New Versus Old Treatments for Hepatitis C
Last updated: March 2023
Hepatitis C (HCV) treatment has come a long way. Before the 1990s, there were no treatment options. The first wave of drugs included interferon (a shot) and ribavirin (a pill). These were taken together and had some severe limitations.
Issues with older treatments
Treatment with interferon and ribavirin had many downsides. These drugs caused many side effects and were hard to tolerate. The side effects were often compared to chemotherapy.1
Interferon and ribavirin had to be taken in combination for 6 months to a year. Sometimes it was even longer. The cure rates of these drugs were also low. For some types of HCV, the cure rate was as low as 40 percent.1
Some people may have needed multiple rounds of these long-term and unpleasant drugs and still were not cured. There were few positives with this treatment, and it was the only option available for many years.1
Development of DAAs
Fortunately, in the early 2010s, the first direct-acting antiviral drug (DAA) was approved. Since then, several others have been released. Some target specific HCV genotypes or strains of the virus. Others target all types. Some DAAs are even approved for children. Most DAAs cause few to no side effects.2-4
DAAs come in pill form. They are often taken for 6 to 12 weeks at a time. Many DAAs have cure rates of more than 90 percent or even higher. A person is considered cured of HCV if they have no detectable virus in their blood 12 weeks after treatment. This is called achieving a sustained virologic response (SVR).2-5
Who gets DAAs?
Most experts agree that as many people as possible with chronic (long-term) HCV should be treated. DAAs are the preferred treatment today for chronic HCV.2,3
Some doctors will wait to treat those with acute (short-term) HCV infection. This is because as many as half with early HCV will clear the virus on their own. If a person does not clear the virus within 6 months, they have chronic HCV. At this point, many doctors will recommend treatment.2,3
To decide if a DAA is right for you, your doctors will consider your:3
- Other medical conditions
- HCV genotype
- Viral load (amount of active virus in the blood)
- Extent of liver damage
- Whether you have been treated for HCV before
At this time, there are no DAAs approved for pregnant women. However, women with HCV can be treated after birth to prevent further transmission.6
Concerns with DAAs
As with any new drugs, there are concerns with DAAs. Some DAAs can interact with other drugs. There is also a small risk a hepatitis B (HBV) infection will be reactivated. HBV can remain dormant (inactive) in the body and reactivate in certain situations. This can cause significant health issues. Before starting DAAs, your doctor may test you for HBV. They will also review all other drugs you take.4
One downside to DAAs is that they can be expensive. Fortunately, many drug companies and doctor’s offices have resources to help cover the cost. Some have pharmacy coupons or can connect you with other financial assistance programs. If you are prescribed a DAA and cannot afford it, talk with your doctor.