Hepatitis C treatment

Key points

There are highly effective treatments that cure more than 95% of people of hepatitis C.
Everyone who has hepatitis C should speak with a service provider about their treatment options.
Medications used to treat hepatitis C are called direct-acting antivirals or DAAs.
Treatment usually involves taking one to three pills once a day for eight or 12 weeks.
Side effects are usually mild and diminish or go away completely after a few weeks.
Various factors are considered when choosing a treatment regimen, such as the stage of liver damage and whether a person has been treated before with DAAs.

There are highly effective treatments that cure more than 95% of people of hepatitis C. Being cured of hepatitis C prevents any further liver injury by the hepatitis C virus and prevents progression to end-stage liver disease. For some people, the health of their liver may get better over time. Being cured can also improve a person’s quality of life; for example, some people have more energy or less body pain after treatment. Being cured also prevents the spread of hepatitis C to other people by eliminating the virus from the body.

Everyone who has hepatitis C should speak with a service provider about their treatment options.

Direct-acting antivirals (DAAs)

Medications used to treat hepatitis C are called direct-acting antivirals or DAAs. DAAs block the ability of the hepatitis C virus to replicate. Hepatitis C treatments are combinations of two or more types of DAAs. Different types of DAAs attack viral replication in different ways. In some cases, people will take DAAs with an additional medication called ribavirin. Ribavirin is an antiviral medication, but it is not a DAA.

Treatment generally means taking one to three pills once a day for eight or 12 weeks. For most people, the treatment causes few side effects. If side effects occur, they are usually mild and diminish or go away completely after a few weeks.

The “Common hepatitis C drugs available in Canada for adults” poster provides summary information on treatments that are commonly used in Canada for adults with chronic hepatitis C. The hepatitis C treatment fact sheets have more information on specific treatments.

Cure

Being cured of hepatitis C means that the hepatitis C virus is no longer in a person’s body. A cure is also called a sustained virological response (SVR). People who have a negative or undetectable hepatitis C virus RNA test result 12 weeks after the end of their hepatitis C treatment are considered to be cured (or to have achieved SVR).

People who are cured will always have hepatitis C antibodies in their blood, but they do not have any hepatitis C virus in their body. This means they will test positive for hepatitis C antibodies for the rest of their life.

There is no immunity against hepatitis C. If a person is cured of hepatitis C they can still get it again. This is called re-infection. To learn more about preventing hepatitis C, check out Prevention and harm reduction.

Treatment for acute and chronic hepatitis C infection

Some people are diagnosed with hepatitis C when the infection is in the acute phase (meaning they are diagnosed within the first six months after infection with the virus). About one in four people will clear the hepatitis C virus from their body on their own within six months. When a person is diagnosed with hepatitis C in the acute phase, a healthcare provider might recommend waiting to see if their body clears the virus on its own.

Current treatment guidelines in Canada focus on treatment for chronic hepatitis C infection (a hepatitis C infection that lasts for more than six months). The treatment guidelines recommend that treatment of acute hepatitis C infection be assessed on an individualized basis. In many cases, a person has to progress to chronic hepatitis C infection before they can receive public or private drug coverage for hepatitis C treatments.

Choosing a treatment regimen

There are a number of factors to consider when choosing a treatment regimen. Careful consideration of these factors will help a person decide with their healthcare provider which hepatitis C medications to take.

Factors to consider

Amount of liver injury

A healthcare provider will assess the level of liver injury a person has as part of their initial tests. For more information on this type of tests, see Liver health monitoring tests. The amount of liver injury a person has can affect decisions about which treatments are the best to take, how long treatment should last and when treatment should start. If a person’s liver is severely injured, they may need to get a liver transplant before being treated for hepatitis C.

Other health conditions or other medications

If a person has other health conditions, this might affect which treatment is used to cure their hepatitis C. Sometimes when people take medications or supplements for more than one condition at the same time, these medications can affect each other. This reaction is called a drug–drug interaction or, more commonly a drug interaction. Drug interactions can cause new side effects, they can increase the severity of existing side effects or they can change how effective a particular medication is. Drug interactions are possible not only with prescription medications but also with over-the-counter medications, supplements and street drugs.

A drug interaction can mean that certain medications should not be used together, or that certain medications can be used together but they may need to be taken at different times so they don’t interact with each other, or that certain medications can be used together but their doses may need to be changed.

A healthcare provider should know about all the medications (prescribed or not prescribed), supplements and street drugs a person is taking so they can choose hepatitis C treatment medications that will not interact with other products the person is taking or so they can develop a plan to manage drug interactions.

See Co-infections and co-morbidities with hepatitis C for more information on hepatitis C treatment for people who have hepatitis C in addition to HIV, hepatitis B or chronic kidney disease.

Genotype or strain of the hepatitis C virus

There are six major strains, or genotypes, of the hepatitis C virus. They are numbered 1 through 6. There can be subtypes, such as 1a and 1b. A healthcare provider can do a test to find out which genotype a person has. Some hepatitis C treatments can cure any genotype of the virus. These are called pangenotypic treatments. Other treatments work against specific genotypes of the virus.

Length of treatment

Most treatments are taken for 8 or 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.

Previous treatment experience

There are two categories of treatment experience:

people who have never been treated for hepatitis C (treatment naïve)
people who have tried treatment and were not cured (treatment experienced)

There are treatments that are highly effective at curing hepatitis C in people who are treatment experienced.

Reasons to delay treatment

Pregnancy

Hepatitis C treatment is generally not recommended during pregnancy. There is not a lot of information on the effects of DAAs during pregnancy. Research is being done on taking DAAs during pregnancy so this may change in the future.

Treatment that includes ribavirin can cause severe birth defects and must not be taken during pregnancy. When a couple wants to have a baby, both partners should avoid using ribavirin for at least six months before trying to get pregnant.

A healthcare provider can help determine a treatment plan and timeline for a person who has hepatitis C and wants to have a baby.

Children and adolescents

Hepatitis C treatment for children over the age of 3 is available in Canada. It is recommended that children who require treatment for hepatitis C be connected to a specialist with experience treating the pediatric population.

Resources for service providers