As the options for treating hepatitis C (HCV) are growing, so is the confusion over what
to take. This is a good problem to have!
HCV Treatment guidelines
With more treatment options come more opportunities for a cure for people with various HCV genotypes (GT), treatment histories, and levels of cirrhosis. With these many options comes confusion about which regimen is right for which genotype or treatment history and so on.
The American Association for the Study of Liver Disease (AASLD), Infectious Diseases Society of American (IDSA), and International AIDS Society-USA (IAS-USA) have collaborated to provide medical providers with expert guidance on screening, managing, and treating HCV. This brief article provides you with a listing of the treatments that are approved or “off-label” (that is, not FDA approved for a particular use but shown to be effective for that condition or population) for people with HCV, the length of treatment, the clinical trial name, and the sustained virologic response rates (SVR, or cure) from each of these trials.
As you will see here, treatments are shorter and more effective than ever before. You will also see that pegylated interferon—a once-weekly injected medication that has a host of challenging side effects—is nowhere to be found. As such, these treatments have the added benefit of being better tolerated with fewer side effects.
This list is not exhaustive: We cover the first-line recommendations for genotypes 1, 2, 3, and 4 only. Of course, any treatment decision will 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.
What about HIV/HCV co-infection?
Everyone living with HIV and most everyone living with HCV should be treated for those infections, according to U.S. guidelines for the two conditions. 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 U.S. hep C treatment guidelines. Thus, all the regimens listed in this article can be taken by co-infected people, and clinical trials show similar response rates as 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. Any switch in your HIV medications should be done in collaboration with your HIV care provider.
At the time of publication, Sovaldi and Viekira Pak are FDA approved for HCV treatment in people living with HIV as well, but Olysio and Harvoni have not been. (Harvoni tablets contain Solvadi—generic name sofosbuvir—along with another hep C medication, ledipasvir.) It is likely Harvoni will be submitted for approval for use in co-infected persons by the end of 2015. That said, both Olysio and Harvoni have been studied in people living with co-infection, and off-label use of these treatments is possible.
WHAT ABOUT TREATMENT OPTIONS FOR PEOPLE WITH OTHER CO-MORBIDITIES (DECOMPENSATED LIVER DISEASE, KIDNEY [RENAL] DISEASE, OR POST-TRANSPLANT)?
Regardless of genotype, patients who have decompensated cirrhosis, kidney disease, or are post-transplant with HCV have treatment options that may mirror these recommendations, but should be done with more 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 to take.
Conclusions
There are many treatment choices available for people living with HCV. The charts here are a snapshot of the options, but there are many considerations such as side effects, other co-morbidities, and other matters to consider before making a treatment decision. Gather the help you need to make that decision. Speak with your medical provider, pharmacist, or nurse. 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 (877) HELP-4-HEP, or (877) 435-7443, to speak with a trained counselor about your treatment options. Read the guidelines at hcvguidelines.org.