New drugs have greatly improved the treatment of hepatitis C in recent years. For more and more patients, that means the goal of a "cure" is within reach.
"We've been curing hepatitis C since the 1990s," says David L. Thomas, MD, MPH. He's a professor of medicine and chief of infectious diseases at Johns Hopkins School of Medicine. "It's just that there's a greater fraction of people who can be cured now."
As treatments keep getting better, nearly everyone with hepatitis C may be able to look forward to a disease-free future.
What Is a 'Cure'?
The goal of treatment is to get rid of the hepatitis C in your body. The technical term for this goal is "sustained virologic response (SVR)." That means the hepatitis C virus is not found in your blood six months after you stop taking medicine. An SVR is basically a cure.
Hepatitis C treatment isn't the same for everyone. It depends on which type of the virus you have. Each type is treated with a different drug or combination of drugs.
Most of those infected in the U.S. have type 1.
Hepatitis C Drugs
A turning point in treatment came with the use of interferon. The drug, approved by the FDA in 1991, boosts your immune system response to help it fight off the hepatitis C virus.
Interferon was followed in the 1990s with the release of another antiviral drug, ribavirin. The two drugs are given together to improve treatment. Thanks to interferon and ribavirin, the cure rate jumped from less than 5% in the 1980s to about 50% by the early 2000s.
But interferon and ribavirin have side effects, including muscle aches, fever, nausea, anxiety, and trouble sleeping. The drugs also need to be taken for up to 48 weeks to see results.
In 2011, the FDA approved two new antiviral drugs: Incivek (telaprevir) and Victrelis (boceprevir). They work by attaching to the virus to stop it from copying itself.
Combining Incivek or Victrelis with interferon and ribavirin boosted success rates as high as 70%. But the drug combination still wasn't ideal.
"Adding that third drug increased the side effects tremendously," says Anna Lok, MD. She's the director of clinical hepatology and professor of internal medicine at the University of Michigan Health System. "Even though the response rate was higher, the treatment was very poorly tolerated."
The New Standard in Hepatitis C Treatment
In 2013, two new drugs were approved by the FDA: Olysio (simeprevir) and Sovaldi (sofosbuvir). Both make important improvements in treatment.
Olysio is used together with interferon and ribavirin. Adding Olysio to the combination clears the hepatitis C virus in up to 80% of people who take it.
Sovaldi is the first drug approved by the FDA to be used without interferon for some types of hepatitis C (which means you won't have the side effects of interferon). But this interferon-free use of Sovaldi is only for people who have "genotype 2" and "genotype 3" hepatitis C. Those types are less common in the U.S. So most Americans with hepatitis C will still need interferon as part of their drug combination.