Editing Hepatitis C (section)

== Treatment ==
Those with chronic {{nowrap|hepatitis C}} are advised to avoid [[alcohol (drug)|alcohol]] and medications that are [[Hepatotoxicity|toxic to the liver]].<ref name=AFP2010 /> They should also be [[vaccinated]] against [[hepatitis A]] and [[hepatitis B]] due to the increased risk if also infected.<ref name=AFP2010 /> Use of [[acetaminophen]] is generally considered safe at reduced doses.<ref name=Kim2016>{{cite journal | vauthors = Kim A | title = Hepatitis C Virus | journal = Annals of Internal Medicine | volume = 165 | issue = 5 | pages = ITC33–ITC48 | date = September 2016 | pmid = 27595226 | doi = 10.7326/AITC201609060 | type = Review | s2cid = 95756 }}</ref> [[Nonsteroidal anti-inflammatory drug]]s (NSAIDs) are not recommended in those with advanced liver disease due to an increased risk of bleeding.<ref name=Kim2016/> [[Ultrasound]] surveillance for [[hepatocellular carcinoma]] is recommended in those with accompanying cirrhosis.<ref name=AFP2010 /> Regular, moderate [[coffee]] consumption, especially [[Caffeine|caffeinated]], has been associated with a slower rate of liver [[fibrosis|scarring]] in those infected with HCV.<ref name=Kim2016/><ref>{{cite journal|vauthors=Ruiz-Margáin A, Román-Calleja BM, Moreno-Guillén P, González-Regueiro JA, Kúsulas-Delint D, Campos-Murguía A, Flores-García NC, Macías-Rodríguez RU|date=15 October 2021|title=Nutritional therapy for hepatocellular carcinoma|journal=World J Gastrointest Oncol|volume=13|issue=10|pages=1440–1452|doi=10.4251/wjgo.v13.i10.1440|pmc=8529929|pmid=34721776|doi-access=free}}</ref><ref>{{cite journal|vauthors=Shan L, Zhao N, Wang F, Zhai D, Liu J, Lv X|date=11 March 2024|title=Caffeine in Hepatocellular Carcinoma: Cellular Assays, Animal Experiments, and Epidemiological Investigation|journal=J Inflamm Res|volume=17|issue=|pages=1589–1605|doi=10.2147/JIR.S424384|pmc=10941793|pmid=38495344|doi-access=free}}</ref>

=== Medications ===
[[File:Ribavirin.svg|thumb|right|[[Ribavirin]]]]
More than 95% of chronic cases are resolved with treatment.<ref name=whofactsheet/> Treatment with [[antiviral medication]] is recommended for all people with proven chronic hepatitis C who are not at high risk of death from other causes.<ref name=IDSA2015>{{cite journal | title = Hepatitis C guidance: AASLD-IDSA recommendations for testing, managing, and treating adults infected with hepatitis C virus | journal = Hepatology | volume = 62 | issue = 3 | pages = 932–54 | date = September 2015 | pmid = 26111063 | doi = 10.1002/hep.27950 | doi-access = free | author1 = AASLD/IDSA HCV Guidance Panel }}</ref> People with the highest complication risk, based on the degree of liver scarring, should be treated first.<ref name=IDSA2015 /> The initial recommended treatment depends on the type of hepatitis C virus, if the person has received previous hepatitis C treatment, and whether the person has cirrhosis.<ref name=IDSA2017/> [[Direct-acting antivirals]] are the preferred treatment and have been validated by testing for virus particles in patients' blood.<ref>{{cite journal | vauthors = Jakobsen JC, Nielsen EE, Feinberg J, Katakam KK, Fobian K, Hauser G, Poropat G, Djurisic S, Weiss KH, Bjelakovic M, Bjelakovic G, Klingenberg SL, Liu JP, Nikolova D, Koretz RL, Gluud C | display-authors = 6 | title = Direct-acting antivirals for chronic hepatitis C | journal = The Cochrane Database of Systematic Reviews | volume = 2017 | pages = CD012143 | date = September 2017 | issue = 9 | pmid = 28922704 | pmc = 6484376 | doi = 10.1002/14651858.CD012143.pub3 }}</ref>

====No prior treatment====
