Treatment
- Antiviral medications. Hepatitis C infection is treated with antiviral medications intended to clear the virus from your body.
- Liver transplantation. If you have developed serious complications from chronic hepatitis C infection, liver transplantation may be an option.
- Vaccinations. ...
What is the initial treatment of hepatitis C virus (HCV) infection?
Initial Treatment of HCV Infection. Initial treatment of HCV infection includes patients with chronic hepatitis C who have not been previously treated with interferon, peginterferon, ribavirin, or any HCV direct-acting antiviral (DAA) agent, whether experimental, investigational, or US Food and Drug Administration...
What is the best treatment for HCV genotype 1?
Studies of Initial Treatment of Adults with HCV Genotype 1 1 Elbasvir-Grazoprevir. The study enrollment included 288 patients with genotype 1 infection. ... 2 Glecaprevir-Pibrentasvir. Among those enrolled, 33 were coinfected with HIV. ... 3 Ledipasvir-Sofosbuvir. ... 4 Sofosbuvir-Velpatasvir-Voxilaprevir. ...
How often should hepatitis C (HCV) testing be performed?
One-time hepatitis C testing is also recommended regardless of age, setting, or recognized conditions or exposures (e.g., HIV infection, history of injecting drug use, or children born to women with HCV infection). Routine periodic HCV testing is recommended for persons with ongoing risk factors (e.g., injecting drug use or hemodialysis).
What is the AASLD-IDSA guidance on hepatitis C (HCV) treatment?
AASLD-IDSA HCV Guidance for All Genotypes: Retreatment Source: AASLD-IDSA. Recommendations for testing, management, and treating hepatitis C. Retreatment of persons in whom prior therapy has failed: glecaprevir/pibrentasvir treatment failure (all genotypes). [ AASLD-IDSA] - Accessed February 11, 2021. Table 8.
WHO guidelines HCV treatment?
The goal of hepatitis C treatment is to cure the disease. WHO recommends therapy with pan-genotypic direct-acting antivirals (DAAs) for all adults, adolescents and children down to 3 years of age with chronic hepatitis C infection.
What management is recommended after an exposure to HCV?
Wash wounds with soap and water; flush mucous membranes with water. No post-exposure prophylaxis (immune globulin or antiviral medications) is recommended. Counsel the exposed person regarding hepatitis C transmission risk.
What is the primary treatment for hepatitis?
Hepatitis A rarely requires treatment. Chronic HBV can be treated with several oral antivirals; currently, tenofovir or entecavir are the recommended first-line options for initial oral treatment options.
What is the first-line of treatment in hepatitis?
Currently, pegylated interferon alfa (PEG-IFN-a), entecavir (ETV), and tenofovir disoproxil fumarate (TDF) are the first-line agents in the treatment of hepatitis B disease.
What is the protocol for needle stick injury?
If any of these occur, take the following steps: Flush splashes to the nose, mouth, or skin with water. Irrigate eyes with clean water, saline, or sterile irrigants. Report the incident to your supervisor. Immediately seek medical treatment.
What is post exposure prophylaxis against HCV *?
Hepatitis C Post-exposure Prophylaxis PEP for occupational exposures to bloodborne pathogens is treatment given to healthcare personnel in the time period immediately following exposure and has the goal of preventing infection with specific pathogens.
What are the treatments for viral hepatitis?
Currently, the most effective therapy for hepatitis C is a drug combination consisting of pegylated interferon and ribavirin. Pegylated interferon is taken weekly as an injection and ribavirin is a twice daily tablet. The treatment is a form of chemotherapy and the ability to tolerate it varies widely for each person.
What is the latest treatment for hepatitis B?
Currently, pegylated interferon alfa (PEG-IFN-a), entecavir (ETV), and tenofovir disoproxil fumarate (TDF) are the first-line agents in the treatment of hepatitis B disease.
How long should I take tenofovir?
Treatment for HIV is usually lifelong. Continue to take tenofovir regularly for as long as your doctor tells you to, even if you feel well. This is to keep your immune system healthy.
What was the old treatment for hep C?
The early 1990s The first treatment for hepatitis C came in the 1980s, by way of a series of protein-based injections called recombinant interferon-alfa (IFNa).
How long is hep C treatment?
Treatments for hepatitis C New, all-oral medicines are now available for everyone and treatment is usually only for 8-12 weeks. Using these latest medications, around 95% or more of people with hepatitis C will be cured.
