Can a patient be cured of hepatitis C?

Hepatitis C Can Be Cured with Direct-Acting Antiviral Therapy

Yes, hepatitis C can be cured in almost all infected patients (>97%) following the advent of direct-acting antiviral (DAA) medications. 1

Understanding HCV Cure

• A sustained virological response (SVR), defined as undetectable HCV RNA 12 weeks (SVR12) or 24 weeks (SVR24) after treatment completion, represents a cure of the infection in more than 99% of patients 1
• The introduction of all-oral DAA regimens has revolutionized HCV treatment, allowing virtually all patients to achieve SVR regardless of HCV genotype or disease stage 1
• Current DAA treatments have replaced older interferon-based therapies that had lower efficacy and more side effects 1

Available Treatment Options

• Three classes of direct-acting antivirals are currently available 2:
  • Protease inhibitors (anti-NS3/4A)
  • RNA-dependent polymerase inhibitors (anti-NS5B)
  • NS5A inhibitors
• These medications are typically used in combination regimens to target different aspects of the HCV replication cycle 2
• FDA-approved DAA combinations include:
  • Sofosbuvir-based regimens (Sovaldi®, Harvoni®, Epclusa®) 3, 4
  • Ombitasvir/paritaprevir/ritonavir combinations 1
  • Grazoprevir/elbasvir combinations (Zepatier®) 1, 4

Treatment Efficacy and Duration

• Modern DAA regimens achieve SVR rates exceeding 95% in most patient populations 5
• Treatment duration typically ranges from 8-12 weeks for most patients, with some requiring up to 24 weeks depending on specific factors 6, 5
• Treatment success has been demonstrated across all HCV genotypes, though specific regimen selection may vary by genotype 1
• Even historically difficult-to-treat populations now achieve high cure rates, including:
  • Patients with advanced liver disease/cirrhosis 2
  • Patients with HIV co-infection 1
  • Prior treatment failures 1

Post-Cure Considerations

• After achieving SVR, patients without advanced fibrosis generally have excellent outcomes with resolution of liver disease 1
• Patients with cirrhosis who achieve SVR still require monitoring as they remain at risk for complications, though at significantly reduced rates 1
• The risk of hepatocellular carcinoma (HCC) and all-cause mortality is significantly reduced, but not eliminated, in cirrhotic patients who achieve SVR 1
• Patients with complete response to HCC therapy who achieve SVR require indefinite post-SVR HCC surveillance via ultrasound every 6 months 1

Potential for Global Elimination

• The high efficacy and safety profile of DAAs has transformed patient perception of HCV from a chronic disease to one that can be cured 5
• The World Health Organization has set a goal to eliminate HCV as a public health threat by 2030, which is potentially achievable with widespread DAA access 5
• Remaining challenges include increasing screening, improving access to care, and addressing affordability issues to achieve global elimination 7

Conclusion

The development of DAAs has transformed hepatitis C from a difficult-to-treat chronic infection to a curable disease. With cure rates exceeding 97% across virtually all patient populations, HCV elimination is now a realistic goal, though continued efforts are needed to expand access to these life-saving treatments.