Acute HCV is treated similarly to other acute hepatitis diseases, with supportive measures based on symptom severity. Once HCV infection is identified, the patient is monitored to see if they clear the infection. If the infection continues and becomes chronic, then treatment is started. Once chronic HCV (infection lasting for 6 months or more) is diagnosed, direct-acting antiviral (DAA) medications can be prescribed. These medications have revolutionized HCV treatment and in many cases can be curative. DAAs can be taken orally and the specific medication used is based on which genotypes of HCV are involved. It is possible to be infected with more than one strain. Genotyping the HCV can be useful when considering which DAA to use, or, if treatment is failing, which DAA to convert to. Thus, laboratories may find that physicians are ordering HCV genotyping tests. HCV viral load testing is also now routine. Measuring HCV RNA levels allows physicians to monitor the efficacy of treatment. An undetectable HCV RNA level at the end of treatment is the goal. The patient's overall health, especially liver function, is also monitored during treatment. Lifestyle changes are also suggested to the patient during treatment and recovery. These include abstinence from alcohol and smoking, and promotion of exercise and a healthy diet. Below are some of the DAA and their associated HCV genotypes.
DAAs targeting hepatitis C virus replication are available and have proven highly effective in the eradication of hepatitis C infection:
- NS5A inhibitors: ledipasvir, ombitasvir, daclatasvir, elbasvir, velpatasvir, pibrentasvir
- Nucleoside NS5B polymerase inhibitors: sofosbuvir
- Non-nucleoside NS5B polymerase inhibitors: dasabuvir
- NS3/4A protease inhibitors: simeprevir, bocepevir, teleprevir, paritaprevir, grazoprevir, glecaprevir