Can HCV be cured?
Today, chronic HCV is usually curable with oral medications taken every day for two to six months. Still, about half of people with HCV don't know they're infected, mainly because they have no symptoms, which can take decades to appear.
When should I take PEP after being exposed?
PEP (post-exposure prophylaxis) means taking medicine to prevent HIV after a possible exposure. PEP should be used only in emergency situations and must be started within 72 hours after a recent possible exposure to HIV.
How do you do post exposure prophylaxis?
PEP is a combination of three drugs. You take them once or twice a day for 28 days: For adults, the CDC recommends tenofovir, emtricitabine (these two drugs come in one pill), and a third drug, either raltegravir or dolutegravir.
When should you test for hep C after exposure?
For most people who are infected, the anti-HCV blood test will become positive by 6 months after exposure. A special kind of blood test called a nucleic acid test (NAT) that detects HCV RNA (also called a PCR test) can tell if a person is infected within 1–2 weeks of exposure.
How soon should you be tested after a needlestick?
You should be tested for HCV antibody and liver enzyme levels (alanine amino- transferase or ALT) as soon as possible after the exposure (baseline) and at 4-6 months after the exposure. To check for infection earlier, you can be tested for the virus (HCV RNA) 4-6 weeks after the exposure.
What is the best treatment for hepatitis C?
Liver transplantation. If you have developed serious complications from chronic hepatitis C infection, liver transplantation may be an option. During liver transplantation , the surgeon removes your damaged liver and replaces it with a healthy liver.
What to do if you have hepatitis C?
If you receive a diagnosis of hepatitis C, your doctor will likely recommend certain lifestyle changes. These measures will help keep you healthy longer and protect the health of others as well:
How old do you have to be to get tested for hepatitis C?
The U.S. Preventive Services Task Force recommends that all adults ages 18 to 79 years be screened for hepatitis C, even those without symptoms or known liver disease. Screening for HCV is especially important if you're at high risk of exposure, including: Anyone who has ever injected or inhaled illicit drugs.
How long does it take for hepatitis C to clear?
The goal of treatment is to have no hepatitis C virus detected in your body at least 12 weeks after you complete treatment.
How to prevent liver damage?
Avoid medications that may cause liver damage. Review your medications with your doctor, including over-the-counter medications you take as well as herbal preparations and dietary supplements. Your doctor may recommend avoiding certain medications. Help prevent others from coming in contact with your blood.
How long does it take to cure hepatitis C?
As a result, people experience better outcomes, fewer side effects and shorter treatment times — some as short as eight weeks.
How to prepare for a liver appointment?
Because appointments can be brief and because there's often a lot to discuss, it's a good idea to be well prepared. To prepare, try to: Review your medical record. This is particularly important if you are seeing a liver specialist (hepatologist) for the first time after finding out you have hepatitis C.
What to do if you think you have hepatitis C?
If you think you are at risk of having Hepatitis C, talk to your current healthcare provider about getting tested. Once you’ve been diagnosed with Hepatitis C infection, you may want to see a specialist. Specialists who work with people with Hepatitis C include the following healthcare providers:
How does hepatitis C therapy help?
Proper adherence to Hepatitis C therapy will increase your chance of being cured and decrease the long-term complications of Hepatitis C. Adhering to other aspects of your treatment plan is also important.
What percentage of liver is needed for transplant?
People are typically considered for a liver transplant when their liver is working at approximately 10-20 percent of what is considered normal. Chronic Hepatitis C is the most frequent cause of liver transplantation in the United States. A liver transplant replaces a damages liver with a healthy one from someone else.
Can hepatitis C be detected again?
Relapse: The Hepatitis C virus becomes undetectable on treatment, but then is detectable again, either during treatment or after treatment is stopped. Incomplete treatment: Treatment ended earlier that the prescribed duration. The goal of treatment is to have an SVR. This is when you are considered cured.
Can hepatitis C be too high?
Some medicines interact with Hepatitis C medications, which can affect the level of either one – meaning that the level of the Hepatitis C medicine or your other medicine may become too high or too low. There can be risks of toxicity if too high, or the medication may be less effective if too low.
Can you take other medicines for hepatitis C?
Take other medicines, including prescription and over-the-counter medicines, vitamins, and herbal supplements. They may affect how well your hepatitis C treatment works, and your hepatitis C treatment may affect the way other medicines work.
