Treatments for Hepatitis C

Reviewed by: HU Medical Review Board | Last reviewed March 2024 | Last updated: March 2024

The hepatitis C virus (HCV) is a virus that can infect your body. There are many treatment options for HCV. Treatment will depend on how much of the virus is in your body, which is called your viral load. It will also depend on the type of HCV you have and any liver damage you might have.1,2

Many people will not even realize they have HCV. In this case, the body can often recover by itself. This is called acute or short-term HCV. If you realize you have acute HCV, your doctor may recommend rest, a healthy diet, and avoiding alcohol. If you have HCV for longer than 6 months, it is called chronic hepatitis C. Treating chronic hepatitis C is more involved.1,2

Direct-acting antivirals

HCV is most commonly treated with a type of drug called direct-acting antivirals (DAAs). In many cases, DAAs can cure hepatitis C. They work by attacking the virus. You will likely have to take a DAA for 8 to 24 weeks. Your doctor may also prescribe a mix of DAAs.1-3

DAAs fall into 4 main types. Each type targets one or more proteins to stop HCV and lower the body's viral load.1-3

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NS3/4A protease inhibitors

NS3/4A protease inhibitors approved to treat HCV include:1,2

  • Glecaprevir
  • Grazoprevir
  • Paritaprevir
  • Voxileprevir

NS5A protein inhibitors

NS5A protein inhibitors include:1,2

  • Elbasivir
  • Ledipasvir
  • Pibrentasvir
  • Velpatasvir

NS5B inhibitors

NS5B inhibitors used to treat HCV include:1,2

Combination DAAs

Many DAAs work better when used together. In fact, nearly all of the above-listed medicines are available exclusively in combination with 1 or more other DAAs. Combination DAAs used to treat HCV include:1,2

  • Epclusa® (sofosbuvir and velpatasvir)
  • Harvoni® (ledipasvir and sofosbuvir)
  • Mavyret® (glecaprevir and pibrentasvir)
  • Vosevi™ (sofosbuvir, velpatasvir, and voxilaprevir)
  • Zepatier® (elbasvir and grazoprevir)

Before DAAs, HCV was treated with ribavirin or interferon. Ribavirin or interferon are antiviral medicines. Some DAA treatments will also include ribavirin or interferon.1,2

HCV treatments by genotype

There are 6 major genotypes or strains of HCV. The genotypes of HCV are:1-3

  • 1 (1a and 1b)
  • 2
  • 3
  • 4
  • 5
  • 6

Genotypes 1a, 1b, 2, and 3 are the most common types in the United States. Your doctor will use a test to determine which genotype you have. The type of DAA your doctor prescribes will likely depend on your genotype. Some DAAs, like Epclusa, Mavyret, or Vosevi, can treat all genotypes.1-3

Other factors that can impact your treatment include:1-3

  • If you have liver scarring and how serious it is
  • If you have received treatment for HCV before
  • Other health conditions you have
  • If you have ever had hepatitis B

Follow-up care after SVR

Achieving sustained virologic response (SVR) means the HCV virus cannot be detected in your body. This means the treatment was successful. However, you can still be infected with HCV again. Follow-up care after SVR may include:4

  • Avoiding risk factors for re-infection. This includes sharing needles, syringes, razors, and tattoo equipment, or having unprotected sex.
  • Your doctor may monitor your liver function to make sure it is still healthy.
  • You may have a follow-up test to make sure the virus is still not detected.

Liver transplant

If chronic HCV has led to liver damage, you may need treatments for these complications. If HCV infection has led to scarring (cirrhosis), you may need to see a liver doctor. They may use medications or procedures to manage your liver damage. In severe cases, some people with HCV may need a liver transplant. Chronic hepatitis C is the most common cause of liver transplants in the United States.1,2