If you’ve just found out you have hepatitis C, you have a lot of questions. If you’re like most people with this condition, you probably never knew you had it until now.
You’re not alone. Hepatitis C isn’t rare in the U.S., especially among baby boomers -- people born between 1945 and 1965. People this age are five times more likely than others to get the virus, which causes swelling and scarring of the liver.
Even though it was surely a shock to get your test results, they’re your first step toward a cure.
And hepatitis C can be cured. It happens when your doctor finds no trace of the virus in your body 6 months after you finished the medication.
In 1990, strong drugs called interferons were approved to treat the disease. But they had severe side effects, and a low cure rate. “Now, we are curing more than 90% with pills,” says David L. Thomas, MD, director of the division of infectious Diseases at Johns Hopkins Medicine.
Fear looms large when people find out they have hepatitis C. “Most want to know if they will have to be on interferon or have a liver biopsy,” Thomas says. Some people have avoided getting care or being tested because they're afraid of these things.
Interferon is no longer required for most people, says Paul Gaglio, MD, medical director of liver transplantation at Montefiore Medical Center. “Most can be cured with one tablet, taken once a day for 8, 12, or 24 weeks.”
Next Step, More Tests
One of the first things to do is find a specialist to take over your care. Doctors trained to treat organs of the digestive tract (gastroenterologists), liver doctors (hepatologists), and infectious disease specialists all stay up to date on how to treat and cure hepatitis C.
Now, get ready for a few tests. Your doctor will want to find out which of six kinds (genotypes) of hepatitis C you have.
The doctor will also order an ultrasound test to see liver damage, says Kapil Chopra, MD, medical director of the Comprehensive Liver Program at the University of Pittsburgh.
He describes a procedure called a FibroScan, which can be done in the doctor’s office. A probe on the outside of your abdomen measures how stiff your liver is. Other tests include FibroSure, a score based on six signs (or markers) in a blood test, and liver biopsy, where the doctor takes a small sample of your liver with a needle or other tool.
These test results will help the doctor decide which treatment is right for you. They also may play a role in decisions made by your insurance company, Medicaid, or other sources of help with your payment.
Prevent and Protect
Right from the start, your doctor will talk about how to prevent more liver damage. Take these steps to protect your health:
- Give up alcohol or recreational drug use, for good. Even a small amount can harm you.
- If you haven’t had shots for hepatitis A and B, ask your doctor if you should get them.
- Check with your doctor before taking prescriptions, over-the-counter drugs, or supplements. Some are hard on the liver, so you should avoid them.
Follow these rules to keep people around you safe from the virus:
- Keep others away if you’re bleeding.
- Use bleach and water to clean objects or surfaces your blood may have spilled on or touched.
- Don’t donate blood, organs, or semen.
Treat to Cure
Once tests are done and the results are back, it’s time to plan for and begin treatment. Pharmacists, nurses, nurse practitioners, and doctor’s assistants that specialize in liver diseases may join the effort.
You are the most important player on your treatment team. Your doctor will stress that you must take your medicine just as prescribed. He’ll ask you to promise not to miss a check-up. If you do, he won’t be able to keep track of how you’re medicine is working or decide how long you should take it.
If you drink alcohol or use recreational drugs, stop on your own, or get into a treatment program. If you don’t, your insurance won’t pay for your hepatitis C medication. Or your doctor may not give it to you. These issues can be touchy, but remember: “Your doctor is interested in your overall health, not just treating your liver,” Chopra says.
Which treatment is right for you also depends on what other health problems you may have and any other medicine you’re taking. Some products, even something as simple as an antacid you can buy at the drugstore, can keep new hepatitis C drugs from working or cause side effects.
Doctors consider all these things -- along with how ready you are to do what you need to do to be cured -- before they set a plan in motion.
“All newly diagnosed patients should be considered for the best treatment today,” Chopra says. That’s an all-oral combination of drugs that doesn’t involve interferon.
Drugs called direct-acting antiviral (DAA) agents, approved in the past few years, fit this description. Your doctor will want to try them first, as long as you qualify. You’ll probably take a mix of pills.
Recently, two different drugs have been given approval as just one pill a day treatments. But elbasvir-grazoprevir (Zepatier) and ledipasvir-sofosbuvir (Harvoni) are both expensive. “The new treatments are transformative,” Thomas says. “Now, one thing I warn my patients about, because it’s going to come up, is the high cost of treatment. You shouldn’t expect to go to the corner drugstore and pick it up tomorrow.”
Patience Is Key
Even though you want to do all you can to get cured, there will be insurance hoops to jump through. Treatment requires pre-approvals, approvals, and justification for coverage. Expect to wait a while.
You can look at these delays in a couple of ways, Thomas says. “This is not like a cancer, which, if you wait a few weeks or a month to treat, it spreads so much it can’t be cured.”
Just because it’s safe to wait doesn’t mean you won't be anxious about having hepatitis C. But, Thomas says, “an added benefit of cure” can lift some of your worries.