Is it important to know about hepatitis C?
Many hepatitis C medications have important considerations that you should be aware of before starting a course of treatment for your HCV infection. Some considerations are specific to a particular drug, while others are more general in nature.
What are the different types of HCV drugs?
Classes of drugs to treat HCV 1 Nonstructural 3/4A protease inhibitors. Protease inhibitors block NS3/4A serine protease, inhibiting functional viral proteins from being created. 2 Nonstructural 5A complex inhibitors. Although the exact antiviral action of NS5A inhibitors is unclear, they are thought to cause faulty HCV assembly by inhibiting hyperphosphorylation of the NS5A protein and altering the protein's location from the endoplasmic reticulum. 3 Nonstructural 5B polymerase inhibitors. There are two distinct classes of these drugs: nucleos (t)ide inhibitors and nonnucleoside inhibitors. Nucleos (t)ide inhibitors are analogues that are incorporated into the viral RNA genome by RNA-dependent RNA polymerase (RdRp). This causes termination of further replication and competitively binds the active polymerase site. This class of NS5B polymerase inhibitors has a high barrier to resistance and works broadly against genotypes with intermediate potency. On the other hand, nonnucleoside inhibitors are small molecules that inhibit the RdRp by binding an allosteric site in a noncompetitive fashion, which changes the biochemical activity of the polymerase.
How many people in the world have HCV?
According to the World Health Organization, 130 million to 150 million people worldwide are infected with HCV, and this population is expected to increase by an average of 3 million to 4 million cases annually.
Can HCV go undetected?
Hepatitis C virus (HCV) infection can lead to cirrhosis and its related complications, hepatocellular carcinoma (HCC), liver failure and death. Once one of the leading indications for liver transplantation, HCV frequently goes undetected, mainly because it can take decades for symptoms to appear. In an article recently published in Gastroenterology and Hepatology, Mayo Clinic author Hugo E. Vargas, M.D., and co-author Jennifer L. Horsley-Silva, M.D., provided a comprehensive overview about HCV infection and treatment. Dr. Vargas addresses some of these issues in the questions and answers that follow.
What is the first treatment for HCV?
Initial treatment of HCV infection includes patients with chronic hepatitis C who have not been previously treated with interferon, peginterferon, ribavirin, or any HCV direct-acting antiviral (DAA) agent, whether investigational, or US Food and Drug Administration (FDA) approved .
What is recommended regimen?
Recommended regimens are those that are favored for most patients in a given group, based on optimal efficacy, favorable tolerability and toxicity profiles, and treatment duration.
How are recommended and alternative regimens listed?
Recommended and alternative regimens are listed in order of level of evidence. When several regimens are at the same recommendation level, they are listed in alphabetical order. Regimen choice should be determined based on patient-specific data, including drug-drug interactions.
How is hepatitis C spread?
Hepatitis C is spread through contact with blood from an infected person. Today, most people become infected with the hepatitis C virus by sharing needles or other equipment used to prepare and inject drugs.
How long does it take to get tested for hepatitis C?
Getting tested for hepatitis C is important, because treatments can cure most people with hepatitis C in 8 to 12 weeks.
Is hepatitis C a long term illness?
For some people, hepatitis C is a short-term illness, but for more than half of people who become infected with the hepatitis C virus, it becomes a long-term, chronic infection. Chronic hepatitis C can result in serious, even life-threatening health problems like cirrhosis and liver cancer. People with chronic hepatitis C can often have no symptoms ...
Is hepatitis C a risk factor?
CDC continues to recommend people with risk factors, including people who inject drugs, be tested regularly. CDC recommendations for hepatitis C screening among adults – United States, 2020. Hepatitis C is a liver infection caused by the hepatitis C virus (HCV). Hepatitis C is spread through contact with blood from an infected person.
What is the best pill for HCV?
Elbasvir and grazoprevir (Zepatier): This once-a-day pill treats HCV types 1 and 4. It may also offer new hope for people with hep C who also have cirrhosis, HIV, late-stage kidney disease, and other hard-to-treat conditions. Like the other antivirals, the side effects are mild.
How long does it take for a virus to be removed from your blood?
Most of the time, these meds remove all traces of the virus from your blood within 12 weeks. This is called sustained virologic response (SVR), and it’s what doctors look for to tell if you’re cured.
