In the past, deciding to start treatment for hepatitis C—or hep C—was complicated. It was a matter of weighing the risks and the benefits. Taking older hepatitis C medications was notoriously difficult. Pegylated interferon was the standard treatment in combination with ribavirin. It required commitment to months of treatment that could have significant side effects. Treatment guidelines from the American Association for the Study of Liver Diseases (AASLD) and the Infectious Diseases Society of America (IDSA) now recommend other treatments for all genotypes—or strains—of the virus. Fortunately, there has been a lot of progress on hep C medications in recent years. There are now more options with fewer side effects—and they are all oral medicines. Hep C treatment times are also shorter than ever, with many regimens lasting only 8 to 12 weeks. Understand your options and work with your doctor to design the best hepatitis C treatment for you. The goal of these initial treatments for hep C is a sustained viral response (SVR). You achieve SVR when lab tests can’t detect any hep C virus in your blood six months after you stop medicines. SVR is essentially a hepatitis C cure. There are many factors that determine your likelihood of SVR. Ribavirin (Copegus, Ribasphere, Virazole) Ribavirin is an oral antiviral medicine. It is not effective against hep C by itself. So doctors always use ribavirin in combination with other hepatitis C medications. In the past, pegylated interferon was always the other drug. Today, doctors can choose other drugs to combine with ribavirin. But it’s not a first-line treatment for any genotype. Doctors may use it as part of an alternative treatment. Ribavirin has two side effects that are potentially serious. The first one is a blood disorder—hemolytic anemia—and the second is birth defects. Women should avoid pregnancy during treatment and for six months afterwards. Men who have pregnant partners should also avoid this drug. Daclatasvir (Daklinza) Daclatasvir is a NS5A replication complex inhibitor. This first-in-class drug blocks viral production in very early stages. AASLD/IDSA guidelines recommend it as alternative treatment in combination with sofosbuvir (Sovaldi) for genotypes 1a, 1b, 2 and 3. It was the first drug to show it can treat genotype 3 without interferon or ribavirin. The most common side effects are fatigue, headache, nausea and diarrhea. Simeprevir (Olysio) Simeprevir is a protease inhibitor. Drugs in this class directly attack the hep C virus. Protease inhibitors are very effective at treating hep C. Simeprevir is an alternative treatment for genotype 1, which is the most common genotype in the United States. Doctors use it in combination with another antiviral drug, sofosbuvir. The most common side effects are rash, itching and nausea. Sofosbuvir (Sovaldi) Sofosbuvir is a polymerase inhibitor. This drug also directly attacks the hep C virus. It just works on a different enzyme than protease inhibitors. Sofosbuvir is a primary or alternate treatment for all hep C genotypes. Doctors can also use it to treat people with both hep C and HIV. Like all hep C medicines, sofosbuvir must be combined with other antiviral drugs. Most people tolerate this medicine very well. Elbasvir-Grazoprevir (Zepatier) This tablet combines a protease inhibitor and an NS5A inhibitor. It is a main or alternate treatment for genotype 1a. It is also a main treatment for genotypes 1b and 4 in the AASLD/IDSA guidelines. Most people tolerate this once-daily drug well. In clinical trials, common side effects included fatigue, headache and nausea. Glecaprevir-Pibrentasvir (Mavyret) Current AASLD/IDSA guidelines recommend this combination tablet as a main treatment for all genotypes. It is the first treatment capable of treating all types of hep C, even when compensated cirrhosis is present. With compensated cirrhosis, people do not have symptoms. It combines a protease inhibitor and an NS5A inhibitor. Like other similar combinations, people tolerate well. Headache and fatigue are the most common side effects. Ledipasvir-Sofosbuvir (Harvoni) This was the first oral combination product for hep C. It adds an NS5A inhibitor to sofosbuvir. The AASLD/IDSA guidelines recommend it as a main treatment for hep C genotypes 1, 4, and 5 or 6. Most people tolerate this medicine very well. The most common side effects are fatigue and headache. Sofosbuvir-Velpatasvir (Epclusa) and Sofosbuvir-Velpatasvir-Voxilaprevir (Vosevi) The combination of sofosbuvir and velpatasvir is also a main treatment for all genotypes. You may hear people use the term ‘pangenotypic’ when drugs cover all six genotypes. Like the other products containing two drugs, the most common side effects are headache and fatigue. There is also a three-drug product that adds voxilaprevir under the brand name Vosevi. It is the first pangenotypic to combine three drugs from three different classes. Vosevi is for NS5A treatment-experienced people—meaning they have already taken an NS5A inhibitor. Diarrhea and nausea are additional side effects. Ombitasvir-Paritaprevir-Ritonavir/Dasabuvir (Viekira Pak) and Ombitasvir-Paritaprevir-Ritonavir (Technivie) This combination pack contains two tablets. One has ombitasivr, paritaprevir and ritonavir. The other is dasabuvir. All four are antiviral medicines. The AASLD/IDSA guidelines list this product in combination with ribavirin as an alternate treatment for genotype 1. Doctors may also use it without the dasabuvir tablet as an alternate treatment for genotype 4. The triple-combination of ombitasvir-paritaprevir-ritonavir is available under the brand name Technivie. Like other newer drugs, people generally tolerate these products well. Fatigue, nausea, and skin reactions are the most common side effects. With today’s treatments, sustained viral response is possible in over 95% of people. It’s a remarkable time to witness these enormous advances in the treatment of hep C.