Infectious Disease Focus: Hepatitis C Treatment Options

Hepatitis C virus (HCV) is a type of viral infection that causes inflammation to the liver and frequently results in liver damage. HCV, which has 7 genotypes and more than 67 subtypes, spreads to humans mostly through contaminated blood. This type of infection may go unnoticed until the liver becomes damaged, after which, patients start showing symptoms.¹

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According to the US Centers for Disease Control and Prevention, approximately 2 million people in the United States are infected with HCV. In 2020, rates of infections were the highest among male patients aged 20-39 years. This includes the American Indian/Alaska Native population, those who use injectable drugs, and those living in the Eastern and Southeastern United States. A total of 41 states reported about 107,300 new cases. Consequently, HCV-associated deaths also increased during 2020 by 4% compared to 2019.²

Every HCV infection starts with the acute phase, the symptoms of which may include jaundice, fatigue, nausea, and fever. Some patients also experience muscle aches. These symptoms start approximately 1 to 3 months after the patient has been exposed to the virus and may last for 3 to 4 months afterwards.¹

The acute phase does not always lead to the chronic phase. Some patients can clear the virus from their body, which is called the spontaneous viral clearance (SVC). Approximately 15% to 25% of patients experience SVC.

Symptoms of HCV also include easy bruising, easy bleeding, loss of appetite, dark-colored urine, itchy skin, fluid build-up in the abdomen, weight loss, confusion, and slurred speech. Some patients also experience fatigue, nausea, fever, and muscle aches.¹

Treatment for HCV includes preventive measures to start with. The US Preventive Services Task Force recommends all adults aged 18 to 79 years to be screened for the virus, regardless of whether symptoms are present. If symptoms are presented, diagnosis tests may include liver biopsy, imaging studies, and blood tests, as well as those physical exams by the specialists. ¹

HCV infection is mostly curable and treated with antiviral medications, which can clear the virus from the body. The goal for the treatment is to completely eradicate the virus from the body, after 12 weeks of therapy.

Until recently, patients diagnosed with the virus had to take weekly injections and oral medications. Following advancements in the development of direct-acting antiviral drugs, patients can be cured after taking oral medications every day for 2 to 6 months.¹

Since 2014, a few antiviral treatment options have been developed to treat HCV. First line treatment options include elbasvir/grazoprevir (Zepatier), glecaprevir/pibrentasvir (Mavyret), sofosbuvir/ledipasvir (Harvoni), and sofosbuvir/velpatasvir (Epclusa). Second-line treatment option includes sofosbuvir/velpatasvir/voxilaprevir (Vosevi).

Treatment with these medications can usually be recommended for approximately 8-12 weeks, and in some cases, may continue for up to 16 weeks. If the patient has liver damage, the provider may recommend longer therapy for up to 24 weeks.³ Adverse effects of these medications may include nausea, fatigue, headache, and insomnia.⁴

Sofosbuvir/velpatasvir has a treatment course of 12 weeks, with a dosage fixed at 400 mg of sofosbuvir and 100 mg of velpatasvir once daily, with or without food. Sofosbuvir, velpatasvir and voxilaprevir is similar to sofosbuvir/velpatasvir, recommended for 12 weeks and includes the dosage of 400 mg of sofosbuvir, 100 mg of velpatasvir, and 100 mg of voxilaprevir once daily with food.

Glecaprevir and pibrentasvir is an 8-week treatment for all genotypes of HCV. Based on the diagnosis and the patient’s condition, the treatment could be recommended for 12 or 16 weeks long as well. Dosage includes 100 mg of glecaprevir and 40 mg of pibrentasvir, which is taken as 3 tablets daily with food.⁴

Elbasvir and grazoprevir has a treatment timeline of 12 to 16 weeks. The dose is 50 mg of elbasvir and 100 mg of grazoprevir, once daily, with or without food. Ledipasvir and sofosbuvir is recommended for 8 to 24 weeks, with a dose of 90 mg ledipasvir and 400 mg of sofosbuvir once daily.

With the treatment options available recently for patients infected with HCV, and the advancements made to cure this disease, patients infected with the virus have many options that may cure them of the virus. Depending on the patient and based on specialist recommendations, patients may be prescribed any of these medications that best fits their diagnosis, comorbidities, and other medications taken, such as in cases of an HIV coinfection.

References

1. Hepatitis C (2021) Mayo Clinic. Available at https://www.mayoclinic.org/diseases-conditions/hepatitis-c/diagnosis-treatment/drc-20354284. Accessed July 10, 2023.
2. 2020 hepatitis C (2022) Centers for Disease Control and Prevention. Available at: https://www.cdc.gov/hepatitis/statistics/2020surveillance/hepatitis-c.htm. Accessed July 10, 2023.
3. Rena K. Fox, Mdw. M.E. (2018) July 2020. Va.gov: Veterans Affairs, Hepatitis C Medications: An Overview for Patients. Available at https://www.hepatitis.va.gov/products/treatment-update.asp#S4X. Accessed July 10, 2023.
4. Hepatitis C medications: New, most effective, and names (no date) Medical News Today. Available at: https://www.medicalnewstoday.com/articles/324209