Hepatitis C (Hep C or HCV) is a viral infection that results in inflammation of the liver, primarily transmitted through blood contact with another infected individual (i.e., blood transfusions, tattoos, piercings, or sharing needles). Hep c is rarely a sexually transmitted disease. Although no vaccination exists to protect us from contracting the hepatitis C virus, both mild short term and chronic cases of hep C may be successfully treated with antiviral medications. The key is to diagnose hep C in the early stages, prior to any liver damage taking place. Leaving chronic hep C untreated significantly increases the risk of developing cirrhosis.
The Centers for Disease Control and Prevention (CDC) has identified six different HCV types (of genotypes) of the hepatitis C virus:
- HCV genotype 1 exists globally, but is considered the most prevalent genotype in America, and makes up roughly 75% of all hep c cases in the U.S.
- HCV genotype 2 is found around the world, but makes up a minor portion of U.S. HCV cases.
- HCV genotype 3 is found worldwide, but can also account for less than 15% of U.S. hep C diagnosis.
- HCV genotype 4 primarily exists in central Africa, the Middle East, and Egypt.
- HCV genotype 5 exists primarily in South Africa
- HCV genotype 6 is found almost exclusively in Southeast Asia.
The HCV genotype can be discovered via blood testing, and will determine the patient’s course of treatment. However, several other factors impact the chosen treatment, including:
- Age
- Ongoing alcohol abuse
- Existing liver damage
- Adverse response to prior treatment
- Existing conditions that affect immune strength (i.e., organ transplant, HIV)
- HCV virus levels in the blood
- IL28B genes predictors (can affect PEG/ribavirin treatment response)
The following hep C treatment options give patients and health care providers options for effective treatment options that vary in duration and side effects:
1. Ribavirin (RBV)
This oral treatment aims to eradicate the hep C virus from the patient’s body. Ribavirin is typically combined with interferon or prescribed in combination with one of these recent FDA-approved drugs:
- Victrelis (boceprevir) or Incivek (telaprevir) are known as direct-acting antivirals (or DAAs) that block the hep C virus from reproducing in patients with HCV genotype 1.
- Sovaldi (sofosbuvir) prescribed as a once-daily oral treatment for patients with HCV genotypes 1, 2, 3 and 4, who also have HIV. Sovaldi is often used as a pill-only treatment for HCV genotype 2 and 3 patients while HCV genotype 1 and 4 patients often use it in combination with 12-weeks of peginterferon/ribavirin.
- Olysio (simeprevir) this oral hep C treatment is typically prescribed for HCV genotype 1 patients in combination with Sovaldi (sofosbuvir).
- Harvoni (ledipasvir/sofosbuvir) is a one pill per day oral treatment that combines two direct-acting antiviral drugs (DAAs), Sovaldi (sofosbuvir) and ledipasvir.
2. Pegylated interferon (Peg-IFN)
Until all-oral treatments for were FDA approved, Pegylated interferon (or Peg-IFN) was administered via injection in a long-acting antiviral medication that fought off various infections. Often used in combination with ribavirin, Peg-IFN has some pretty nasty side effects (i.e., including fatigue, nausea, loss of appetite, headache, muscle aches, fever, and irritation and bruising at the injection site) that made patients with low immunity unable to tolerate treatment.
