Hepatitis C medications & treatments

Medically reviewed by  Jamie Winn, PharmD

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Hepatitis C is a viral infection of the liver that affects about 2.4 million people in the United States and around 58 million people around the world, according to the World Health Organization (WHO). They also estimated that in 2019, around 290,000 people died from hepatitis C, mostly from cirrhosis and liver cancer.

About half of the people with the hepatitis C virus (HCV) are asymptomatic and don’t know they have the infection. It is because of this, that if you are between the ages of 18 to 79, you should be screened for HCV, even if you have no symptoms or history of liver disease.

There is no vaccine for hepatitis C but 95% of those infected can be cured with antiviral medicines.

What is hepatitis C?

Hepatitis C is a swelling and inflammation of the liver caused by the hepatitis C virus. It is spread through contaminated blood. The majority of people who become infected are not aware of their infection because they have no symptoms.

Hepatitis C can be short-term (acute) or long-term (chronic):

• Acute hepatitis C virus infection frequently involves no symptoms at all. Symptoms may appear within a week or two after exposure and can last up to 6 months. The number of reported acute hepatitis C infections has more than quadrupled from 2010 to 2018, mainly due to increased injection of opioids and other drugs.
• Chronic hepatitis C virus infections have symptoms that last more than 6 months. It can lead to serious complications such as liver damage and cirrhosis.

Hepatitis C causes

You are at an increased risk if you:

• Have injected drugs (currently the most common mode of HCV transmission in the United States)
• Are a healthcare worker exposed to contaminated blood such as through a needlestick injury
• Were born to a mother who has HCV
• Have been on long-term kidney dialysis
• Had a blood transfusion or organ transplant before July 1992
• Received clotting factor or other blood products before 1987
• Have HIV
• Got tattoos or body piercings with unsterile equipment
• Have worked or been in prison
• Have unprotected sexual contact with an HCV-infected person
• Had an organ transplant from a donor infected with HCV
• Share personal items such as razors, toothbrushes, and nail clippers

You cannot catch hepatitis C through:

• Breastfeeding
• Sharing food
• Casual contact such as hugging, holding hands, or kissing
• Sneezing
• Coughing

How is hepatitis C diagnosed?

To properly diagnose hepatitis C, your doctor or healthcare professional will look at your symptoms, review your medical history, perform a physical exam, and run some blood tests.

Your doctor may take some blood and test it for:

• Anti-HCV antibodies. This antibody test measures these proteins your body makes in response to the hepatitis C in your blood. They are typically detectable about 12 weeks after infection.
• HCV RNA. If you have a positive test for anti-HCV antibodies, your doctor will run a nucleic acid test for HCV RNA to confirm your diagnosis. This RNA test is almost 100% accurate and can usually detect an infection within a few weeks after you have been exposed to the virus.

Once you have been diagnosed with chronic HCV infection, you may have further testing done, including:

• Genotype test. This test will determine which of the 6 genotypes of hepatitis you have been infected with. HCV genotype 1 is the most common (46%) genotype globally. The specific genotype will help guide your treatment plan.
• Liver function test. This test is used to assess liver damage by checking for elevated enzyme levels in your blood.
• Liver biopsy. This involves your doctor using a needle to take a small piece of tissue from your liver. They will then analyze to check for liver damage.

Hepatitis C symptoms

It may take months after becoming infected before you may see some of the following symptoms:

• Clay-colored stool
• Dark urine
• Fever
• Stomach pain (upper right part of your abdomen)
• Fatigue
• Jaundice (yellowing of the skin and eyes)
• Nausea
• Vomiting
• Loss of appetite
• Joint pain

What are some hepatitis C treatment options?

An acute infection of HCV does not typically require treatment. Your immune system response will usually help your resolve the infection. If your HCV infection becomes chronic, there are medicines used to treat it that have very high cure rates. The choice of medicine will depend on the genotype of HCV you have and the severity of your condition.

Antiviral Medications

Doctors use antiviral medicines as the main treatment for chronic hepatitis C infections to attack and clear the virus from your body. The choice of which medicine can depend on the genotype of HCV you have. In most cases, treatment with antivirals can cure the disease.