* HCV genotype 1a (no cirrhosis): 8 weeks of [[glecaprevir/pibrentasvir]] or [[ledipasvir/sofosbuvir]] (the latter for people who do not have [[HIV/AIDS]], are not [[African-American]], and have less than 6 million HCV viral copies per milliliter of blood) or 12 weeks of [[elbasvir/grazoprevir]], ledipasvir/sofosbuvir, or [[sofosbuvir/velpatasvir]].<ref name="HCVGuidelinesGenotype1a">{{cite book | title=HCV Guidance: Recommendations for Testing, Managing, and Treating Hepatitis C | chapter = Treatment: Naive Genotype 1a Without Cirrhosis | chapter-url=https://www.hcvguidelines.org/treatment-naive/gt1a/no-cirrhosis| via = www.hcvguidelines.org|publisher=American Association for the Study of Liver Diseases|access-date=26 April 2017}}</ref> [[Sofosbuvir]] with either [[daclatasvir]] or [[simeprevir]] may also be used.<ref name=IDSA2017>{{cite web | title=HCV Guidance: Recommendations for Testing, Managing, and Treating Hepatitis C |url=http://hcvguidelines.org/sites/default/files/full-guidance-pdf/HCVGuidance_April_12_2017_b.pdf|access-date=28 July 2017|date=12 April 2017|url-status=dead|archive-url=https://web.archive.org/web/20170710035751/http://hcvguidelines.org/sites/default/files/full-guidance-pdf/HCVGuidance_April_12_2017_b.pdf|archive-date=2017-07-10}}</ref>
* HCV genotype 1a (with compensated [[cirrhosis]]): 8 weeks of glecaprevir/pibrentasvir or 12 weeks of elbasvir/grazoprevir, ledipasvir/sofosbuvir, or sofosbuvir/velpatasvir. An alternative treatment regimen of elbasvir/grazoprevir with weight-based ribavirin for 16 weeks can be used if the HCV is found to have antiviral resistance mutations against NS5A protease inhibitors.<ref name="HCVGuidelinesGenotype1acompensated">{{cite book |title=HCV Guidance: Recommendations for Testing, Managing, and Treating Hepatitis C| chapter = Treatment: Naive Genotype 1a With Compensated Cirrhosis | chapter-url= https://www.hcvguidelines.org/treatment-naive/gt1a/compensated-cirrhosis| via = www.hcvguidelines.org|publisher=American Association for the Study of Liver Diseases|access-date=26 April 2017}}</ref>
* HCV genotype 1b (no cirrhosis): 8 weeks of glecaprevir/pibrentasvir or ledipasvir/sofosbuvir (with the aforementioned limitations for the latter as above) or 12 weeks of elbasvir/grazoprevir, ledipasvir/sofosbuvir, or sofosbuvir/velpatasvir. Alternative regimens include 12 weeks of [[ombitasvir/paritaprevir/ritonavir]] with [[dasabuvir]] or 12 weeks of [[sofosbuvir]] with either [[daclatasvir]] or [[simeprevir]].<ref name="HCVGuidelinesGenotype1b">{{cite book |title=HCV Guidance: Recommendations for Testing, Managing, and Treating Hepatitis C | chapter = Treatment: Naive Genotype 1b Without Cirrhosis| chapter-url=https://www.hcvguidelines.org/treatment-naive/gt1b/no-cirrhosis | via = www.hcvguidelines.org|publisher=American Association for the Study of Liver Diseases|access-date=26 April 2017}}</ref>
* HCV genotype 1b (with compensated cirrhosis): 8 weeks of [[Glecaprevir/pibrentasvir|glecaprevir]]/pibrentasvir or 12 weeks of [[elbasvir/grazoprevir]], ledipasvir/sofosbuvir, or sofosbuvir/velpatasvir. A 12-week course of paritaprevir/ritonavir/ombitasvir with dasabuvir may also be used.<ref name="HCVGuidelinesGenotype1bcompensated">{{cite book |title=HCV Guidance: Recommendations for Testing, Managing, and Treating Hepatitis C | chapter = Treatment: Naive Genotype 1b With Compensated Cirrhosis| chapter-url=https://www.hcvguidelines.org/treatment-naive/gt1b/compensated-cirrhosis| via = www.hcvguidelines.org|publisher=American Association for the Study of Liver Diseases|access-date=26 April 2017}}</ref>
