Hepatitis C is a viral infection that causes inflammation and damage to the liver. This can lead to cirrhosis (permanent scarring of the liver), liver cancer, liver failure, and even death. Like other forms of viral hepatitis (ex.- hepatitis A and hepatitis B), hepatitis C infection can be acute (within 6 months of infection), or chronic (long-term). Less than half (15-30%) of people who get acute hepatitis C can fight the virus on their own and recover from the disease. Unfortunately, most people who have acute hepatitis C go on to develop chronic hepatitis C, which greatly increases the risk of liver damage and health complications. Hepatitis C is considered a bloodborne illness. It is transmitted through contact with the blood of someone with hepatitis C. This could happen through sexual contact, sharing needles, razors, toothbrushes, or nail clippers, contact with the open wound of someone who is infected, accidental sticks from an infected sharp object such as a needle or knife, and childbirth (passed from mother to child). Symptoms of hepatitis C infection include stomach pain, nausea and vomiting, fever, loss of appetite, joint pain, tiredness, weakness, jaundice (yellowing of the skin and whites of the eyes), dark urine, pale faeces, swelling/fluid in the belly and arms/legs, easy bleeding/bruising, and confusion. Not all infected people will have these symptoms. Often, patients with hepatitis C do not have any symptoms until they have advanced to chronic disease, even several years after getting the virus, and already have liver damage.
Treatment for hepatitis C has advanced significantly over the past several years. Several newer antiviral medications are available that treat hepatitis C and can cure the disease. However, as stated above, many cases of hepatitis C may not be diagnosed until there is already liver damage. So, treatment may involve treating cirrhosis, liver failure, or liver cancer that can occur because of hepatitis C infection. In severe cases, a liver transplant may be required, but antiviral treatment is still recommended for these patients to prevent hepatitis C infection of the new liver. Sometimes, if you have acute hepatitis C, your healthcare provider may want to wait and see if your body can clear the virus on its own, but usually antiviral treatment is recommended if it is available.
You must take medications with care and caution if you have hepatitis C because many are processed through the liver and can cause extra stress on your already inflamed liver. You will need to discuss any medications you are taking with your doctor and/or pharmacist, including OTC and herbal/dietary supplements. You may need to temporarily discontinue some medications or take a different dose to allow your liver time to rest and heal. You should also avoid drinking alcohol because it can further damage the liver.
Direct-Acting Antivirals (DAAs) are currently the mainstay of treatment for hepatitis C. The goal of therapy with these antiviral medications is to clear the virus from your body and cure the disease, and they are often successful. DAA treatment also helps decrease symptoms, increase quality of life, and decrease and prevent liver damage/failure. These medications work against a specific protein needed in the hepatitis C virus life cycle to stop the virus from growing/reproducing. Before treatment, your healthcare provider will do blood tests to determine the specific genotype/strain of the hepatitis virus you have. This will help determine which medication is best to treat your hepatitis C infection. Tests will also be done to determine your kidney health, and how much liver damage you have. You may receive a combination of two or more antivirals. These are oral medications that are given for 8-24 weeks. Periodic bloodwork will be done to monitor the status of the virus in your body, and treatment will stop after the virus is undetectable in your blood. Examples of direct-acting antivirals include daclatasvir, elbasvir, grazoprevir, glecaprevi, pibrentasvir, ledipasvir, sofosbuvir, ombitasvir, paritaprevir, ritonavir, ombitasvir, dasabuvir, simeprevir, isofosbuvir, velpatasvir, and voxilaprevir. There are some combination pills that contain more than one medication, and some medication packs available that contain more than one antiviral for easier treatment regimens.
Ribavirin is an older antiviral medication that is sometimes added to DAAs for hepatitis C treatment depending on your specific genotype of the virus, and if you have liver cirrhosis. This medication can cause birth defects and should not be taken if you are pregnant, or if you are a male and your partner is pregnant.
Interferon Injections are man-made proteins like the ones your body makes to fight infection and inflammation. These are given daily or weekly to help your body fight the hepatitis C virus and to treat inflammation in the liver. Interferons are usually used in combination with ribavirin but are not used much anymore since better treatment options are available. The interferon most often used for hepatitis C is peginterferon alpha.
The most common side effects you may experience while taking hepatitis C antivirals include:
Rarely, an allergic reaction to a medication or vaccine can occur. If you experience a combination of rash, swelling, hives, shortness of breath, and nausea/vomiting, you should seek medical attention.
Many significant drug interactions exist with DAAs. These may require a change in therapy and increase the risk for toxicity/serious side effects from medications. It is important that your doctor and/or pharmacist are aware of every medication you are taking, including over-the-counter medications and supplements so that they can monitor for drug interactions.
Anaemia, or decreased blood cell counts can occur while taking these medications. It is important that you follow up with your doctor for routine blood work to check your blood counts. If you experience extreme weakness, or abnormal bruising or bleeding, including blood in the urine, vomit, or faeces (may look pink, red, black/tarry, or coffee-ground appearance), seek medical attention right away.
Hepatitis B reactivation can occur while taking antivirals for hepatitis C treatment. This means hepatitis B that you had before can become active again, which can cause further liver damage and health problems. You should be tested for other forms of hepatitis before beginning treatment.
There is currently no vaccine available that can help prevent hepatitis C. However, it is recommended that you receive the hepatitis A and B vaccines if you have hepatitis C to prevent contracting these other viruses that can further damage the liver and increase complications. Important ways to prevent hepatitis C include practicing safe sex (always using a condom), avoiding shared needles/drug use, using gloves when cleaning up the blood/body fluids of others, ensuring the proper sterilization/cleaning of needles/instruments used for tattoos, piercings, or medical procedures, disposing of needles properly (in a hard, closed container), avoiding sharing toothbrushes, razors, and nail care tools (clippers, etc.). It is recommended that when cleaning blood, you use a solution of 1 part bleach to 10 parts clean water. You should discuss your risk of getting hepatitis C with your healthcare provider and consider getting screened (tested) for the disease.