Five years ago, the list of hepatitis C (HCV) treatment options would have been very short and no one would have been excited to take them! Today, we have 10 FDA-approved direct-acting antivirals (DAAs), as well as ribavirin, for treating all HCV genotypes in nearly all patients. With so many options, there can be confusion over what treatment to take.
A Patient’s Guide to the Professional Guidance: AASLD/IDSA HCV treatment guidelines
There are many treatment options for people with all HCV genotypes (GT), treatment histories, levels of cirrhosis, and other co-morbidities (things like renal disease or HIV/HCV co-infection). With so many options comes confusion about which regimen is right for which genotype or treatment history and so on. This confusion goes for patients and providers alike!
The American Association for the Study of Liver Disease (AASLD) and the Infectious Disease Society of American (IDSA) produce a guide to help medical providers with expert guidance on screening, managing, and treating HCV. This section is designed to provide you with a listing of these recommendations for treating HCV in treatment-naïve and treatment-experienced persons, with and without compensated cirrhosis. All of these treatments are FDA approved, but there are also some “off-label” options (that is, not FDA approved for a particular use but shown to be effective and safe for that condition or population) for people with HCV.
If you’ve talked to someone who took the earlier HCV treatments, you likely heard nightmare stories of a yearlong treatment with terrible side effects that didn’t always cure people. As you will see in this section, treatments are now shorter—8 or 12 weeks for everyone—and the cure rates are around 95-100%. The treatments have the added benefit of being better tolerated with fewer side effects. For information on possible side effects, check out the individual drug pages found in this year’s guide.
This list of treatment options is not exhaustive: We cover the recommended treatments only. There are alternatives listed in the HCV guidance, and your provider can review those with you should you need them. Of course, any treatment decision should be done with your medical provider. We hope this article provides you with a clear starting point in your journey to a cure from HCV.
Who should be treated?
In short, everyone! Current HCV treatment guidelines recommend treatment for everyone, regardless of severity of liver disease, co-morbidities (what other diseases one might have, including HIV or kidney disease), or current (or past) substance using history. The only patients who should not consider treatment are those with less than 6 months to live who would not benefit from HCV treatment or a liver transplant.
That said, sometimes treatment gets denied. Medical providers might not think someone who uses drugs should be treated because they fear the patient won’t take the medications consistently or will re-infect themselves. Some insurance companies also have “sobriety” restrictions, requiring a varying period of abstinence from drugs or alcohol before treatment. These restrictions are unnecessary barriers, as research and real-world experience shows that people who use drugs or drink alcohol can and do take their HCV medications properly, get cured at similar rates as their non-drug using counterparts, and do not re-infect themselves at high rates. People who use drugs are part of the “everyone” we reference above!
Additionally, some insurance companies, including state Medicaid programs, may have restrictions for treatment based on severity of disease: That is, if you have hep C, but it has yet to do much damage to your liver, you have to wait for the cure until it does! For example, if you are infected with HCV, but only have a fibrosis score of F1, you may not be eligible, but when the disease progresses to F3, you can get treated and cured. If this sounds ridiculous to you, that’s because it is. Again, everyone should be cured!
If you find you get denied treatment, call HELP-4-HEP (see below for details) and they can help you with the appeals process to make treatment happen. Sometimes this is as easy as having your medical provider write a letter, while other times it can be more complex. Regardless, don’t do it alone. Don’t let “No” stop you from getting cured. Get the support to get treated. You deserve it!
What about HIV/HCV co-infection?
Just as everyone living with HCV alone should be treated for their disease, this is equally true of people co-infected with HIV/HCV, according to U.S. guidelines for both diseases. Fortunately, the same hep C treatment options are available for people co-infected with both viruses.
HIV/HCV-co-infected persons should be treated and retreated the same as persons without HIV infection, according to the AASLD/IDSA Guidance. Thus, all the regimens listed below can be taken by co-infected people, and the cure rates show similar response rates as they do for people living with HCV alone.
Patients living with co-infection may have to adjust their HIV regimen to avoid drug-drug interactions, but no one should ever stop their HIV medications to accommodate their HCV ones. Switching HIV medications can be a very traumatic experience for someone, and if this is an issue for you, do not hesitate to talk to your medical provider about this.
Regardless, your HIV and HCV medical provider should be in consultation with one another, and any switch in your HIV medications should be done in collaboration with your HIV care provider.
What about the treatment options for people with other co-morbidities?
Regardless of genotype, patients who have decompensated cirrhosis, kidney (renal) disease, or are post-transplant with HCV have treatment options, but they should have enhanced monitoring by a medical practitioner who has expertise in managing that condition, ideally in a liver transplant center. If you fall into one of these patient categories, consult with your provider about the best course of care and treatment to take.
Conclusions
There are many treatment choices available for people living with HCV. See treatment charts online for both treatment-naïve and treatment-experienced patients. These are a snapshot of the choices, but there are many considerations such as side effects, co-morbidities, and other matters that one must consider before making that treatment decision. Gather the help you need to make that decision: Speak with your medical provider, pharmacist, or nurse about these options. Go to a support group and speak with other patients to hear about their experiences. Project Inform and four HCV organizations staff The Support Partnership’s “Help-4-Hep” national HCV phone line. Call us at (877) HELP-4-HEP, or (877) 435-7443, and speak with a trained counselor about your treatment options. See the guidelines at hcvguidelines.org.