* HCV genotype 2 (no cirrhosis): 8 weeks of glecaprevir/pibrentasvir or 12 weeks of sofosbuvir/velpatasvir. Alternatively, 12 weeks of sofosbuvir/daclatasvir can be used.<ref name="HCVGuidelinesGenotype2">{{cite book |title=HCV Guidance: Recommendations for Testing, Managing, and Treating Hepatitis C | chapter = Treatment; Naive Genotype 2 Without Cirrhosis| chapter-url=https://www.hcvguidelines.org/treatment-naive/gt2/no-cirrhosis| via = www.hcvguidelines.org|publisher=American Association for the Study of Liver Diseases|access-date=26 April 2017}}</ref>
* HCV genotype 2 (with compensated cirrhosis): 8 weeks of glecaprevir/pibrentasvir or 12 weeks of sofosbuvir/[[velpatasvir]]. An alternative regimen of sofosbuvir/daclatasvir can be used for 16–24 weeks.<ref name="HCVGuidelinesGenotype2compensated">{{cite book |title=HCV Guidance: Recommendations for Testing, Managing, and Treating Hepatitis C | chapter = Treatment – Naive Genotype 2 With Compensated Cirrhosis| chapter-url=https://www.hcvguidelines.org/treatment-naive/gt2/compensated-cirrhosis| via = www.hcvguidelines.org|publisher=American Association for the Study of Liver Diseases|access-date=26 April 2017}}</ref>
* HCV genotype 3 (no cirrhosis): 8 weeks of glecaprevir/pibrentasvir or 12 weeks of sofosbuvir/velpatasvir or sofosbuvir and daclatasvir.<ref name="HCVGuidelinesGenotype3">{{cite book |title=HCV Guidance: Recommendations for Testing, Managing, and Treating Hepatitis C |chapter = Treatment: Naive Genotype 3 Without Cirrhosis| chapter-url=https://www.hcvguidelines.org/treatment-naive/gt3/no-cirrhosis| via = www.hcvguidelines.org|publisher=American Association for the Study of Liver Diseases|access-date=26 April 2017}}</ref>
* HCV genotype 3 (with compensated cirrhosis): 8 weeks of glecaprevir/pibrentasvir or 12 weeks of sofosbuvir/velpatasvir, or if certain antiviral mutations are present 12 weeks of sofosbuvir/velpatasvir/[[voxilaprevir]] (when certain antiviral mutations are present), or 24 weeks of sofosbuvir and daclatasvir.<ref name="HCVGuidelinesGenotype3compensated">{{cite book |title=HCV Guidance: Recommendations for Testing, Managing, and Treating Hepatitis C | chapter = Treatment: Naive Genotype 3 With Compensated Cirrhosis| chapter-url=https://www.hcvguidelines.org/treatment-naive/gt3/compensated-cirrhosis| via = www.hcvguidelines.org|publisher=American Association for the Study of Liver Diseases|access-date=26 April 2017}}</ref>
* HCV genotype 4 (no cirrhosis): 8 weeks of glecaprevir/pibrentasvir or 12 weeks of sofosbuvir/velpatasvir, elbasvir/grazoprevir, or ledipasvir/sofosbuvir. A 12-week [[ombitasvir/paritaprevir/ritonavir]] regimen is also acceptable in combination with weight-based [[ribavirin]].<ref name="HCVGuidelinesGenotype4">{{cite book|title=HCV Guidance: Recommendations for Testing, Managing, and Treating Hepatitis C | chapter = Treatment: Naive Genotype 4 Without Cirrhosis| chapter-url = https://www.hcvguidelines.org/treatment-naive/gt4/no-cirrhosis| via = www.hcvguidelines.org|publisher=American Association for the Study of Liver Diseases|access-date=26 April 2017}}</ref>
* HCV genotype 4 (with compensated cirrhosis): 8 weeks of glecaprevir/pibrentasvir or 12 weeks of sofosbuvir/velpatasvir, elbasvir/grazoprevir, or ledipasvir/sofosbuvir is recommended. A 12-week course of ombitasvir/paritaprevir/ritonavir with weight-based [[ribavirin]] is an acceptable alternative.<ref name="HCVGuidelinesGenotype4compensated">{{cite book |title=HCV Guidance: Recommendations for Testing, Managing, and Treating Hepatitis C | chapter = Treatment: Naive Genotype 4 With Compensated Cirrhosis| chapter-url=https://www.hcvguidelines.org/treatment-naive/gt4/compensated-cirrhosis| via = www.hcvguidelines.org|publisher=American Association for the Study of Liver Diseases|access-date=26 April 2017}}</ref>
