Hepatitis C Treatment Calculator
Determine optimal hepatitis C treatment regimen based on genotype, cirrhosis status, and prior treatment history. Pangenotypic direct-acting antivirals (DAAs) offer cure rates exceeding 95%.
Treatment Parameters
Additional Factors
Understanding Hepatitis C Treatment
Direct-Acting Antivirals (DAAs)
Modern HCV treatment uses all-oral DAA regimens that directly inhibit viral replication. These medications have revolutionized HCV treatment with:
Advantages
- • Cure rates >95% across all genotypes
- • Short treatment duration (8-16 weeks)
- • Excellent tolerability
- • Minimal side effects
- • No interferon or ribavirin (usually)
- • Once-daily dosing
DAA Classes
- • NS5A inhibitors (velpatasvir, pibrentasvir)
- • NS5B polymerase inhibitors (sofosbuvir)
- • NS3/4A protease inhibitors (glecaprevir)
- • Pangenotypic regimens combine multiple classes
Treatment Monitoring
Recommended Timeline:
- Baseline:HCV RNA, genotype, CBC, hepatic panel, HIV/HBV testing, pregnancy test
- Week 4:Check adherence, side effects (HCV RNA optional)
- End of Tx:HCV RNA, hepatic panel
- Week 12 post-Tx:HCV RNA for SVR12 assessment (primary endpoint)
Drug Interactions
DAAs have important drug interactions that must be checked before treatment:
- •Avoid: Amiodarone (bradycardia with sofosbuvir), rifampin, St. John's wort, carbamazepine
- •Caution: Proton pump inhibitors, statins, antiretrovirals, immunosuppressants
- •Resource: Check HEP Drug Interactions website (hep-druginteractions.org) before prescribing
Frequently Asked Questions
What does SVR mean and is it a cure?
SVR (Sustained Virologic Response) means HCV RNA is undetectable 12 weeks after completing treatment. SVR12 represents a virologic cure with >99% chance of permanent viral clearance. However, there is no immunity - patients can be reinfected if re-exposed to HCV. Patients with cirrhosis still need HCC surveillance even after achieving SVR.
What are pangenotypic regimens?
Pangenotypic regimens are DAA combinations that are effective against all HCV genotypes (1-6). Examples include glecaprevir/pibrentasvir and sofosbuvir/velpatasvir. These regimens simplify treatment by eliminating the need for genotype testing in some cases, though genotype testing is still recommended to optimize treatment duration and predict response.
Can hepatitis C come back after successful treatment?
True relapse after achieving SVR12 is extremely rare (<1%). If HCV RNA becomes detectable after SVR, it's almost always reinfection from new exposure rather than relapse. Reinfection is a concern in people who inject drugs or have other ongoing risk factors. Reinfection can be treated again with DAAs with similar success rates.
Do I still need treatment if I have no symptoms?
Yes, all patients with chronic hepatitis C should be considered for treatment regardless of symptoms or liver disease stage. HCV causes progressive liver damage over decades, even without symptoms. Early treatment prevents cirrhosis, liver failure, and hepatocellular carcinoma. Modern DAAs are so well-tolerated that there are few contraindications to treatment.
How long does hepatitis C treatment take?
Most patients require 8-12 weeks of treatment with modern DAAs. Treatment-naive patients without cirrhosis often qualify for 8-week regimens (e.g., glecaprevir/pibrentasvir). Patients with cirrhosis, prior treatment failure, or decompensated liver disease may need 12-16 weeks. This is dramatically shorter than old interferon-based regimens which lasted 24-48 weeks.
What are the side effects of DAA treatment?
Modern DAAs are very well tolerated. The most common side effects are mild and include fatigue, headache, and nausea. Serious side effects are rare. This is a dramatic improvement over interferon-based therapy, which caused flu-like symptoms, depression, and required injectable medications. Most patients complete DAA therapy without significant side effects.
Can I be treated if I have kidney disease or am on dialysis?
Yes, glecaprevir/pibrentasvir is approved for all stages of kidney disease including dialysis without dose adjustment. Sofosbuvir-based regimens were previously avoided in severe kidney disease (eGFR <30) but recent data suggest they can be used safely in many cases. Discuss options with your hepatologist or nephrologist.
Will cirrhosis improve after HCV treatment?
Yes, achieving SVR can lead to regression of liver fibrosis and even cirrhosis over time. Liver inflammation decreases, and fibrosis markers improve in most patients. However, the risk of hepatocellular carcinoma (HCC) persists in patients with cirrhosis even after SVR, so lifelong HCC surveillance (ultrasound every 6 months) is still recommended. Decompensated cirrhosis may not fully reverse.