Contents

Hepatitis C treatment

Key points

  • While some people spontaneously clear the virus, most people need treatment to cure hepatitis C.
  • Highly effective treatments cure more than 95% of people with hepatitis C.
  • Medications used to treat hepatitis C are called direct-acting antivirals or DAAs.
  • Treatment typically involves taking one to three pills daily for eight or 12 weeks, with mild to no side effects. 
  • A few factors, like liver damage, other health conditions and previous treatment experience, are considered when choosing a treatment regimen.

Treatment

While about one in four people spontaneously clear the virus during the first six months of having hepatitis C, most people need treatment to cure their infection. Highly effective hepatitis C treatment cures more than 95% of people of hepatitis C with one course of treatment. To give treatment the best chance of curing hepatitis C, it is important that the medication is taken every day for the full treatment period as prescribed. This is called adherence. Hepatitis C treatment can still be effective for people who miss some of their doses. Although full adherence is encouraged, it is still possible to be cured of hepatitis C without it. While a person is taking hepatitis C treatment, their health will be monitored by a healthcare provider. 

Being cured of hepatitis C has many health benefits. Being cured means that the hepatitis C virus is no longer in the body, so it can’t cause any more inflammation or injury to the liver and it can’t cause other non-liver health issues related to hepatitis C infection. For some people, liver health, non-liver health issues related to hepatitis C infection, and quality of life may improve over time after cure. This includes lowering a person’s risk for liver cancer and liver failure. In addition to the health benefits, curing a person of hepatitis C prevents further transmission of the virus. This helps reduce the number of new infections in Canada and around the world.

Current treatment guidelines in Canada focus on treatment for chronic hepatitis C infection, which is when the infection has lasted for more than six months. These guidelines indicate that acute infections, which are infections that people have had for less than six months, should be treated on a case-by-case basis.

Sometimes, the first course of hepatitis C treatment does not cure a person’s hepatitis C infection. If this happens a person can still be cured of hepatitis C. In such cases, there are alternative hepatitis C treatments that are highly effective at curing hepatitis C when the initial treatment has failed.

Hepatitis C medications

Hepatitis C medications, called direct-acting antivirals or DAAs, work by preventing the virus from making copies of itself inside the liver. By stopping the virus from replicating, DAAs help the immune system eliminate the remaining virus, curing the person’s infection.

Treatment usually involves taking one to three pills once a day for eight or 12 weeks, depending on the specific combination of DAAs prescribed. In some cases, ribavirin, an antiviral medication that is not a DAA, may be added, such as when a person has severe liver injury.

Side effects of treatment

Side effects are generally mild to moderate and tend to diminish or stop after a few weeks. It is rare that the side effects are so severe that a person discontinues treatment. Common side effects of DAAs include headache, tiredness (fatigue), nausea and diarrhea. Ribavirin can cause other side effects such as irritability, difficulty sleeping, anemia and a rash or itchy skin. Most side effects can be managed with support from a healthcare provider. It is important for people to discuss all their symptoms with a healthcare provider, as they may not always be related to the medication.

Determining if someone is cured

When someone is cured of hepatitis C, it means that the hepatitis C virus is no longer in their body. This is known as a sustained virologic response (SVR). To confirm if someone is cured, a blood test is performed 12 weeks after the person completes hepatitis C treatment. This blood test is called a hepatitis viral load test. It measures the amount of virus in the body. If the test comes back as negative or undetectable, this means there is no virus in the blood and the person is cured of hepatitis C (sometimes called “achieving SVR”).

People who are cured of hepatitis C no longer have hepatitis C virus in their body, but they will always have hepatitis C antibodies in their blood. Because these antibodies remain, the person will test positive for hepatitis C antibodies for the rest of their life, even if they do not have an active infection.

There is no immunity against hepatitis C. If a person is cured of hepatitis C or they spontaneously clear the virus, they can still get it again if they are exposed to the virus. This is called reinfection. If reinfection occurs, the treatment process is the same as treating a person with hepatitis C for the first time. To learn more about preventing hepatitis C, check out Prevention and harm reduction.

Choosing a treatment regimen

When choosing a treatment regimen for hepatitis C, several factors are considered. By carefully considering these factors, individuals can work with their healthcare providers to decide on the most suitable medications. 