Some of the first treatments for HCV are still used such as Intron A (interferon alfa 2b), PEG-Intron (peginterferon 2b), and Copegus (ribavirin).

New medications from the last 10 years are now the drugs of choice, sometimes in combination with the older ones. These include Sovaldi (sofosbuvir), Epclusa (sofosbuvir/velpatasvir), and Harvoni (ledipasvir/sofosbuvir).

Liver transplant

If you develop serious complications from HCV, such as liver cancer, liver failure, or cirrhosis, your doctor may recommend a liver transplant.

Replacing your liver will most likely not cure you of your HCV infection and you will still have to take medications to manage your condition.

After receiving a liver transplant from a deceased donor, your average survival rates, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) are:

• 86% at 1 year
• 78% at 3 years
• 72% at 5 years
• 53% at 20 years

While there is currently no vaccine for hepatitis C, it may be beneficial to receive vaccines for the hepatitis A and hepatitis B viruses.

What is the best medication for hepatitis C?

The best medication for the treatment of hepatitis C will depend on the individual’s specific medical hepatitis C, medical history, medications that the individual is already taking that may potentially interact with hepatitis C medications, and the individual’s potential response to the treatment. It is advisable to always speak with your healthcare provider about the best medication for you. The table below includes a list of the most prescribed or over-the-counter medications for HCV treatment approved by the Food and Drug Administration (FDA).

Best medications for Hepatitis C

Your healthcare provider will determine the right dosage based on your response to the treatment, medical hepatitis C, weight, and age. Other possible side effects may exist; this is not a complete list.

What are the most common side effects of hepatitis C medications?

As with all medicines, those used for hepatitis C will have some side effects, depending on the class you are taking. The most common side effects include:

• Fatigue
• Headache
• Nausea
• Diarrhea
• Weakness
• Insomnia

What are some home remedies for hepatitis C?

If you have chronic HCV, certain lifestyle changes can help improve your overall health, such as avoiding alcohol and eating a healthy diet.

If you have HCV, there are some ways to keep from spreading it to other people, such as:

• Not sharing needles or syringes
• Not sharing personal items such as razors
• Do not have unprotected sex. Use a latex condom every time
• Cleaning and cover any cuts with a waterproof bandage
• Getting tattoos or piercings at licensed facilities
• Wearing gloves when treating someone else’s wound
• Not donating blood

Frequently asked questions about hepatitis C

What are the chances of someone with HCV infection developing cirrhosis or liver cancer?

Between 5 to 25 percent of people infected with HCV will develop cirrhosis within 10 to 20 years. Patients who develop cirrhosis have a 1%–4% annual risk of developing liver cancer.

Who should get tested for HCV?

The Centers for Disease Control and Prevention (CDC) now recommends one-time hepatitis C testing of all adults (18 years and older) and all pregnant women during every pregnancy. Other high-risk groups should get tested such as if you have injected drugs, were born to a mother who has HCV, have been on kidney dialysis, or have HIV.

How can I avoid spreading HCV to others?

A few ways to reduce the risk of spreading HCV to other people include:

• Not sharing personal care items, such as toothbrushes or razors
• Cleaning and covering any cuts with a waterproof dressing
• Cleaning any blood from surfaces with household bleach
• Not sharing needles or syringes
• Not donating blood

What medications should I avoid if I have HCV?

If you have acute or chronic hepatitis C, the following medications and supplements should be avoided:

• Tylenol (acetaminophen)
• Iron
• Vitamin A
• Amoxicillin
• St. John’s Wort
• Red yeast rice extract

Make sure to talk to your doctor about all medications and supplements you are taking or are considering taking.

What foods and drinks should I avoid if I have HCV?

If you have hepatitis C, there are some foods and drinks to avoid or consume less of, including:

• Raw oysters
• Shellfish
• Fatty foods
• Sugary foods
• Alcohol

Related resources for hepatitis C

• Hepatitis C overview. MayoClinic
• Hepatitis C key facts. World Health Organization
• Hepatitis C and the Hep C virus. WebMD
• Hepatitis C information. Centers for Disease Control and Prevention
• What is Hepatitis C? National Institute of Diabetes and Digestive and Kidney Diseases
• Hepatitis C basic information. HHS
• Everything you want to know about Hepatitis C. Healthline