Hepatitis C Is Curable: What Direct-Acting Antivirals Changed

Hepatitis C is now curable in the great majority of people who are treated. That sentence would have been wrong twenty years ago, and it is still news to many patients who were told otherwise at diagnosis.

What "cure" means here

Cure is defined as sustained virological response at 12 weeks (SVR12): no detectable virus in the blood twelve weeks after finishing treatment. Relapse after SVR12 is rare. For practical purposes, SVR12 means the infection is gone.

Modern direct-acting antiviral (DAA) regimens achieve SVR12 in over 95% of patients.

How direct-acting antivirals work

The older approach used interferon injections, which broadly stimulated the immune system. It worked perhaps half the time, took up to a year, and caused flu-like illness, depression and anaemia severe enough that many people could not finish.

DAAs instead block specific proteins the hepatitis C virus needs to copy itself. Three targets are used, and regimens combine agents from more than one class so the virus cannot escape by mutating a single site:

• NS3/4A protease inhibitors — names ending in *-previr* (glecaprevir, grazoprevir)
• NS5A inhibitors — names ending in *-asvir* (velpatasvir, ledipasvir, pibrentasvir)
• NS5B polymerase inhibitors — names ending in *-buvir* (sofosbuvir, dasabuvir)

The suffixes are a genuinely useful shortcut for reading an unfamiliar prescription.

Pangenotypic regimens

Hepatitis C has six main genotypes, and older treatment had to be matched to the genotype. Current first-line regimens are pangenotypic — they work across all of them, so genotype testing is no longer always required before starting.

Two combinations dominate: sofosbuvir with velpatasvir, and glecaprevir with pibrentasvir. Both are single daily tablets. Treatment usually runs 8 or 12 weeks depending on the regimen and whether cirrhosis is present.

What treatment actually involves

For most patients, one tablet a day for two to three months, with a blood test before starting, sometimes one during, and one at twelve weeks after. Side effects are typically mild — headache and fatigue are the common ones.

Two things do need care:

• Drug interactions. DAAs interact with a number of common medicines, including some statins, certain acid-reducing drugs, amiodarone, and St John's wort. A full medication list, including anything bought over the counter, needs to go to the prescriber.
• Hepatitis B reactivation. Anyone who has had hepatitis B can experience reactivation during DAA treatment, so screening for it beforehand is standard.

Cure is not the same as no follow-up

Clearing the virus stops ongoing liver damage. It does not undo damage already done.

Patients with cirrhosis before treatment remain at elevated risk of liver cancer afterwards and need continued surveillance — typically ultrasound every six months — indefinitely. This is one of the most commonly missed points after a successful cure.

Reinfection is also possible. Cure confers no immunity, so the exposure that caused the first infection can cause a second.

Why it is still under-treated

The barrier is rarely medical. It is that people do not know they are infected — hepatitis C is often symptomless for years — and that access to treatment varies enormously between countries.

If you are sourcing treatment internationally, our guide to importing prescription medicine covers what documentation is normally required. You can also browse our hepatitis C and infectious disease ranges.

This article is general information, not medical advice. Treatment decisions belong with a qualified clinician who knows your history. Every medicine mentioned is prescription-only and requires a valid prescription.