Is Hepatitis C Curable?
Yes, hepatitis C is curable—achieving a sustained virological response (SVR) with direct-acting antiviral (DAA) therapy represents a definitive cure in more than 99% of patients. 1, 2
What "Cure" Means
A cure is defined as undetectable HCV RNA 12 weeks after treatment completion (SVR12), measured by a sensitive molecular assay with a lower limit of detection <15 IU/ml. 1 This endpoint has >99% concordance with SVR24 (24 weeks post-treatment) and represents permanent viral eradication in the vast majority of cases. 1, 3
Current Treatment Success Rates
Modern DAA regimens achieve cure rates exceeding 95-97% across all patient populations, including those historically difficult to treat. 2, 3, 4 The most commonly recommended pangenotypic regimens include:
- Sofosbuvir/velpatasvir for 12 weeks (SVR rate 98% for genotype 1a) 3, 5
- Glecaprevir/pibrentasvir for 8-12 weeks depending on cirrhosis status 2, 3
These all-oral, interferon-free combinations work across all HCV genotypes and have revolutionized treatment since their approval. 4, 6
Clinical Benefits of Achieving Cure
Curing HCV infection prevents the complications of chronic liver disease, including cirrhosis, hepatic decompensation, hepatocellular carcinoma, and death. 1, 7 Additional benefits include:
- Resolution of hepatic necroinflammation and fibrosis 1
- Improvement in quality of life and removal of stigma 1
- Resolution of extrahepatic manifestations (cryoglobulinemia, vasculitis) 3
- Prevention of onward transmission to others 1
Important Caveats for Patients with Advanced Disease
While cure is achievable in nearly all patients, those with established cirrhosis (F4) or advanced fibrosis (F3) remain at reduced but ongoing risk for hepatocellular carcinoma even after achieving SVR. 1, 2 These patients require:
- Continued HCC surveillance with ultrasound every 6 months indefinitely 2, 7
- Ongoing monitoring for cirrhotic complications, though at significantly reduced rates 3, 7
The risk of decompensation and HCC is substantially reduced but not eliminated after cure in cirrhotic patients. 2
Treatment Failure and Re-treatment
In the rare cases where initial DAA therapy fails (<5% of patients), re-treatment is highly successful. 8 Sofosbuvir-based regimens remain effective as NS5B resistance-associated variants are uncommon, making sofosbuvir a reliable backbone for salvage therapy. 8 Over 90% of treatment failures can be successfully re-treated with regimens like sofosbuvir/velpatasvir/voxilaprevir or glecaprevir/pibrentasvir. 8
Who Should Be Treated Urgently
All patients with chronic HCV should be offered treatment without delay. 1 Priority should be given to:
- Patients with significant fibrosis or any degree of cirrhosis (F2-F4) 1, 2
- Those with clinically significant extrahepatic manifestations 1
- Individuals at risk of transmitting HCV (people who inject drugs, men who have sex with men with high-risk practices, women of childbearing age wishing to conceive, hemodialysis patients) 1
- Patients with HCV recurrence after liver transplantation 1
- Those with concurrent comorbidities accelerating liver disease (HIV, HBV coinfection, diabetes) 1
The notion that treatment should be deferred for potentially better future therapies is explicitly rejected—we have already cured far too few patients to impact the burden of chronic liver disease. 1