Hepatitis C Cure: Symptoms, Transmission, Treatments, and Costs

  • Medical Author:

    Sandra Gonzalez Gompf, MD, FACP is a U.S. board-certified Infectious Disease subspecialist. Dr. Gompf received a Bachelor of Science from the University of Miami, and a Medical Degree from the University of South Florida. Dr. Gompf completed residency training in Internal Medicine at the University of South Florida followed by subspecialty fellowship training there in Infectious Diseases under the directorship of Dr. John T. Sinnott, IV.

  • Medical Editor: Charles Patrick Davis, MD, PhD
    Charles Patrick Davis, MD, PhD

    Charles Patrick Davis, MD, PhD

    Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.

blood test hepatitis C std lab

What is hepatitis C (HVC, hep C), and what are the signs and symptoms of infection?

Hepatitis C (HVC, hep C) is one of several viruses that cause hepatitis (inflammation of the liver). It's hard for the human immune system to eliminate the virus from the body, and 85% of infections with hep C become chronic. Over decades, chronic infection damages the liver and can cause end-stage liver disease in the form of cirrhosis. Even though the damage to organ health is occurring, it usually doesn't cause symptoms or signs, and an infected patient's liver enzymes may be normal or only slightly elevated. In the U.S., infection with the hepatitis C virus is the most common cause of chronic hepatitis, and the most common reason for liver transplantation. Chronic infection also is associated with liver cancer.

Hepatitis C infection may cause disease outside of the liver (extrahepatic). Extrahepatic inflammatory conditions may include:

More importantly, chronic inflammation caused by chronic hepatitis C can lead to:

Symptoms occur usually late (years) after infection and may include:

How do you get hepatitis C, and is it contagious?

Hepatitis refers to any cause of liver inflammation and scarring of the liver (cirrhosis). It is contagious, and is spread from person-to-person by blood-to-blood contact. Causes of hepatitis A, B, C and E are viruses: Other types of noninfectious causes of hepatitis include:

How are hepatitis A, B, and E spread?

  • Transmission of hepatitis A and E: These forms of the virus are acquired from improper hygiene during food or drink preparation by someone who's infected.
  • Transmission of hepatitis B: This form is spread by blood-to-blood or sexual contact.

Quick GuideHepatitis C (Hep C) Symptoms and Treatment

Hepatitis C (Hep C) Symptoms and Treatment

Can You Drink Alcohol If You Have Hepatitis C?

Hepatitis is inflammation of the liver. Hepatitis C viral (HCV) infection causes this inflammation. There are several risk factors for contracting HCV infection due to the hepatitis C virus. One serious risk factor is drinking alcohol with HCV infection. The combination of HCV and alcohol can cause complications, and may result in more severe and serious liver injury including chronic cirrhosis (scarring of the liver). It also increases your chances of developing liver cancer; having an alcohol induced increase in viral replication; and rapid mutation of the hep C virus, which creates complications like:

  • Greater viral capacity
  • Increased liver cell death
  • Increased inflammatory response
  • Suppression of the immune responses
  • Fatty liver disease
  • Iron overload (hemochromatosis)

Reference: Schiff, ER, MD. et al. "Hepatitis C and Alcohol." National Institute of Alcohol Abuse and Alcoholism.

How is the virus spread?

  • Hepatitis C spreads most commonly through inadvertent blood-to-blood exposure from sharing needles during intravenous drug abuse.
  • Recreational drugs and HIV-infected men: There is an especially high incidence of HCV in those who inject recreational drugs and share injection equipment or needles, as well as HIV-infected men who have sex with men, thus these individuals should be screened for the disease at least once a year.
  • Sharing razors, toothbrushes, nail clippers, etc.: People with HCV should not share razors or toothbrushes with anyone else, because of the risk of blood-to-blood contact.

Lower risks of becoming infected

  • Sexual contact risks: The risk is very low of acquiring hepatitis C through sexual contact (even in long-term relationships). However, risky behaviors such as unprotected sex with multiple partners without condom use has a higher likelihood of sexual transmission. Using drugs and/or alcohol during sex, adds risks for any blood-borne infection, including HCV and HIV.
  • During pregnancy and breastfeeding: The risk is very low of your baby becoming infected inutero or while being breastfed.
  • Casual household items: Casual household contact, like sharing utensils or sharing drinks with someone, does not transmit HCV.
  • Tattooing: The risk of acquiring hepatitis C from tattooing is very low when performed by a licensed professional practitioner who uses proper infection prevention precautions in a facility that passes regular public health inspections.
  • Health care workers have a low risk of getting the disease from accidental needle sticks, about 1.8%. While the virus can be transmitted by blood transfusion, the blood supply has been carefully undergoing screening since 1992, and this risk is very rare.

How long can the virus live on surfaces and objects?

At room temperature, the hepatitis C virus can survive on surfaces and other objects for up to 3 weeks.

Can HCV go away without treatment?

About 15% of people who are infected with hepatitis C are able to eliminate it in the first several weeks of infection. At present, there is no clinical sign or test that helps predict which patient will clear the virus and which will develop chronic infection.