What are the side effects of hep C?
Glecaprevir and pibrentasvir (Mavyret): Three pills daily can treat all types of hep C. Side effects are mild and can include headache, fatigue, diarrhea, and nausea.
Is Ledipasvir a hep C pill?
Ledipasvir and sofosbuvir (Harvoni): This once-a-day pill launched a revolution in hep C treatment. It was the first interferon-free med for people with type 1. A year later, the FDA also gave the thumbs up for people with HCV types 4, 5, and 6 to use it. Side effects are mild.
Is research moving on hep C?
Research is moving rapidly on treatments for hep C. As a result, what doctors will recommend for each case may change. Researchers may continue to come up with new treatments, and some of the combinations of medications below may change as they make new discoveries.
Does dasabuvir help with HCV?
Ombitasvir, paritaprevir, and ritonavir, with dasabuvir (Viekira Pak): Doctors say this treatment works well for people with HCV type 1.
Is there a one size fits all treatment for hepatitis C?
There's no one-size-fits-all option. There are many different types, or "genotypes," of hepatitis C. Type 1 is the most common. This is important to understand when you talk to your doctor. Not all meds work on all types. Which medicine is best for you also depends on how much liver scarring (cirrhosis) you have.
What are the factors that influence the choice of treatment for HCV?
For treatment-naïve adults with chronic HCV genotype 1 infection, the main factors that influence the choice and duration of therapy are (1) presence or absence of cirrhosis, and (2) medication cost or insurance considerations. In the case of elbasvir-grazoprevir use, the HCV genotype 1 subtype (1a or 1b) is also important, as the presence of specific baseline NS5A RASs significantly reduces SVR12 rates in persons with HCV genotype 1a. [ 10, 11, 12] In cases where the genotype 1 subtype is not known, the individual should be treated as HCV genotype 1a. The baseline HCV RNA level generally does not influence the treatment choice or duration, except in treatment-naïve noncirrhotic patients in whom 8 or 12 weeks of ledipasvir-sofosbuvir is being considered. [ 13] Additional data from the HCV-TARGET registry and the Veterans Affairs National Healthcare System demonstrated comparable SVR rates of 94 to 98% for adults without cirrhosis treated with either 8 or 12 weeks of ledipasvir-sofosbuvir if the baseline HCV RNA levels were less than 6 million IU/mL. [ 14, 15, 16] In addition to the factors noted above, drug interactions may also influence the choice of therapy, particularly for individuals with HIV coinfection who are taking antiretroviral medications. Of note, individuals with HCV and HIV coinfection, depending on their specific antiretroviral therapy, are eligible for most of the same regimens for initial treatment of genotype 1 as for persons with HCV monoinfection, except that persons with HIV should not receive (1) any 8-week option of ledipasvir-sofosbuvir, or (2) the 8-week option of glecaprevir-pibrentasvir if cirrhosis is present. [ 11, 12, 17, 18]
What are the factors that affect the choice of treatment for HCV genotype 1?
For individuals with chronic HCV genotype 1 infection, the main factors that influence the choice and duration of therapy are cirrhosis status and prior treatment experience . With the use of certain regimens for persons with HCV genotype 1a, namely elbasvir-grazoprevir, the genotype 1 subtype (1a or 1b) also impacts the choice of therapy, as elbasvir-grazoprevir is only recommended for persons with HCV genotype 1a who do not have baseline NS5A resistance-associated substitutions (RASs). In addition, the HCV RNA level and the patient’s HIV status can impact the duration of ledipasvir-sofosbuvir, but does not affect the duration of other regimens. Finally, the cost of the regimen, insurance coverage, and provider preference can play a major role in the regimen choice. The following treatment recommendations are based on the AASLD-IDSA HCV Guidance for initial treatment of adults with HCV genotype 1 and for retreatment of adults in whom prior therapy failed, including those with HCV genotype 1. [ 4, 5]
What is the AASLD-IDSA HCV guidance?
