Hepatitis C treatment is a fast-moving area of medicine, with new drugs frequently coming onto the market and a constant stream of studies identifying the most effective treatment for specific groups of patients.
To help doctors across the country make sense of this complexity and to help people get the best treatment, expert clinicians have prepared guidelines.
Who Should Get Treatment?
The guidelines recommend treatment for virtually everyone who has hepatitis C. Specific recommendations are made for people in a wide range of circumstances.
This includes people who have both HIV and hepatitis C. The guidelines for their treatment are exactly the same as for people who only have hepatitis C, apart from the need to check that the medicines used for each condition don't interact with each other.
But the guidelines also acknowledge the reality that many insurance companies and health plans will only cover treatment for people who are already quite ill. They recommend that -- when necessary -- treatment be prioritized for people with advanced liver disease. This includes those who have a scarred liver or symptoms in other parts of the body, as well as those who've had a liver transplant.
What Treatment Should You Take?
The good news is that the currently recommended treatments are more effective and have far fewer side effects than earlier treatments. They usually no longer include weekly injections of pegylated interferon.
The recommendations depend on your hepatitis C genotype. In the U.S., three quarters of people living with hepatitis C have genotype 1, whereas other genotypes are more common in other parts of the world.
If you have genotype 1, there's now a choice of three therapies: Gilead's Harvoni (ledipasvir/sofosbuvir), AbbVie's Viekira Pak (dasabuvir/ombitasvir/paritaprevir/ritonavir), or Gilead's Sovaldi (sofosbuvir) taken alongside Janssen's Olysio (simeprevir). The range of options should help people who have both HIV and hepatitis C choose a therapy that can be safely taken with their HIV treatment.
The same drugs are recommended for people new to hepatitis C treatment and for those who've had treatment before that wasn't successful.
Many people will only need to take a 12-week (three-month) course. A longer course of 24 weeks (six months) may be needed if hepatitis C has seriously damaged your liver (in medical language: compensated cirrhosis).
Around one in five Americans living with hepatitis C has either genotype 2 or 3. For both, the recommended treatment is Gilead's Sovaldi plus ribavirin. Most people with genotype 2 and 3 should take it for 12 weeks, however, those with genotype 2 and cirrhosis should extend treatment to 16 weeks, while those with genotype 3 who are "interferon-eligible" may need a 24-week course.
There are specific recommendations for people with advanced liver disease and for those with the rarer genotypes 4, 5 and 6. This can involve additional drugs and different lengths of treatment.
The guidelines will be updated whenever important research comes out and the most up-to-date recommendations can be found online.