Treating hepatitis C

Hepatitis C can often be treated successfully by taking a combination of medicines for several months.

Ifthe infection is diagnosed inthe early stages, known as acute hepatitis, treatment may not need to begin straightaway.

Instead, you may have another blood test after a few months to see if your body fights off the virus.

If the infection continues for several months, known as chronic hepatitis, treatment will usually be recommended.

Your treatment plan

Treatment for hepatitis C involves:

• makinglifestyle changes to help prevent further damage to your liver and reduce the risk of spreading the infection
• taking a combination of two or three medications to fight the virus this is known as combination therapy

You'll normally need to take medication for 12 to 48 weeks. The length of time will depend on the exact medicines you're takingand which version (strain) of the hepatitis C virus you have. Your doctor will advise you about this.

There are six main strains of the virus. In the UK, the most common strains are known as genotype 1 and genotype 3.

During treatment, you should have Blood tests to checkifyour medication is working. If the test shows treatment ishaving little effect, it may be stopped as further treatment may be of little use.

Lifestyle measures

There are somethings you can do to help limit any damage to your liver and prevent the infection spreading to others.

These caninclude:

• eating a healthy and balanceddiet
• exercising regularly
• cutting out alcohol or limiting your intake
• stopping smoking
• keeping personal items, such as toothbrushes or razors, for your own use
• not sharinganyneedles or syringes with others

Readsome FAQs about living with hepatitis C for more information.

Hepatitis C medications

Until relatively recently, treatment for chronic hepatitis C usually involved taking two main medicines:

• pegylated interferon a medication that encourages the immune system to attack the virus
• ribavirin an antiviral medication that stops the virus reproducing

These medications werefrequently just taken together,butnowadays they're often combined with a third medication, such as simeprevir or sofosbuvir. These are newer hepatitis C medications that have been shown to make treatment more effective.

Insome cases, a combination of these newer medications may be taken without needing to take pegylated interferon and ribavirin as well.

You can be trained to inject yourself at home. It usually needs to be taken forup to48 weeks, depending on your circumstances.

Ribavirin is available as capsules, tablets or an oral solution. It's normally taken twice a day with food. It needs to be taken alongside pegylated interferon forup to48 weeks.

For more information, see the National Institute for Health and Care Excellence (NICE) guidelines on peginterferon alfa and ribavirin for the treatment of chronic hepatitis C .

Newer medications

There are also a number of newer medicines that are often used to treat hepatitis C nowadays.

Some of these are taken alongside pegylated interferon and ribavirin, while some can be taken on their own or in combination with other new medicines.

These medications include:

• simeprevir
• sofosbuvir
• daclatasvir
• a combination of ledipasvir and sofosbuvir
• a combination of ombitasvir, paritaprevir and ritonavir, taken with or without dasabuvir

These medications are taken as tablets once or twice a day for between8 and 48 weeks, depending on the exact medicine you're taking, your hepatitis C genotype, and the severity of your condition.

These medicines are generally used to treat people with either genotype 1 or genotype 4 hepatitis C, although sometimes they'realso used to treat people with other genotypes.

For more information, see the NICE guidelines on:

• simeprevir for treatingchronic hepatitis C
• sofosbuvir for treating chronic hepatitis C
• daclatasvir for treating chronic hepatitis C
• ledipasvir-sofosbuvir for treating chronic hepatitis C
• ombitasvir-paritaprevir-ritonavir with or without dasabuvir for treating chronic hepatitis C

Research into even more effective medications is ongoing.

How effective is treatment?

The effectiveness of treatment for hepatitis C can depend on the strain of the virus you have.

Genotype 1 used to be more challenging to treat and, until quite recently, less than half of people treated would be cured.

However, with the newer medications now available, the chances of a cure can be much higher.

Combinations of tablets can now have a cure rate of more than 90%. This is higher than the chances of curing most other hepatitis C genotypes.

Treatment for genotype 3 will usually involve the standard treatments of pegylated interferon and ribavirin. About 70-80% of those treated will be cured.

If the virus is successfully cleared with treatment, it's important to be aware that you're not immune to the infection. This means, for example, that you could become infected again if you continue to inject drugs after treatment.

If treatment doesn't work, it may be repeated, extended, or tried using a different combination of medicines.

Side effects of treatment

Side effects of combination therapy involving interferon are quite common. The new tablet treatments have far fewer side effects and most people feel unaffected by them.

If your treatment involves interferon, side effects can include:

• flu -like symptoms, such as a headache, extreme tiredness(fatigue) and a high temperature (fever)
• a reducednumber of red blood cells (anaemia) , which can make you feel tired and out of breath
• a rash
• depression
• itchy skin
• feeling and being sick
• constipation or diarrhoea
• problems sleeping (insomnia)
• loss of appetite and weight loss

Hepatitis C medications can have unpredictable reactions when takenwith other medicines or remedies. Always check with your specialist, GP or pharmacist before taking other types of medication.

Any side effects may improve with time as your body gets used to the medications. Tell your care team if any side effect is becoming particularly troublesome.

Coping with side effectscan be challenging, but you should continue to take your medication as instructed. Missing dosesmay reduce the chances of you being cured.

Treatment during pregnancy

The medications used to treat hepatitis C, particularly ribavirin, can be harmful to unborn babies and aren't normallyused during pregnancy.

If you're pregnant when diagnosed with the infection, treatment will usually be delayed until you have given birth.

Otherwise, you'll be advised to use contraception throughout your treatment and may need to have regular pregnancy tests.

If you're a man taking ribavirin, youshouldn't havesex with a pregnant women unless you use a condom.

If your partner isn't pregnant, you should ensure contraception is used duringthe course of your treatment. Your partner may need to have regular pregnancy tests.

Deciding against treatment

Some people with chronic hepatitis C decide against treatment. This may be because they:

• don't have any symptoms
• are willing to live with the risk of cirrhosis at a later date
• don't feel the potential benefits of treatment outweigh the side effects treatment cancause

Your care team can give you advice about this,but the final decision about treatment will be yours.

If you decide not to have treatment but then change your mind, you can ask to be treated at any point.