How is hepatitis C treated?

Experts consider the hepatitis C to be acute if the infection started less than half a year ago. Acute infections clear up on their own and have no effects in about 20 to 40 out of 100 people. That is why it is sometimes possible to wait to see how it develops at first. This is mainly the case for people who

• have a good chance of recovering without treatment, and
• don't have an increased risk of passing the virus on to other people (such as when taking drugs).

If the amount of virus in the blood (viral load) does not decrease significantly within four weeks, it is very likely that the hepatitis C will become chronic. Treatment is then recommended.

Chronic hepatitis C only very rarely clears up on its own and often leads to liver damage and other medical problems. That is why experts recommend starting treatment as soon as possible.

The medications aren't approved for use by pregnant women or nursing mothers. There are not enough studies into how effective and safe they are for the pregnant woman and her baby.

That is why good contraception is very important during hepatitis C treatment. If a woman takes ribavirin, reliable contraception is necessary for up to nine months after finishing the treatment because the active ingredient stays in the body for a long time. Reliable contraception is recommended for up to six months after finishing treatment if her (male) partner is taking ribavirin. This is because traces of ribavirin can also be found in sperm and there is no proof that it wouldn't affect the fetus’s development.

It might be a good idea for women wishing to have children who have an increased risk of infection to be tested for hepatitis C. If treatment is necessary, it can then be finished before pregnancy.

Specialists for internal medicine and gastroenterology (diseases of the stomach and bowels) usually treat the disease. The specialist field for liver diseases is called hepatology. But specialists for infectious diseases and addiction, as well as experienced family doctors, can also treat hepatitis C. Treatment in a specialized clinic is recommended for advanced liver damage.

Various drug groups are used in antiviral medications. They all stop hepatitis C viruses from reproducing, but in different ways:

• Polymerase inhibitors: They block certain enzymes (polymerases) that are responsible for generating the virus's genetic information. The drug sofosbuvir is one example.
• Protease inhibitors: They block other enzymes (proteases) that make the virus reproduce. They include the active ingredients glecaprevir, grazoprevir, and voxilaprevir.
• NS5A inhibitors: They block the reproduction of genetic material as well, but also have other effects. They include the active ingredients pibrentasvir, elbasvir, ledipasvir, and velpatasvir.
• Ribavirin: It is not exactly clear how this substance works.

As a rule, medications are used that contain 2 or 3 active ingredients from different groups. Some people do not tolerate ribavirin as well as the other medications, which is why it is only rarely used.

The medication is usually taken for 8 or 12 weeks, and in rare cases for 16 or 24 weeks. It is taken once a day as a tablet or as a powder (for children). Treatment is usually outpatient. It is important that the medication is taken consistently for the entire recommended period for it to be as effective as possible.

Tests are done twelve weeks after finishing the treatment to check if the virus is still in the blood. If the virus is gone, no further testing is needed usually. People whose livers are already severely damaged by hepatitis C will have regular testing after treatment, though. Their risk of complications such as liver cancer is still increased.

Most medications are effective against all hepatitis C virus types. That is why lots of people can be treated with one of them. Only sometimes do certain factors influence the decision. They include

• how severely the liver is damaged,
• if they have any other diseases, such as kidney failure,
• which other medication the person is taking,
• what possible side effects the medications can have, and
• if the hepatitis C infection has been treated before.

Some medications target specific virus types. It is then important to identify the virus type before starting treatment. It is also important to identify the virus type in people with severe liver damage or severe kidney failure, or for whom a different medication was not effective. Doctors then do a blood test to check the virus’s genetic characteristics and select the right medication.

Most people are free of the hepatitis C virus after finishing treatment: The virus can no longer be detected in about 95 out of 100 people, and they are no longer contagious, either.

Fewer than 1 out of 100 treated people experience a relapse after initially successful treatment. Treatment can then be repeated.

The treatment also reduces the risk of complications. The medications also help people with liver damage. Liver damage can even get better following successful hepatitis C treatment. But because a damaged liver often can't completely recover, the risk of certain complications such as liver cancer is still high. That is why people with liver damage are advised to have two check-ups per year.

If a treatment is not effective, it's usually because the viruses are resistant to one or more of the active ingredients taken. Resistance can be identified with a blood test. The treatment can then be continued with a different combination of drugs.

The medications are usually well tolerated. Possible side effects are:

• Headaches
• Nausea
• Tiredness
• Skin reactions

About 8 out of 100 people experience mild side effects. Only very few stop treatment because of that. Which side effects occur how often depends on the medication. For instance, ribavirin causes certain side effects such as anemia more often than other drugs.

Severe side effects are rare. But doctors monitor treatment especially carefully if you have any of the following underlying medical conditions:

• Hepatitis B
• Severe kidney failure
• Liver dysfunction

Interactions with other medications are also possible. That is why it’s important to tell your doctor about any medications that you are already taking. That includes any over-the-counter products and natural remedies. People who take drugs should also tell their doctor which ones.

The medications are still effective even if the liver is already damaged. Treatment should be carried out in a specialist liver clinic if you have very advanced cirrhosis of the liver. They can also check whether a transplant might be an option. The medications are not quite as effective if you have advanced liver damage, and the risk of side effects is slightly higher.

Protease inhibitors are not an option for advanced liver disease because they are then thought to cause severe side effects more often.

Hepatitis C can also be treated effectively in children and teenagers. Some of the antiviral medications are authorized for children aged over three, but with lower doses than for adults. Children and teenagers usually tolerate the medications well, too. Severe side effects are rare.

Hepatitis C used to be treated with interferons. They also stop the virus from reproducing. But they are less effective than the antiviral medications and have significantly more side effects. That is why they are no longer recommended for treatment.

No other medicines are known to effectively treat hepatitis C. Natural remedies are sometimes offered but there is no proof that they help.

Hepatitis C can severely damage the liver, even causing life-threatening liver failure. Doctors can do blood tests and other examinations to assess how severe the disease is. A liver transplant might then be an option depending on the circumstances. The diseased liver is then removed and replaced with a donated liver or part of a liver. Liver transplant is also an option for early-stage hepatocellular carcinoma (liver cancer) that can't be removed surgically.

A healthy and balanced diet is generally a good idea, but a special diet isn't usually recommended for people with hepatitis C. If your liver is already severely damaged by cirrhosis, it can have an effect on your metabolism. The liver is responsible for absorbing and processing nutrients such as carbohydrates and proteins. If it can no longer do that properly, your body won't get enough energy from your food, which leads to deficiencies. Your doctor might then talk to you about changing your diet. It is important to get enough protein and calories. Eating something in the late evening to bridge the gap until your next meal is then recommended. Special dietary counseling can help to make sure you get enough nutrients despite impaired liver function.

Because alcohol damages the liver, it is a good idea to drastically reduce your intake or, even better, to stop drinking alcohol completely.