I Have Hepatitis C. What Are My Treatment Options?

I Have Hepatitis C. What Are My Treatment Options?

As the options for treating hepatitis C (HCV) are increasing, so is the confusion. This is a good problem to have: with more treatment options come more opportunities for people with various HCV genotypes (GT), treatment history and varying levels of cirrhosis to get cured. But which regimen is right for which genotype or treatment history, and so on?

At the 2014 Liver Meeting of the American Association for the Study of Liver Diseases, Dr. Andrew Muir of Duke University, and a leading expert in HCV care and treatment, delivered a lecture called "Efficacy of Current and Future All-Oral Regimens". His presentation explained the various treatment regimens available for medical providers to prescribe in an extremely clear and accessible manner.

Project Inform believed that this presentation would also be valuable for patients. With Dr. Muir's permission, we have adapted his presentation, made minor adjustments and re-wrote it into a more patient-friendly manner to help those living with HCV make informed choices about the HCV regimens available to them.

This brief article will provide you with a list of approved and "off-label" (that is, not FDA approved but effective in treating HCV) for people with HCV, the length of treatment, and the sustained virologic rates (SVR, or cure) that each had during their clinical studies. As you will see in the list below, treatments are shorter and more effective than ever before.

You will also see below that pegylated interferon -- a once-weekly shot that carries a host of challenging side effects -- is nowhere to be found! These new regimens have the added benefit of being better tolerated with mild side effects. This list in not exhaustive, and any treatment decision will be done with your medical provider. We hope it provides you with a clear starting point in your journey to a cure from HCV.

I have genotype 1, have never been on treatment and do not have cirrhosis. What can I take?

RegimenLength of TreatmentClinical Trial SVR
Harvoni (viral load <6 million)8 weeks97%
Harvoni (viral load >6 million)12 weeks95%
Viekira Pak (GT 1a)12 weeks97%
Viekira Pak (GT 1b)12 weeks99.5%
Sovaldi + Olysio12 weeks95%

I have genotype 1, have never been on treatment, but I do have cirrhosis. What can I take?

RegimenLength of TreatmentClinical Trial SVR
Harvoni12 weeks97%
Viekira Pak12 weeks94%
Sovaldi + Olysio24 weeks100%

I have genotype 1, I took treatment before and it didn't work, and I don't have cirrhosis. What can I take?

RegimenLength of TreatmentClinical Trial SVR
Harvoni12 weeks95%
Viekira Pak12 weeks95%
Sovaldi + Olysio12 weeks95%

I have genotype 1, I took treatment before and it didn't work, and I do have cirrhosis. What can I take?

RegimenLength of TreatmentClinical Trial SVR
Harvoni24 weeks100%
Viekira Pak (GT 1a)12 weeks89%
Viekira Pak (GT 1a)24 weeks94%
Viekira Pak (GT 1b)12 weeks99%
Viekira Pak (GT 1b)24 weeks100%
Sovaldi + Olysio24 weeks100%

I am genotype 2, have never been on treatment and I do not have cirrhosis. What should I take?

RegimenLength of TreatmentClinical Trail SVR
Sovaldi + ribavirin12 weeks98%

I am genotype 2, have either been on treatment and it didn't work and/or I have cirrhosis. What should I take?

RegimenLength of TreatmentClinical Trail SVR
Sovaldi + ribavirin16 weeksTreatment experienced: 98%Cirrhosis: 60%

I am genotype 3, have never been on treatment and I do not have cirrhosis. What should I take?

RegimenLength of TreatmentClinical Trail SVR
Sovaldi + ribavirin24 weeks93%

I am genotype 3, have either been on treatment and it didn't work and/or I have cirrhosis. What should I take?

RegimenLength of TreatmentClinical Trail SVR
Sovaldi + ribavirin24 weeksTreatment experienced: 85%Cirrhosis: 60%

I am genotype 4. What should I take? (Note, results for both treatment naïve and experienced were the same)

RegimenLength of TreatmentClinical Trail SVR
Sovaldi + ribavirin24 weeks93%

I am co-infected with hepatitis C and HIV. What should I take?

All the regimens listed above can be taken in people living with HIV and HCV, and clinical data show similar response rates as people living with HCV alone. It should be noted that although Sovaldi and Viekira Pak are FDA approved for HCV treatment in people living with HIV as well, Olysio and Harvoni have not. They have been studied in people living with co-infection, and off-label use of these treatments is possible.

Conclusions

There are many treatment choices available for people living with HCV. The above charts are a snap-shot of these choices, but there are many other considerations such as side effects, other co-morbidities (such as kidney disease), and matters that one must consider before making that treatment decision.

Gather the help you need to make that decision: Speak with your medical provider, pharmacist of nurse about these options. Go to a support group and speak with other patients to hear about their experiences. Project Inform has joined with four other HCV organizations to staff The Support Partnership's "Help-4-Hep" national phone line. Call us at 1-877-HELP-4-HEP (1-877-435-7443) and speak with a trained counselor about your treatment options.