Hepatitis C Treatment Options

When a person learns that they have Hepatitis C first there is shock, fear and then a steep learning curve to find out what the Hepatitis C treatment options are.
Ultimately this learning curve leads to these questions;
What medicines are used for the treatment of Hepatitis C?
What do they cost and how does one get them?

For many people the first pieces of information come from the mainstream medical professionals and the news is not good. The medicines are outrageously expensive.

However, in reality, this is not true. Because of the widespread availability of generic versions of the various Hepatitis C treatments Hep C medicines are actually quite cheap and easily accessible.

In this post I will try to explain what the Hep C treatment options are simply and concisely.

Background
Until 2014 the only available treatment for Hep C was a combination of Interferon + Ribavirin. This treatment had a very low cure rate and very bad side effects. Many people chose to not treat their Hep C rather than undergo Interferon treatment.
Then came Gilead’s Sovaldi (Sofosbuvir 400 mg) followed by a range of other Direct Acting Antivirals (DAAs), such as Daclatasvir, Ledipasvir and so on.
Initially these new treatments were based around Sofosbuvir but with the basic DAA technology quickly becoming public knowledge the other pharmaceutical companies started building molecules that could compete with Gilead’s Hepatitis C products and we saw such drugs as the Viekira Pack and Mavyret come onto the market.
Now in 2018 there are a number of non- Sofosbuvir based drugs available but none of them are any better than those original Sofosbuvir based drugs.
For example the Viekira Pak is not better than Harvoni for treating Hepatitis C genotype 1 and Mavyret is not a better pan-genotype treatment than Epclusa or Vosevi.
Importantly only the Sofosbuvir based drugs are available as cheap generic treatments. The prices for a 12 week treatment of a Sofosbuvir based generic range from US0 to US,000 depending on the genotype of Hep C that needs to be treated.
So here are generic Hepatitis C treatment options based on genotypes.
Genotype 1
Hepatitis C genotype 1 can be treated with a number of drug combinations including Harvoni (Sofosbuvir 400 mg + Ledipasvir 90 mg), Epclusa (Sofosbuvir 400 mg + Velpatasvir 100 mg) and the combination of Sofosbuvir 400 mg and Daclatasvir 60 mg. The cure rate using Harvoni or Sofosbuvir +Daclatasvir is about the same at around 95%. some indication that Sof + Daclatasvir may be slightly better than Harvoni. Epclusa appears to have the best cure rate at around 97%.

Genotype 2
Hepatitis C genotype 2 can be treated with either Sofosbuvir + Daclatasvir or Epclusa both have about the same cure rate for G2.

Genotype 3
Hepatitis C genotype 3 can be treated with either Sofosbuvir + Daclatasvir or Epclusa. Epclusa is more effective than Sof + Dac with 12 weeks treatment with Epclusa giving about the same cure rate as 24 weeks treatment with Sof + Dac. People with genotype 3 should consider doing more than 12 weeks treatment with Epclusa if it is possible as Genotype 3 is a difficult variety of Hepatitis C to clear.

Genotypes 4 and 5
Both these rare genotypes can be treated with any of the above mentioned medications.

Treatment Times
The general rule for treating Hepatitis C with DAAs is to treat for 12 weeks. However there are other factors to consider.
If you have failed previous treatments then you should consider doing 24 weeks treatment rather than 12 weeks.
If you have cirrhosis you should consider doing 24 weeks treatment.
If you have Hep C genotype 3 then it would be wise to consider doing more than 12 weeks treatment with Sofosbuvir 400 mg + Velpatasvir 100 mg (Epclusa).
It can be safely said that the longer the treatment time the higher the cure rates. The length of treatment time is something you should give significant thought to. If you have a good doctor then discuss treatment time with him or her.

For people with Hepatitis C Genotype 2 please note that this is an Australian chart and here they use Sovaldi + Ibavyr because they got a cheaper price on Ibavyr than was offered for Dalkina. Sovaldi + Daklinza is just as good for treating Genotype 2.

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