* HCV genotype 5 or 6 (with or without compensated cirrhosis): 8 weeks of glecaprevir/pibrentasvir is recommended. If cirrhosis is present, then a 12-week course of sofosbuvir/velpatasvir, or [[ledipasvir/sofosbuvir]] is an alternative option.<ref name="HCVGuidelinesGenotypes5and6">{{cite book |title=HCV Guidance: Recommendations for Testing, Managing, and Treating Hepatitis C | chapter = Treatment: Naive Genotype 5 or 6| chapter-url=https://www.hcvguidelines.org/treatment-naive/gt5-6| via = www.hcvguidelines.org|publisher=American Association for the Study of Liver Diseases|access-date=26 April 2017}}</ref>

More than 95% of people with chronic infection can be cured when treated with medications;<ref name=CDC2019>{{cite web |title=Hepatitis C Questions and Answers for Health Professionals |url=https://www.cdc.gov/hepatitis/hcv/hcvfaq.htm |website=www.cdc.gov |access-date=23 July 2019 |language=en-us |date=2 July 2019}}</ref><!-- Quote = Over 90% of HCV-infected persons can be cured of HCV infection regardless of HCV genotype, with 8-12 weeks of oral therapy --> this could be expensive, but by 2022 prices had dropped dramatically.<ref name=whofactsheet/> The combination of [[Sofosbuvir/velpatasvir/voxilaprevir|sofosbuvir, velpatasvir, and voxilaprevir]] may be used in those who have previously been treated with sofosbuvir or other drugs that inhibit [[Hepatitis C virus nonstructural protein 5A|NS5A]] and were not cured.<ref>{{cite press release | title=FDA approves Vosevi for Hepatitis C|url=https://www.fda.gov/news-events/press-announcements/fda-approves-vosevi-hepatitis-c |website=U.S. [[Food and Drug Administration]] (FDA) |access-date=27 July 2017|date=18 July 2017|url-status=live|archive-url=https://web.archive.org/web/20170723062106/https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm567467.htm|archive-date=23 July 2017}}</ref>

Before 2011, treatments consisted of a combination of [[pegylated interferon]] alpha and [[ribavirin]] for a period of 24 or 48 weeks, depending on HCV [[genotype]].<ref name=AFP2010 /> This treatment produces cure rates of 70–80% for genotype 2 and 3, respectively, and 45–70% for genotypes 1 and 4.<ref name=NEJM2013>{{cite journal | vauthors = Liang TJ, Ghany MG | title = Current and future therapies for hepatitis C virus infection | journal = The New England Journal of Medicine | volume = 368 | issue = 20 | pages = 1907–17 | date = May 2013 | pmid = 23675659 | pmc = 3893124 | doi = 10.1056/NEJMra1213651 }}</ref> Adverse effects with these treatments were common, with 50–60% of those being treated experiencing [[Influenza-like illness|flu-like symptoms]] and nearly a third experiencing depression or other emotional issues.<ref name=AFP2010 /> Treatment during the first six months of infection (the acute stage) is more effective than when {{nowrap|hepatitis C}} has entered the chronic stage.<ref name=Tah2009 /> In those with chronic hepatitis B, treatment for hepatitis C results in reactivation of hepatitis B about 25% of the time.<ref name="Mücke2018">{{cite journal | vauthors = Mücke MM, Backus LI, Mücke VT, Coppola N, Preda CM, Yeh ML, Tang LS, Belperio PS, Wilson EM, Yu ML, Zeuzem S, Herrmann E, Vermehren J | display-authors = 6 | title = Hepatitis B virus reactivation during direct-acting antiviral therapy for hepatitis C: a systematic review and meta-analysis | journal = The Lancet. Gastroenterology & Hepatology | volume = 3 | issue = 3 | pages = 172–180 | date = March 2018 | pmid = 29371017 | doi = 10.1016/S2468-1253(18)30002-5 }}</ref>

=== Surgery ===