The following is a summary of the AASLD-IDSA HCV Guidance for adults with HCV genotype 1 infection who are treatment experienced and failed prior DAA therapy , including those without cirrhosis and those with compensated cirrhosis. [ 5, 28, 29, 30] For individuals with cirrhosis, the AASLD-IDSA HCV Guidance defines compensated cirrhosis as Child-Turcotte-Pugh class A and decompensated cirrhosis as Child-Turcotte-Pugh class B or class C. The AASLD-IDSA HCV Guidance for retreatment is no longer genotype specific, but instead emphasizes a pangenotypic approach to retreatment based on the prior treatment regimen. In addition, the AASLD-IDSA HCV Guidance no longer includes recommendations for the retreatment of persons who experienced prior treatment failure with interferon-based therapy, including interferon plus first-generation protease inhibitors ( telaprevir, boceprevir ); these individuals have robust cure rates with modern DAA regimens similar to that observed with treatment-naïve persons. The recommended regimens in the tables below are based on prior regimen failure and listed by evidence level; when the evidence level is considered equivalent, the regimens are listed alphabetically.
Treatment
- HCV infection is curable, and persons with diagnosed HCV infection should be linked to care and treatment. Providers should consult existing guidelines to learn about the latest advances in treating HCV infection (https://www.hcvguidelines.orgexternal icon) and with hepatitis specialist…
Management of Sex Partners
- Because incident HCV has not been demonstrated to occur among heterosexual couples followed over time (1334,1371–1373), condom use might not be necessary in such circumstances. Persons with HCV infection with one long-term, steady sex partner do not need to change their sexual practices. However, they should discuss the risk for transmission with their partner and d…
Other Management Considerations
- All persons with HCV infection for whom HIV and HBV infection status is unknown should be tested for these infections. Those who have HIV or HBV infection should be referred for or provided with recommended care and treatment. Persons without previous exposure to HAV or HBV should be vaccinated.
Prevention
- Reducing the burden of HCV infection and disease in the United States requires implementing both primary and secondary prevention activities. Primary prevention reduces or eliminates HCV transmission, whereas secondary prevention identifies persons through screening and then provides treatment to reduce chronic liver disease and other chronic diseases and HCV transmi…
Postexposure Follow-Up
- No PEP has been demonstrated to be effective against HCV infection. Testing for HCV is recommended for health care workers after percutaneous or perimucosal exposures to HCV-positive blood. Prompt identification of acute infection is vital because outcomes are improved when treatment is initiated early during the illness course.
Special Considerations
- Pregnancy
All pregnant women should be screened with each pregnancy for HCV antibodies at the first prenatal visit in settings where the HCV prevalence is >0.1% (https://www.cdc.gov/hepatitis/hcv/index.htm) (154,155). Although the rate of transmission is hi… - HIV Infection
All persons with HIV infection should undergo serologic screening for HCV at initial evaluation (98) (https://www.hcvguidelines.orgexternal icon). Providers should be aware of the likelihood that MSM with HIV infection can acquire HCV after initial screening. Because acute HCV infectio…
Diagnosis
- Screening for hepatitis C
The U.S. Preventive Services Task Force recommends that all adults ages 18 to 79 years be screened for hepatitis C, even those without symptoms or known liver disease. Screening for HCVis especially important if you're at high risk of exposure, including: 1. Anyone who has ever i… - Other blood tests
If an initial blood test shows that you have hepatitis C, additional blood tests will: 1. Measure the quantity of the hepatitis C virus in your blood (viral load) 2. Identify the genotype of the virus
Treatment
- Antiviral medications
Hepatitis C infection is treated with antiviral medications intended to clear the virus from your body. The goal of treatment is to have no hepatitis C virus detected in your body at least 12 weeks after you complete treatment. Researchers have recently made significant advances in treatmen… - Liver transplantation
If you have developed serious complications from chronic hepatitis C infection, liver transplantation may be an option. During liver transplantation, the surgeon removes your damaged liver and replaces it with a healthy liver. Most transplanted livers come from decease…
Clinical Trials
- Explore Mayo Clinic studiestesting new treatments, interventions and tests as a means to prevent, detect, treat or manage this condition.
Lifestyle and Home Remedies
- If you receive a diagnosis of hepatitis C, your doctor will likely recommend certain lifestyle changes. These measures will help keep you healthy longer and protect the health of others as well: 1. Stop drinking alcohol.Alcohol speeds the progression of liver disease. 2. Avoid medications that may cause liver damage.Review your medications with your doctor, including o…
Preparing For Your Appointment
- If you think you may have a risk of hepatitis C, see your family doctor. Once you've been diagnosed with a hepatitis C infection, your doctor may refer you to a specialist in liver diseases (hepatologist) or infectious diseases.