Is there a cure for hepatitis C infection?

Considerable progress has been made by past clinical trials in the medical treatment of hepatitis C. The rate of cure has increased (about 95%-98%) with the development of direct-acting, all-oral antiviral regimens, and the length of therapy is much shorter. Treatment recommendations continue to change as new medicines become available. Treatment helps to reduce progression of liver damage to cirrhosis, may prevent liver cancer, and may prevent spread of the virus to others.

What drugs cure the infection?

Most hepatitis C is currently treated with all-oral ("interferon-free") medical regimens of "direct-acting antivirals" or DAAs. DAAs is a term used to distinguish these hepatitis C drugs from an older generation of injected medicines (interferon, pegylated interferon) that act indirectly on the immune response to the hepatitis C virus. DAAs act directly on the virus to block different steps in its life cycle. There are several DAAs that are used in combinations that have been scientifically proven to cure hepatitis C. They are not interchangeable, and some are only available combined in one pill or dose pack as a specific combination. DAAs are not used as single-drug therapy because of the risk of the virus developing resistance and the fact that they work best in combinations. The choice of which regimen to use depends upon the genotype of the virus, the level of liver fibrosis (liver scarring), and any drug resistance that may be present (for example, someone who has received treatment before, but was not cured).

Examples of combination DAAs with cure rates between 91%-100% include:

Genotype 1a and 1b are the commonest genotypes in the United States. Of all the genotypes, genotype 3 is the most difficult to treat with DAAs alone and requires the use of pegylated interferon. Genotypes 5 and 6 may also require the use of pegylated interferon and ribavirin if there is no response to DAAs.

The goals of treatment include prevention of cirrhosis and liver cancer, stopping diseases that affect other organs, and preventing transmission to others. Thus people who should have higher priority for treatment include those with advanced liver fibrosis or who may need a liver transplant, those with extrahepatic diseases, and those with risk factors for transmitting HCV, such as women planning pregnancy, IV drug users, and men who have sex with men.

A complete list of all approved hepatitis C used to treat the infection is available at the FDA website.

What are the side effects of HCV drugs?

The DAA are overall very well tolerated. This is a major advantage over interferon-based treatments, which may cause many physical and mental side effects, some of which may be life-threatening. An older medicine, ribavirin, is used in certain combinations. Ribavirin may cause anemia that may require additional treatment for it.

In the era of highly effective DAAs, a new and unanticipated adverse effect of hepatitis C therapy is flare up of liver inflammation in those who have had hepatitis B.1 This may occur even if hepatitis B infection resolved years earlier. After early infection, hepatitis B may become "latent" or live in the liver cells without causing chronic hepatitis. Treating or eliminating the HCV somehow allows or triggers the hepatitis B to reactivate. This has caused hepatitis B to flare up severely and even cause liver failure in some cases. Some cases occurred even after the end of HCV therapy. Therefore people are now screened for hepatitis B antibodies before HCV treatment. If there is evidence of current or past hepatitis B, suppressive hepatitis B medication is given along with the treatment for hepatitis C. A complete list of approved drugs used to treat hepatitis B is available at the FDA website.

How long does it take to cure hepatitis C?

Depending on the drug combination, the specific genotype of hepatitis C that is to be treated, and whether the person has cirrhosis, the duration of medical therapy may be as few as 8 weeks, or up to 24 weeks. This is much shorter than the interferon-based treatments years ago that lasted up to 48 weeks. Generally, a person is not considered "cured" until the "RNA viral load" is undetectable (there is no hepatitis C detected in the blood) for 24 weeks after therapy is stopped. This is called "sustained virologic response" or SVR.

The presence of cirrhosis or liver fibrosis (liver scarring) is determined by liver biopsy, noninvasive fibrosis scans, or formulas that estimate liver fibrosis based on blood tests, such as AST-to-platelet Ratio Index (APRI) or Fibrosis-4 (FIB-4) Index.3

A very important aspect of treatment is the elimination of all alcohol consumption. Alcohol adds fuel to the fire when it comes to chronic hepatitis. Drinking alcohol greatly worsens liver fibrosis and speeds progression to cirrhosis, and there is no "safe" amount to drink for someone with chronic hepatitis. Drinking alcohol also makes it harder for the medications to be effective and may interfere with proper dosing.

Can I drink alcohol if I have hepatitis C?

The combination of any cause of hepatitis, such as alcohol on top of HCV, adds and accelerates liver damage. Both hepatitis B and C can cause chronic hepatitis and progression to cirrhosis and liver cancer, although the disease is much more likely to become chronic in the U.S. Therefore, people with chronic HCV should not drink alcohol and should talk to a doctor about vaccines for other hepatitis viruses.

Is there a vaccine to prevent hepatitis C?

Currently there is no vaccine to prevent hepatitis C infection.

How much does hepatitis C treatment cost?