Cirrhosis due to hepatitis C is a common reason for [[liver transplant]]ation,<ref name=Tah2009>{{cite journal | vauthors = Ozaras R, Tahan V | title = Acute hepatitis C: prevention and treatment | journal = Expert Review of Anti-Infective Therapy | volume = 7 | issue = 3 | pages = 351–61 | date = April 2009 | pmid = 19344247 | doi = 10.1586/eri.09.8 | s2cid = 25574917 }}</ref> though the virus usually (80–90% of cases) recurs afterwards.<ref name=NEJM2011 /><ref>{{cite book| vauthors  = Sanders M |title=Mosby's Paramedic Textbook|year=2011|publisher=Jones & Bartlett Publishers|isbn=978-0-323-07275-5|page=839|url=https://books.google.com/books?id=PJyhIH8N8qgC&pg=PA839|url-status=live|archive-url=https://web.archive.org/web/20160511134533/https://books.google.com/books?id=PJyhIH8N8qgC&pg=PA839|archive-date=2016-05-11}}</ref> Infection of the graft leads to 10–30% of people developing cirrhosis within five years.<ref name=Ciria2013>{{cite journal | vauthors = Ciria R, Pleguezuelo M, Khorsandi SE, Davila D, Suddle A, Vilca-Melendez H, Rufian S, de la Mata M, Briceño J, Cillero PL, Heaton N | display-authors = 6 | title = Strategies to reduce hepatitis C virus recurrence after liver transplantation | journal = World Journal of Hepatology | volume = 5 | issue = 5 | pages = 237–50 | date = May 2013 | pmid = 23717735 | pmc = 3664282 | doi = 10.4254/wjh.v5.i5.237 | doi-access = free }}</ref> Treatment with pegylated interferon and ribavirin post-transplant decreases the risk of recurrence to 70%.<ref name=Coilly2013>{{cite journal | vauthors = Coilly A, Roche B, Samuel D | title = Current management and perspectives for HCV recurrence after liver transplantation | journal = Liver International | volume = 33 | pages = 56–62 | date = February 2013 | issue = Suppl 1 | pmid = 23286847 | doi = 10.1111/liv.12062 | s2cid = 23601091 | doi-access = free }}</ref> A 2013 review found no clear evidence as to whether antiviral medication is useful if the graft became reinfected.<ref>{{cite journal | vauthors = Gurusamy KS, Tsochatzis E, Toon CD, Xirouchakis E, Burroughs AK, Davidson BR | title = Antiviral interventions for liver transplant patients with recurrent graft infection due to hepatitis C virus | journal = The Cochrane Database of Systematic Reviews | issue = 12 | pages = CD006803 | date = December 2013 | volume = 2014 | pmid = 24307460 | doi = 10.1002/14651858.CD006803.pub4 | pmc = 8930021 }}</ref>

=== Alternative medicine ===
Several [[alternative medicine|alternative therapies]] are claimed by their proponents to be helpful for {{nowrap|hepatitis C}}, including [[Silybum marianum|milk thistle]], [[ginseng]], and [[colloidal silver]].<ref name=NCCAM>[http://nccam.nih.gov/health/providers/digest/hepatitisC-science.htm Hepatitis C and CAM: What the Science Says] {{webarchive|url=https://web.archive.org/web/20110320175202/http://nccam.nih.gov/health/providers/digest/hepatitisC-science.htm |date=2011-03-20 }}. [[National Center for Complementary and Alternative Medicine]] (NCCAM). March 2011. (Retrieved 7 March 2011)</ref> However, no alternative therapy has been shown to improve outcomes for {{nowrap|hepatitis C}} patients, and no evidence exists that alternative therapies have any effect on the virus.<ref name=NCCAM /><ref>{{cite journal | vauthors = Liu J, Manheimer E, Tsutani K, Gluud C | title = Medicinal herbs for hepatitis C virus infection: a Cochrane hepatobiliary systematic review of randomized trials | journal = The American Journal of Gastroenterology | volume = 98 | issue = 3 | pages = 538–44 | date = March 2003 | doi = 10.1111/j.1572-0241.2003.07298.x | pmid = 12650784 | s2cid = 20014583 }}</ref><ref>{{cite journal | vauthors = Rambaldi A, Jacobs BP, Gluud C | title = Milk thistle for alcoholic and/or hepatitis B or C virus liver diseases | journal = The Cochrane Database of Systematic Reviews | issue = 4 | pages = CD003620 | date = October 2007 | volume = 2009 | pmid = 17943794 | doi = 10.1002/14651858.CD003620.pub3 | pmc = 8724782 }}</ref>