Since it’s a bloodborne virus, you’re more likely to be exposed to it if you come into contact with the blood of another person who’s already infected. As you might suspect, people who inject drugs are one of the groups of people at elevated risk. If you or a loved one fall into that category, here’s what you should know about hepatitis C treatment today.

Getting Tested Is Crucial 

The reality is that there’s still a stigma surrounding hepatitis C. And that inhibits some people from getting screened or getting treated for it. For example, if you have a history of intravenous drug use, you may be reluctant to talk about it–even if it’s been years since you last injected any drugs. You may be worried that people will judge you or think less of you. You may be reluctant to even let your doctor know about your past. As a result, you shy away from getting tested. The same goes for people who may currently inject drugs. They may not want to admit it, especially not to their doctors. But don’t let the stigma (or the remains of the stigma) deter you from getting tested. You can’t get treated if you don’t get tested first. And treatment is essential because hepatitis C can cause damage to your liver. Remember: viruses don’t care who they infect. Anyone can contract hepatitis C, so current screening guidelines recommend that everyone over the age of 18 get screened once. And if you’re at increased risk due to your job, activities or other circumstances, you should get screened again periodically. “If they are continuing to use drugs on an ongoing basis, we recommend retesting on an annual basis,” adds Anurag Maheshwari, MD, who specializes in liver disease at the Melissa L. Posner Institute for Digestive & Liver Disease at Mercy Medical Center in Baltimore.

Treatment Options Are Much Better Than They Used to Be

If you’ve ever heard anyone talk about what treatment was like 15 or 20 years ago, you might be a little reluctant to undergo treatment, too. Back then, your treatment options were 26 to 52 weeks of weekly injections of a medication called interferon, usually with an additional daily oral medication called ribavirin. But as Erika Harrington, a clinical pharmacist at the Cleveland Clinic, notes, the combination of interferon injection with ribavirin often caused weight loss, hair loss, low blood counts, anxiety, irritability, emotional lability, agitation, depression and even suicidal thoughts. Many people weren’t sure they could slog through an entire year, but many tried because they were eager, even desperate, to get cured, says Harrington. And here’s the kicker: the cure rates were low. Then came a gamechanger: direct-acting antivirals, or DAAs. Rather than commit to a year of injections, you only have to take an oral medication for 8-12 weeks, depending on which one your doctor prescribes for you. The side effects are minimal—typically fatigue, headaches, or some diarrhea and cramping, according to Harrington. “It’s not something they will have to endure for the entire treatment,” she adds. The two most commonly used DAAs are combination drugs:

Mavyret (glecaprevir /pibrentasvir). Mavyret was first approved by the FDA in 2017 to treat all six genotypes of chronic hepatitis C. You take three tablets with food once a day for eight weeks. Epclusa (sofosbuvir /velpatasvir). The FDA first approved Epclusa in 2016 to treat adults with any of the six genotypes of chronic hepatitis C. You take one pill with or without food once a day for 12 weeks.

These two drugs are considered equally effective, says Harrington, who is working with a program called OH-HAMP to teach and mentor primary care providers to screen, identify, treat and cure patients with hepatitis C, particularly in underserved areas. Other DAAs that can be used in various circumstances include Harvoni (ledipasvir/sofosbuvir) and Zepatier (elbasvir/grazoprevir). And best of all, DAAs are very effective: the cure rate with DAAs exceeds 90% and may be as high as 95%-99%. So, if you do test positive and need to undergo treatment, your options are much better than they used to be. You can help yourself by reducing or eliminating risky behaviors Risky behaviors leave you open to infection–or reinfection. “Unfortunately, reinfection can and does occur,” says Harrington. “Resuming high-risk behaviors puts you right back at risk for infection.” So, it’s important to understand what the risky behaviors are, so you can minimize them. According to the Centers for Disease Control and Prevention (CDC), some of the possible routes of transmission of the hepatitis C virus include:

Sharing needles or other contaminated drug-injection paraphernaliaSex with an infected personTattoos or body piercings with contaminated equipmentSharing personal items like razors and toothbrushes that have come into contact with infected blood

You Can Be Treated Again

If you’ve been treated in the past for a hepatitis C infection but you’ve gotten reinfected—either with the same genotype or a different one—the good news is that you can be treated again. And even better news: research suggests that the retreatment cure rate with direct-acting antivirals hovers around 95%. However, the treatment may be a little different if you’ve been treated in the past. Certain medications are recommended more for certain genotypes (and subgenotypes) of hepatitis C than for others, for example. And hepatitis C treatment guidelines also vary, based on whether you have cirrhosis (scarring of the liver) and how severe it is. So, your doctor might not prescribe the same medication to you, depending on the genotype you have and the state of your liver.
But experts recommend that you get retreated if you do get infected with hepatitis C again—both for your own health, as well as for others. “Because you can get treated, you can prevent yourself from transmitting the disease to others,” says Dr. Maheshwari. Next up: What Is Hepatitis C and How Do You Get It? Expert Answers to Your Questions About This Curable Condition

Sources:

CDC. Hepatitis C Questions and Answers for the Public.Epclusa dosing information.Gastroenterology. Status of Direct-acting Antiviral Therapy for HCV Infection and Remaining Challenges.Erika Harrington, clinical pharmacist at the Cleveland ClinicHCVGuidelines.org. HCV Testing and Linkage to Care.HCVGuidelines.org. Initial Treatment of Adults with HCV Infection.HHS. Hepatitis C Basic Information.HHS. Viral Hepatitis in the United States: Data and Trends.Anurag Maheshwari, MD, who specializes in liver disease at the Melissa L. Posner Institute for Digestive & Liver Disease at Mercy Medical Center in Baltimore.Mavyret dosing information.New England Journal of Medicine. Sofosbuvir, Velpatasvir, and Voxilaprevir for Previously Treated HCV Infection.Open Forum Infectious Diseases. Re-treatment of Hepatitis C Infection After Multiple Failures of Direct-Acting Antiviral Therapy.World Health Organization. Hepatitis C.