It is impossible to say what the exact cost is for the various regimens, but it is in the tens of thousands of dollars. In general, out of pocket cost would be very high for the average person, and most people are treated through a health insurer, federal health benefits, or veteran's benefits. The cost of hepatitis C and the care of its complications, however, is much higher over a person's lifetime, and the roughly estimated savings is believed to make treatment a good health and financial investment. Liver transplantation alone may cost several hundred thousand dollars for the procedure alone, followed by several hundred thousand for the medications needed in the first 6 months afterward.2

Because negotiations are confidential business contracts, little is known about how much is actually paid for medical treatments by these drugs. One example is the medication sofosbuvir - estimated costs for a standard 12-week treatment was $84,000 in the US. Actual costs to individuals depend upon price contracts between pharmaceutical companies and health insurers, as well as government and private organizations. Thus, an individual with healthcare coverage may only pay a monthly co-pay.4

REFERENCES:

1. FDA. "FDA warns about the risk of hepatitis B reactivating in some patients treated with direct-acting antivirals for hepatitis C." Updated: Oct 04, 2016.
< https://www.fda.gov/Drugs/DrugSafety/ucm522932.htm>

2. Costhelper.com. "Liver Transplant Cost." 2017.
<http://health.costhelper.com/liver-transplant.html>

3. Gordon, SC. et al. "Prevalence of cirrhosis in hepatitis C patients in the Chronic Hepatitis Cohort Study (CHeCS): a retrospective and prospective observational study." Am J Gastroenterol. 2015 Aug;110(8):1169-77; quiz 1178. doi: 10.1038/ajg.2015.203. Epub 2015 Jul 28.
<https://www.ncbi.nlm.nih.gov/pubmed/26215529>

4. American Association for the Study of Liver Diseases; Infectious Diseases Society of America (AASLD/IDSA HCV). "HCV Guidance: Recommendations for Testing, Managing, and Treating Hepatitis C." Updated: Jul 06, 2016.
<http://hcvguidelines.org/full-report/overview-cost-reimbursement-and-cost-effectiveness-considerations-hepatitis-c-treatment>

CDC. "Hepatitis C FAQs for the Public." Updated: Oct 17, 2016.
<https://www.cdc.gov/hepatitis/hcv/cfaq.htm#cFAQ41>

CDC. "Viral Hepatitis: Hepatitis C Information. Updated: May 31, 2015.
<https://www.cdc.gov/hepatitis/hcv/index.htm>

Tamaki, M. et al. "Noninvasive Estimation of Fibrosis Progression Overtime Using the FIB-4 Index in Chronic Hepatitis C." J Viral Hepat. 2013 Jan;20(1):72-6. doi: 10.1111/j.1365-2893.2012.01635.x. Epub 2012 Jul 4.
<https://www.ncbi.nlm.nih.gov/pubmed/23231087>

FDA. "Hepatitis B and C Treatments." Updated: Jan 31, 2017.
<>https://www.fda.gov/ForPatients/Illness/HepatitisBC/ucm408658.htm>

Quick GuideHepatitis C (Hep C) Symptoms and Treatment

Hepatitis C (Hep C) Symptoms and Treatment

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Reviewed on 4/13/2017
References
REFERENCES:

1. FDA. "FDA warns about the risk of hepatitis B reactivating in some patients treated with direct-acting antivirals for hepatitis C." Updated: Oct 04, 2016.
< https://www.fda.gov/Drugs/DrugSafety/ucm522932.htm>

2. Costhelper.com. "Liver Transplant Cost." 2017.
<http://health.costhelper.com/liver-transplant.html>

3. Gordon, SC. et al. "Prevalence of cirrhosis in hepatitis C patients in the Chronic Hepatitis Cohort Study (CHeCS): a retrospective and prospective observational study." Am J Gastroenterol. 2015 Aug;110(8):1169-77; quiz 1178. doi: 10.1038/ajg.2015.203. Epub 2015 Jul 28.
<https://www.ncbi.nlm.nih.gov/pubmed/26215529>

4. American Association for the Study of Liver Diseases; Infectious Diseases Society of America (AASLD/IDSA HCV). "HCV Guidance: Recommendations for Testing, Managing, and Treating Hepatitis C." Updated: Jul 06, 2016.
<http://hcvguidelines.org/full-report/overview-cost-reimbursement-and-cost-effectiveness-considerations-hepatitis-c-treatment>

CDC. "Hepatitis C FAQs for the Public." Updated: Oct 17, 2016.
<https://www.cdc.gov/hepatitis/hcv/cfaq.htm#cFAQ41>

CDC. "Viral Hepatitis: Hepatitis C Information. Updated: May 31, 2015.
<https://www.cdc.gov/hepatitis/hcv/index.htm>

Tamaki, M. et al. "Noninvasive Estimation of Fibrosis Progression Overtime Using the FIB-4 Index in Chronic Hepatitis C." J Viral Hepat. 2013 Jan;20(1):72-6. doi: 10.1111/j.1365-2893.2012.01635.x. Epub 2012 Jul 4.
<https://www.ncbi.nlm.nih.gov/pubmed/23231087>

FDA. "Hepatitis B and C Treatments." Updated: Jan 31, 2017.
<>https://www.fda.gov/ForPatients/Illness/HepatitisBC/ucm408658.htm>

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