Table of Contents

Is there a cure?
Can Hepatitis C Be Cured in the near future?
Liver Transplantation

Is there a cure?

Unfortunately, there is no specific cure for this condition (1), but a combination of treatments and medicines can lead to hepatitis c being treated (2, 3). New drugs are making improvements daily and the goal of reaching the point where there is a hep c cure is slowly approaching.

Treatments get better and it is assumed that quite soon, people with this condition will be able to look forward to a future free of the disease.

The goal of every treatment is to fully get rid of the virus in the patient’s body. Patients are considered to be cured if they do not have the virus in the body for a minimum of 6 months after the end of treatment (4).

Summary: Researchers are getting closer to figuring out a cure for hepatitis C, but for now there continues to be improvement in treatments. The goal is to cure the disease by keeping the virus out of the system at least 6 months or more after treatment.

The Beginning of Successful Hepatitis C Treatment

The turning point in finding a cure for hepatitis c came when the patients started interferon treatment back in the 1990s (5, 6). This particular drug is known to boost the immune system which may result in fighting and completely destroying the hepatitis c virus.

What followed was the use of ribavirin, another effective drug in treating hepatitis c patients (7, 8). Furthermore, these two were combined in a single treatment in order to achieve better results. This combo made the cure rate jump from 5 to 50% by the 2000s (9, 10).

Some people still choose to avoid treatment since this combo results in serious side effects, such as muscle aches, sleeping problems, nausea, and anxiety (11, 12). And the duration of their consumption is not really a boost. One must take them for up to 48 weeks for the first results to show.

Later on, in 2011, the FDA also approved boceprevir and telaprevir, otherwise referred to as Victrelis and Incivek. They are making a copy of the virus and stop it in that manner (13, 14). The combo of the two and the interferon and ribavirin achieved the highest success rates at the time, reaching a percentage of 70% (15, 16). But this combination was still not as ideal as planned. The addition of two new drugs to the combo increased not only the cure rate but the side effects too.

The FDA approved four new drugs in 2013 and 2014: ledipasvir-sofosbuvir, ombitasvir-paritaprevir-dasabuvir-ritonavir, simeprevir, and sofosbuvir. These are also referred to as Harvoni, Viekira Pak, Olysio and Sovaldi. The four are considered the new standard in treating hepatitis c (17, 18). The treatment depends on the type of hepatitis C virus (genotype 1, 2,3,4,5 or 6).

Lepidasvir-sofosbuvir is used to treat the hepatitis virus of genotype 1 (19). It can be taken without ribavirin and interferon.

Summary: Interferon treatment paved the way for finding a hepatitis C cure. This drug boosts the immune system, which helps the body fight the virus. Adding ribavirin to the treatment plan has also shown good results. There are side effects to treatment including muscle aches, sleeping issues, nausea, and anxiety. The FDA has approved four new drugs since 2013: Harvoni, Viekira Pak, Olysio, and Sovaldi.

Treating Acute Hepatitis C

If the hepatitis c infection is diagnosed in an early stage, the treatment of this acute hepatitis c may be delayed (20). A doctor may decide to perform a blood test in a couple of months to see if the body has managed to fight off the virus by itself. If the virus remains after a few months, this is known as chronic hepatitis and a treatment must follow (21).

Treating Hepatitis C

Treatment of hepatitis c does not involve hep c cure, but it may involve:

Lifestyle changes

A few lifestyle changes may help prevent further liver damage and reduce the risk of infection spreading in the body.

Medications combo

A combination of a minimum of 2 medications can increase the chances of success in fighting the virus. The duration of medications treatment lasts from 12 to 48 weeks (22, 23). This depends on the medicine combo and the version of the hepatitis c.

Summary: Acute hepatitis C is diagnosed in the early stages. Treatment for this usually doesn’t start right away to see if the body can fight the virus by itself. If after a few months blood tests indicate the virus is still in the system, then treatment starts. Common treatment includes lifestyle changes and taking a minimum of 2 medications for 12-48 weeks depending on the version of hep C.

The 6 Genotypes of the Hepatitis C Virus

A blood test during treatment is a must (24). These are used to show if the medication is working. If the tests result in minor improvements in fighting the virus, another treatment may be proposed and this one can be stopped.

