Is Hepatitis C Curable?

World Hepatitis C Day design logo concept with liver surrounded by hands in a heart shape.
World Hepatitis C Day design logo concept with liver surrounded by hands in a heart shape.

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Hepatitis C (HCV) is part of a family of hepatitis viruses that are associated with liver damage, including an increased risk of liver cancer. The family of hepatitis viruses also includes hepatitis A and B—both of which are vaccine-preventable. Hepatitis C is not yet preventable by vaccine. However, as of around 2010, it is broadly considered to be curable. What changed? The development of safer and more effective treatments.

The Evolution of Hepatitis C Treatment

Hepatitis C has been around for a long time. Even before the development of these new treatments, between 15 to 25 percent of individuals infected with HCV did not become chronically infected. Their bodies were able to clear the virus on their own. However, until relatively recently there were few effective treatment options for hepatitis C.

Historically the major treatment regimen was a long course of pegylated interferon and ribavirin. However, these treatments have significant problems. They show an only moderate ability to get rid of the virus and they have significant side effects. For example, one study found that as many as a quarter of people taking interferon developed major depressive episodes due to the treatment regimen.

In addition, those drugs were contraindicated in individuals with advanced liver or kidney disease. That meant that many people with hepatitis C weren't even eligible to take them.

Interferon and ribavirin were also least effective against the most common types of hepatitis C. Genotype 1 was historically difficult to treat with pegylated interferon and ribavirin. The treatment regimen worked slightly better with genotypes 2 and 3, but those types were also less common.

The combination of poor efficacy and high intolerance were driving forces for the development of interferon-free methods of hepatitis C treatment. These drugs are known as direct acting antivirals (DAAs). It's DAAs that have led to hepatitis C being considered curable.

What a Hepatitis C Cure Means

Scientists have a very specific definition of what it means to be cured of hepatitis C. In order to be considered cured, patients must have undetectable HCV RNA on an HCV test 12 or 24 weeks after completing a course of therapy. The lack of detectable HCV is what is known as a sustained virological response (SVR).

At first, scientists were reluctant to consider an SVR an actual cure. However, research has shown that when HCV RNA is undetectable in both the blood and the liver, the virus has been cured. In theory, this means it may be possible to eliminate all hepatitis C.

More than 95 percent of hepatitis C patients are theoretically curable by an eight- to 12-week treatment regimen with DAAs.

Barriers to a Cure for Hepatitis C

While a potential cure for hepatitis C exists, it doesn't mean that the cure is accessible for most people carrying the virus. A number of factors have historically limited access to even the newly improved HCV treatments. One of the biggest is that screening for hepatitis C isn't universal. Many people don't know they're infected. Therefore, they can't be treated.

Another factor is that it's really important for people to adhere to their treatment regimen and follow-up plan. If someone's virus is resistant to a treatment, other options are available. However, doctors don't want more resistant viruses to develop, and thus they may be reluctant to prescribe these drugs to patients who are unlikely to take them reliably. There are also concerns that high-risk hepatitis C patients, such as those who inject drugs, may be at risk of re-infection.

Cost is a major concern for hepatitis C treatments. The required eight- to 12-week course of treatment can cost tens of thousands of dollars. This can put a substantial burden on insurance companies. That's particularly true for the public insurers who cover a large number of the patients at the highest risk for hepatitis C—individuals who inject drugs. Because of concerns about the cost, particularly in individuals at risk for re-infection, insurers may limit access to direct acting antivirals. They may restrict access to treatment to individuals with advanced liver disease and/or those who have been free from drug use for a period of time.

That said, cost-effectiveness research suggests that hepatitis C treatments are a good deal in the long term. That's true even when they're given to people with early, "silent" HCV or those who are at high risk for reinfection.

A Word from Verywell

According to the CDC, approximately 2.4 million people in the United States are infected with hepatitis C. If you were diagnosed with hepatitis C before the mid-2010s, the idea that the virus is curable may be new to you. It could be new to your doctor as well.

If you're living with HCV infection and have not been offered treatment, talk to your doctor. Depending on your health, where you live, and your insurance coverage, a potential cure may be available. What drugs are most appropriate for you, and the length of treatment, will depend on the specific sub-type of virus you're infected with. However, there are medication options for most people. It may be worth asking if there is a good option for you.

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