Treatment

Hepatitis C can often be treated successfully by taking medicines for several weeks.

If the infection is diagnosed in the early stages, known as acute hepatitis, treatment may not need to begin straight away.

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 chronic hepatitis C (those infected for 6 months or more) involves:

• tablets to fight the virus
• a test to see if your liver is damaged
• lifestyle changes to prevent further damage

There are 6 main strains of the virus. In the UK, the most common strains are genotype 1 and genotype 3. You can be infected with more than 1 strain.

You'll be offered the medicine most appropriate for your type of hepatitis C.

During treatment, you should have blood tests to check that your medicine is working.

If it's not, you may be advised to try another medicine. This will only affect a small number of people.

Your doctor will also assess your liver for damage (scarring), either with a blood test or a scan called a fibroscan.

At the end of your treatment, you'll have a blood test to see if the virus has been cleared and a second blood test 12 or 24 weeks after treatment has stopped.

If both tests show no sign of the virus, this means treatment has been successful.

Hepatitis C medicines

Hepatitis C is treated using direct-acting antiviral (DAA) tablets.

DAA tablets are the safest and most effective medicines for treating hepatitis C.

They're highly effective at clearing the infection in more than 90% of people.

The tablets are taken for 8 to 12 weeks. The length of treatment will depend on which type of hepatitis C you have.

Some types of hepatitis C can be treated using more than 1 type of DAA.

NHS-approved hepatitis C medicines include:

• sofosbuvir
• a combination of ledipasvir and sofosbuvir
• a combination of ombitasvir, paritaprevir and ritonavir, taken with or without dasabuvir
• a combination of elbasvir and grazoprevir
• a combination of sofosbuvir and velpatasvir
• a combination of sofosbuvir, velpatasvir and voxilaprevir
• a combination of glecaprevir and pibrentasvir
• ribavirin

For more information, see the NICE guidelines on:

• sofosbuvir for treating chronic hepatitis C
• ledipasvir-sofosbuvir for treating chronic hepatitis C
• ombitasvir-paritaprevir-ritonavir with or without dasabuvir for treating chronic hepatitis C
• elbasvir-grazoprevir for treating chronic hepatitis C
• sofosbuvir-velpatasvir for treating chronic hepatitis C
• sofosbuvir-velpatasvir-voxilaprevir for treating chronic hepatitis C
• glecaprevir–pibrentasvir for treating chronic hepatitis C

Side effects of treatment

Treatments with direct-acting antivirals (DAAs) have very few side effects. Most people find DAA tablets very easy to take.

You may feel a little sick and have trouble sleeping to begin with, but this should soon settle down.

Your nurse or doctor should be able to suggest things to help ease any discomfort.

You need to complete the full course of treatment to ensure you clear the hepatitis C virus from your body.

If you have any problems with your medicines, speak to your doctor or nurse straight away.

Side effects for each type of treatment can vary from person to person.

For a very small number of people, more severe side effects from hepatitis C treatments may include:

• depression
• skin irritation
• anxiety
• problems sleeping (insomnia)
• anorexia
• tiredness caused by anaemia
• hair loss
• aggressive behaviour

How effective is treatment?

Direct-acting antivirals (DAAs) cure 9 out of 10 patients with hepatitis C.

Successful treatment does not give you any protection against another hepatitis C infection. You can still catch it again.

There's no vaccine for hepatitis C.

If treatment does not work, it may be repeated, extended, or a different combination of medicines may be tried.

Your doctor or nurse will be able to advise you.

Things you can do during treatment for hepatitis C

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

These can include:

• eating a healthy, balanced diet
• exercising regularly
• cutting out alcohol or limiting how much you drink
• quitting smoking
• keeping personal items, such as toothbrushes or razors, for your own use
• not sharing any needles or syringes with others
• practising safer sex
• telling sexual partners who might need to get tested

Pregnancy and hepatitis C

The new hepatitis C medicines have not been tested in pregnancy.

You should not become pregnant while taking treatment as it could be harmful to unborn babies.

If you're pregnant, you must delay treatment until after your baby is born.

Speak to your doctor before starting hepatitis C treatment if you're planning to become pregnant in the near future.

You'll need to wait several weeks after treatment has ended before trying to get pregnant.

Women taking ribavirin should use contraception during treatment and for another 4 months after the end of treatment.

Men taking ribavirin should use a condom during treatment and for another 7 months after the end of treatment. This is because semen can contain ribavirin.

If you become pregnant during treatment, speak to your doctor as soon as possible to discuss your treatment options.

Deciding against treatment

Some people with chronic hepatitis C decide against treatment.

This may be because they:

• do not have any symptoms
• are willing to live with the risk of cirrhosis at a later date
• do not feel the potential benefits of treatment outweigh the side effects some treatments can cause

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.