Lifestyle Changes

If a patient wants to cure hepatitis c, there are a couple of things that must be done to limit liver damage and prevent the infection from spreading. These may include:

Eating a healthy diet
Regular exercise
Cutting out alcohol completely or limiting the intake to a minimum
Quitting smoking
Not sharing needles, syringes, toothbrushes, and razors with anyone

Summary: Testing patient’s blood is essential to see if the medications are working. If tests show minor improvements, another treatment may be proposed. Eating a healthy diet, exercising regularly, reducing alcohol intake, smoking cessation, and not sharing anything that shares bodily fluids (needles, syringes, toothbrushes, razors) are important to maintain liver function and prevent spread of infection.

Can Hepatitis C Be Cured in the near future?

The medical advancements reach the time where one pill a day with minor side effects becomes possible. The new interferon-free drugs are expected to come and be approved really soon.

People with chronic HCV genotype 1 are prescribed the Viekira Pak multi-pill. The purpose of this treatment is to prohibit the hepatitis c growth (25). The recommended dosage is 2 ombitasvir, paritaprevir, ritonavir tablets in the morning and one dasabuvir in the morning and the evening. This treatment lasts for a minimum of 12 weeks and has proved to result with a 91- 100 cure rate (26).
Another combination is simeprevir with ribavirin and interferon (27). This combination is used to clear up the virus in 80% of patients that consume it.
Sofosbuvir can also be used without interferon (28). This applies to cases of patients suffering from some other types of hepatitis c. This treatment comes in the form of a pill that is taken once a day for a period of 12 weeks. The number of people being cured of it reaches 90%.
In 2014, the FDA also granted Olysio to be combined with Sovaldi without adding interferon or ribavirin. This is a treatment for genotype 1 hepatitis C patients (29).
In 2015, the FDA approved the combo of ombitasvir, paritaprevir, ritonavir and ribavirin for the treatment of hepatitis C of genotype 4 (30). This is the first option for patients who are infected with genotype 4 that does not include interferon. The cure rates are as high as 100%.
In the same year, the FDA approved daclatasvir as a treatment for genotype 3 infections. This is taken in combination with Sovaldi to increase the cure rates to 98%.
This year, elbasvir and grazoprevir were approved to be used in combination without ribavirin (31). This combo is used to treat genotype 4 and 1. It is a single tablet drug that joins Viekira Pak and Harvoni in genotype 1 treatments, with the exclusion of interferon. The cure rates reach 94%-97% for genotype 1 and 100% cure rates for genotype 4.
Pegylated interferon is taken in the form of a weekly injection (32) and the patient may be trained to inject himself at home. The treatment usually lasts for up to 48 weeks, depending on the circumstances.
Ribavirin is available in the form of tablets, capsules or oral solution (33). It is usually consumed twice daily in combination with food. It needs to be taken for 48 weeks.

Summary: With medication advancement, there will eventually be a treatment of one pill per day with little side effects. Treatment varies based on severity of hepatitis C and level of liver damage. There are also different genotype classifications of hepatitis C, which is also important in deciding which treatment method is best for fending off the virus.

The Effectiveness of Treatment

The effectiveness of hepatitis c treatment depends on the existing virus type. Genotype 1 was more challenging in the past when less than half of the people diagnosed with it could be cured. The new advances in treatment available increased the chances of hepatitis c cure greatly and the cure rate now reached higher than 90%. This is now higher than the chances of curing the other hepatitis c genotypes.

The treatment for genotype 3 most commonly involves standard treatments of pegylated interferon and ribavirin (34). The cure rate here reaches 70-80% of the patients taking this cure.

Having been treated by the virus does not provide you with a guarantee. Patients who are successfully treated from hepatitis c, are not immune to the infection and can be infected again (35).

If the treatment does not prove to be effective, it may either be repeated, extended or replaced with another that uses different medication combinations.

Summary: As time goes on, treatment for hepatitis C improves. Treatment depends on the existing virus type. Genotype 1 was previously more challenging to treat, but medical advancements have helped improve its outcome. Patients who are successfully treated are not immune to infection again. Treatment methods can be changed based on the patient’s response to the medication regime.

Side Effects of Treatment

Side effects of the therapies for hepatitis c are quite common, especially if the treatment involves interferon (36). The new advanced tablet treatments have fewer side effects, some even so minor that people feel almost unaffected by them.

In treatments that involve interferon, the following side effects are to be expected:

Headache
Flu symptoms such as fatigue and extreme tiredness
Fever
Reduced red blood cells number
Rashes
Depression
Itchy skin
Feeling of sickness
Diarrhea
Constipation
Sleeping problems and insomnia
Loss of appetite
Excessive weight loss

The medications for hepatitis c can also cause unpredictable and unexpected reactions if taken with other remedies or medicines. Therefore, one must always inform the doctor of the medications they are taking in order for the doctor to find the right treatment to use to cure hepatitis C.