Factors to consider

Other health conditions or other medications

If a person has other health conditions, this might affect which treatment is used to cure their hepatitis C. This is because when people take medications or supplements for another condition at the same time, these medications can affect each other. This reaction is called a drug–drug interaction or, more commonly, a drug interaction. A drug interaction can make one or both medications less effective or it can increase side effects. A healthcare provider should know about all the medications (prescribed or not prescribed), supplements and other drugs a person is taking so they can choose hepatitis C treatment medications that will not interact with other products the person is taking or develop a plan to manage drug interactions.

Other health conditions that are commonly seen with hepatitis C include hepatitis B, HIV and chronic kidney disease. These health conditions can affect which treatment is used to cure a person’s hepatitis C. If a person has chronic hepatitis B, they should start hepatitis B treatment first. This is important because hepatitis C treatment can cause a flare-up of the hepatitis B virus in rare cases, which can lead to serious liver injury and complications. For people with HIV and hepatitis C co-infection, HIV treatment is usually started first. In some cases, there could be drug interactions between HIV and hepatitis C treatments, which would require a change in HIV treatment to allow hepatitis C treatment to be given. When the kidneys are injured because of chronic kidney disease, this affects their ability to process some hepatitis C treatments in the body, making some treatments less safe to take. However, there are hepatitis C treatments that are safe for people with chronic kidney disease. A healthcare provider will recommend a treatment that is approved for a person with advanced kidney disease.

Amount of liver injury

A healthcare provider will assess the level of liver injury a person has as part of their initial tests. The amount of liver injury a person has can affect decisions about which treatments are the best to take, how long treatment should last and when treatment should start. If a person’s liver is severely injured, they may need to get a liver transplant before being treated for hepatitis C.

Cirrhosis

Over time, the hepatitis C virus destroys liver cells, causing inflammation that leads to severe liver scarring and damage. This happens through a process called fibrosis. When most of the liver is scarred, this is called cirrhosis. Hepatitis C treatments are highly effective, including for people with cirrhosis. Having cirrhosis can change which treatments are safest and most effective and how long a person needs to take their treatment. A healthcare provider will consider the amount of liver injury a person has when recommending hepatitis C treatment.

Genotype or strain of the hepatitis C virus

In some cases, the genotype of the virus may impact the type of treatment that is chosen. There are six major strains, or genotypes, of the hepatitis C virus. They are numbered 1 through 6. There can be subtypes, such as 1a and 1b. The most commonly prescribed hepatitis C treatments used in Canada can cure any genotype of the virus. These are called pangenotypic treatments. Testing for the genotype before beginning treatment is not required if a person is going to take a pangenotypic treatment. However, there are some treatments that only treat specific genotypes of the virus. If these treatments are being considered, testing for genotype is required. 

Previous treatment experience

Whether or not a person with hepatitis C has been treated before will be considered when choosing a treatment combination. There are two categories of treatment experience:

  • people who have never been treated for hepatitis C (treatment naïve)
  • people who have been treated before and were not cured (treatment experienced)

There are treatments that are highly effective at curing hepatitis C in people who are treatment experienced. A person who was cured of hepatitis C and requires treatment for a reinfection is not considered treatment experienced. If reinfection occurs, the treatment process is the same as treating a person with hepatitis C for the first time. 

Children and adolescents

Hepatitis C treatment for children over the age of three is available in Canada. It is recommended that children who require treatment for hepatitis C be connected to a specialist with experience treating the pediatric population.

Reasons to delay treatment

Pregnancy

Hepatitis C treatment is generally not recommended during pregnancy, as there is very little information on the effects of DAAs during pregnancy. Research is being done on taking DAAs during pregnancy so this may change in the future. Treatment can be started once a person is no longer pregnant.

Treatment that includes ribavirin can cause severe birth defects and must not be taken during pregnancy. When a couple wants to have a baby, both partners should avoid using ribavirin for at least six months before trying to get pregnant.

A healthcare provider can help determine a treatment plan and timeline for a person who has hepatitis C and is pregnant or wants to have a baby.

Resources for service providers

Resources for clients

Revised 2025.