What is Hepatitis C (Hep C) and how is it treated?

Explaining Hepatitis C to a Patient

Hepatitis C is a curable viral infection that primarily affects the liver, with modern treatments achieving cure rates over 95% using oral medications called direct-acting antivirals (DAAs).

What is Hepatitis C?

• Hepatitis C virus (HCV) is a blood-borne RNA virus that primarily targets liver cells and can cause both acute and chronic liver disease 1, 2
• HCV infection affects approximately 57-71 million people worldwide, with 1.7 million new infections occurring annually 2, 3
• The virus is transmitted through blood-to-blood contact, with major risk factors including unsafe injection drug use and unsterile medical procedures 4

How Hepatitis C Affects the Body

• After infection, approximately 70-80% of people develop chronic hepatitis C infection 2, 5
• If left untreated, about 20% of chronically infected patients develop liver cirrhosis, and some may progress to hepatocellular carcinoma (liver cancer) 2, 5
• HCV can evade the body's immune system, allowing it to establish long-term infection 2
• The virus has 6 different genotypes, with genotype 1 being the most common in the United States 6

Diagnosis of Hepatitis C

• Diagnosis involves two main tests: antibody testing (anti-HCV) and HCV RNA testing 1
• The antibody test detects if you've ever been exposed to the virus, while the RNA test confirms active infection 1
• Additional tests may include viral genotype determination and assessment of liver damage 1
• People who should be tested include those who have:
  • Ever injected drugs, even once
  • Received blood transfusions before July 1992
  • Been on long-term hemodialysis
  • HIV infection
  • Unexplained liver enzyme abnormalities 1

Treatment of Hepatitis C

• Modern treatments use direct-acting antivirals (DAAs) that target specific viral proteins essential for HCV replication 7, 2
• Current DAA regimens can cure over 95% of patients with minimal side effects 7, 4
• Common FDA-approved medications include:
  • Sofosbuvir-based combinations (targets the NS5B viral protein) 8
  • Ledipasvir/sofosbuvir combination 9
  • Glecaprevir/pibrentasvir 7
• Treatment duration typically ranges from 8-12 weeks for most patients, though some may require 24 weeks 7
• A cure is defined as sustained virological response (SVR), meaning undetectable HCV RNA 12 weeks after completing treatment 1, 7

Factors Affecting Disease Progression

• Several factors can accelerate liver damage in chronic HCV infection:
  • Alcohol consumption (most significant factor)
  • Older age at time of infection
  • Male sex
  • Obesity/overweight
  • Co-infection with HIV or hepatitis B
  • Duration of infection 5

After Treatment

• After achieving SVR (cure), patients without advanced fibrosis generally have excellent outcomes with resolution of liver disease 7
• Patients with cirrhosis who achieve SVR still require monitoring as they remain at risk for complications, though at significantly reduced rates 7
• It's important to understand that being cured does not protect against reinfection if re-exposed to the virus 2
• Patients should continue to avoid alcohol and maintain a healthy weight to protect liver health 5

Prevention

• There is currently no vaccine available for hepatitis C 2, 4
• Prevention focuses on avoiding blood exposure:
  • Never share needles or injection equipment
  • Ensure tattoo and piercing equipment is properly sterilized
  • Healthcare workers should follow standard precautions
  • Sexual transmission is uncommon but possible 1