Side effects are also known to improve with time. This happens as the body gets used to the medications. In cases where the side effects are too troublesome, some changes in treatment must be made.

If the side effects are not too difficult to handle, one must continue taking the medications as instructed. Sure, this can be challenging but it must be in order to be effective. Missing doses for the purpose of avoiding side effects may worsen the condition and reduce the chances of being cured.

Summary: Side effects depend on the patient and medication. Interferon causes headache, flu-like symptoms, fever, reduced blood cell counts, rashes, depression, diarrhea, constipation, insomnia, loss of appetite, and excessive weight loss. Doctors also must know what medications are already being taken to prevent medication interactions that can cause more symptoms.

Hepatitis C Treatment during Pregnancy

The medications that are usually used to cure hepatitis c can be harmful to the child a woman is carrying (37). Some drugs, such as ribavirin, are not used during pregnancy. In most cases of pregnant women being diagnosed with hepatitis c, the treatment is delayed until the giving of birth (38). Otherwise, the advice of the doctors is to use contraception throughout the treatment and perform regular pregnancy tests.

When it comes to men taking ribavirin, it is not recommended to have sex with a pregnant woman without a condom (39). Even in cases where the partner is not pregnant, contraception should always be used in the duration of the treatment. The partner may need to have regular pregnancy tests.

Summary: Treatment medications to cure hepatitis C can harm a pregnant woman’s child. Treatment is generally delayed until the woman gives birth. Men taking hep C medications also should not have sex with a woman without a condom to prevent spread of hepatitis C.

Decision against Treatment

As previously stated, some people who suffer from chronic hepatitis C decide not to go with treatment. The reasons may be the following:

They do not experience any symptoms of the disease
They are willing to live with the risk of cirrhosis
They do not find the treatment a good option because of the side effects it can cause

Every patient is advised on this, but the final decision is always left to them. If a patient decides on not having treatment, he can always change the decision and ask to be treated later.

Summary: Some patients with chronic hepatitis C decide against treatment. It may be because they don’t experience any symptoms of the disease, are willing to live with the risk of developing cirrhosis, or they do not want to experience the side effects from treatment.

Liver Transplantation

Serious chronic hepatitis c complications may lead to the sole option for a cure being liver transplantation (40). During this procedure, the surgeon replaces the damaged liver with a healthy one. Most of these healthy livers come from deceased donors, but people now have the chance to donate a portion of their livers too.

A liver transplant does not mean that the patient is cured of hepatitis C. The infection is very likely to return in most cases, requiring additional antiviral medication treatment (41). This is used to prevent damage to the healthy transplanted liver.

There are several studies nowadays that have demonstrated that a few antiviral regimens of direct-acting medication are actually effective at curing hepatitis C after a transplant (42, 43). Treatment with antiviral can also prove to be effective in some patients prior to the start of the liver transplantation surgery.

Summary: Severe chronic hepatitis C complications can cause the liver to shut down, which means the patient needs a liver transplant. Having a liver transplant does not mean the patient is cured of hepatitis C because the infection is very likely to return in most cases. Antiviral medication treatments are used after transplantation to prevent damage to the new liver.

Vaccines for Hepatitis C

Even though there is no cure for hepatitis c, there are certain vaccines that may be recommended as a treatment type. These vaccines are only available for hepatitis A and B viruses, but can also help cure the hepatitis C virus (44).

Hepatitis c is a commonly spread virus and there are many people suffering from this disease today. However, the medical advances move fast and new medications for treating this disease are approved every year. With the advanced medication of nowadays and the speed of progress in treatment, a cure for hepatitis c is probably soon to be found.

Summary: Vaccines can be recommended as a treatment type. The vaccines are only available for hepatitis A and B viruses, but may help cure hepatitis C virus. Medication advancement has helped decrease the spread of the hepatitis C virus and cure many who have been diagnosed with it. A cure for hepatitis C is probable in the near future.

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Is there a cure?

Treating Acute Hepatitis C

Treating Hepatitis C

Lifestyle Changes

Can Hepatitis C Be Cured in the near future?

Liver Transplantation

Donna Schwontkowski, MS, BS

Anh Tran, BHSc, MPH

Callie Miller, MHS, RDN, LD