Clinical Care of Hepatitis C

Treatment options

The use of ribavirin with interferon or peginterferon is no longer recommended due to poor efficacy and high rate of adverse effects with the regimen. DAA therapy is better tolerated and more effective and has a shorter duration.

There are 3 types of later, next-generation DAA therapies for non-pregnant adults and children over age 3:

• Protease inhibitors
• Nucleoside analog polymerase inhibitors
• Nonstructural protein 5A (NS5A) inhibitors

Many agents have antiviral activity against all genotypes. 123

Available therapies can cure more than 95% of people infected with HCV within 8–12 weeks of therapy.345

Learn more about oral therapy (DAA) options from the University of Washington Infectious Disease Education & Assessment (IDEA) program.

Treatment recommendations

Except for pregnant people and children under 3, clinicians should treat people with detectable HCV RNA in their blood with oral DAA therapy. There is no need to wait for potential spontaneous viral resolution.

Clinicians should also:

• Conduct a full medical evaluation for chronic liver disease.
• Conduct a risk assessment and testing for HBV and HIV.
• Vaccinate against hepatitis A and hepatitis B as recommended.

For more information about management of people diagnosed with acute or chronic HCV infection, see the HCV Guidance: Recommendations for Testing, Managing, and Treating Hepatitis C from the American Association for the Study of Liver Diseases (AASLD) and the Infectious Diseases Society of America (IDSA).

Treatment precautions

DAA therapies are not approved for pregnant people and children under 3. There are efforts underway to develop prenatal treatment options and/or infant antiviral postexposure prophylaxis to prevent perinatal transmission.

Hepatitis B virus reactivation risk

Some co-infected patients receiving DAA therapy for HCV infection have reported reactivation of hepatitis B virus (HBV) infection.

Therefore, clinicians should test all patients starting HCV DAA therapy for HBV infection. The Centers for Disease Control and Prevention (CDC) recommends the following tests:

• hepatitis B surface antigen (HBsAg)
• antibody to hepatitis B surface antigen (anti-HBs)
• total antibody to hepatitis B core antigen (anti-HBc)

Clinicians should monitor people who test positive for HBsAg or for an isolated positive anti-HBc for reactivation of HBV infection while they are receiving treatment.

Learn more about treating HBV/HCV co-infected patients from the AASLD and IDSA. For more information on HBV reactivation, visit the American Gastroenterological Association.

Helping patients stay well

Your patient is considered cured of hepatitis C if there is no detectable HCV RNA after 12 weeks of treatment. This indicates they have had a sustained virologic response to therapy.

To help your patient stay well, you should also talk to them about:

• Maintaining a healthy diet and active lifestyle.
• Avoiding excessive alcohol intake.
• Checking with a provider before taking new prescription pills, over-the-counter drugs, or supplements.

You should remind patients of proper practices to avoid HCV transmission while on treatment and to avoid reinfection after successfully completing treatment, like

• Avoiding activities that can lead to transmission, like sharing injection drug use equipment.
• Avoiding blood, tissue, and semen donation.