatment combinations.

There are a number of factors to consider when choosing a treatment combination. Careful consideration of these factors will help a person make a decision with their healthcare provider about which Hep C medications to take.

Factors to consider:

Genotype or strain of the Hep C virus

There are six major strains, or genotypes, of the Hep C virus. They are numbered 1 through 6. A healthcare provider 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.

Information in the Hepatitis C drugs approved in Canada for adults chart is organized by treatments that work for all genotypes and then treatments that work for specific genotypes.

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). The cure rates are determined from clinical trials that tested the medications. Currently recommended treatments have cure rates of 95% or more.

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.

Length of treatment

In general, a treatment combination has to be taken for a fixed amount of time. Most treatments are taken for 8 to 12 weeks. In some cases, it may be necessary to take treatment for more than 12 weeks. A healthcare provider will suggest the most appropriate length of treatment. 

Stage of liver damage

A healthcare provider will assess the level of liver injury 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.

If a person’s liver is severely injured, they may need to get a liver transplant prior to being treated for Hep 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 the healthcare provider 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 have been tested in people who are co-infected with HIV and Hep C. People co-infected with HIV and Hep C tend to be cured as often as people who only have Hep C.

Cost and coverage of medications

Paying for treatment is becoming easier as more programs are available to help pay for the medication, including publicly funded drug benefits programs, private health insurance and drug company programs.

There are also programs run by the federal government for specific groups such as Inuit and First Nations people, people in the military, people in prison and people who got Hep C from a blood transfusion received between 1986 and 1990.

A healthcare provider can help you figure out if you qualify for treatment and if you can get financial or other types of support from any of these programs.  There is also more information about these programs in Treatment coverage in your region.

Reasons to delay treatment:

Pregnancy

A pregnant person cannot start treatment for Hep C until after childbirth. If pregnancy is possible, birth control should be used during treatment and for six months after treatment is finished. A healthcare provider can help determine a treatment plan and timeline for a person who has Hep C and wants to have a baby.

Children and Adolescents

Current treatment guidelines recommend involving a specialist in caring for children with Hep C. Children are generally not treated until they are older. It is rare that treatment needs to be started earlier and can generally wait until after a child has completed their physical and mental development.

Revised 2018.

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