Hepatitis C is a viral infection that primarily targets the liver, causing inflammation and potentially serious damage over time. The hepatitis C virus (HCV) attacks liver cells, leading to scarring and reduced liver function. Without proper treatment, chronic HCV infection can progress to cirrhosis, liver failure, or hepatocellular carcinoma. The liver's ability to filter toxins, produce proteins, and store nutrients becomes compromised as the virus continues to replicate and damage healthy tissue.
HCV spreads through direct contact with infected blood. Common transmission routes include sharing needles, receiving contaminated blood transfusions before 1992, and exposure through unsterilized medical equipment. Risk factors encompass injection drug use, occupational exposure to blood, unregulated tattooing or piercing, and sharing personal items like razors. Sexual transmission is possible but less common. Healthcare workers and individuals born between 1945-1975 face elevated risks due to historical screening gaps.
Acute HCV infection occurs within the first six months of exposure, often presenting mild or no symptoms. Approximately 15-25% of individuals naturally clear the virus during this stage. Chronic HCV develops when the infection persists beyond six months, affecting 75-85% of infected persons. Chronic infection can remain asymptomatic for decades while gradually damaging the liver, making early detection crucial for preventing long-term complications.
Many HCV infections remain asymptomatic initially. When symptoms appear, they may include fatigue, joint pain, abdominal discomfort, and dark urine. Advanced stages can present jaundice, easy bruising, swelling, and cognitive difficulties. Regular screening is essential since symptoms often emerge only after significant liver damage has occurred.
HCV diagnosis begins with an antibody test that detects immune system responses to the virus. A positive antibody test requires confirmation through HCV RNA testing, which identifies active viral replication. The RNA test distinguishes between past and current infections, as antibodies remain detectable even after successful treatment or natural clearance. These blood tests are highly accurate and provide definitive diagnosis when performed by qualified healthcare professionals.
HCV genotype testing identifies the specific viral strain, crucial for determining optimal treatment strategies. Six main genotypes exist, with genotype 1 being most common in Canada. Genotype information influences medication selection, treatment duration, and expected cure rates. Modern direct-acting antivirals have simplified treatment protocols, but genotype testing remains valuable for personalizing therapeutic approaches and monitoring treatment effectiveness.
Liver function tests measure enzymes, proteins, and bilirubin levels to assess liver health and damage extent. Fibrosis assessment through FibroScan or liver biopsy determines scarring severity. These evaluations guide treatment urgency and help monitor disease progression throughout the therapeutic process.
Sofosbuvir-based Direct-Acting Antiviral (DAA) medications represent the cornerstone of modern Hepatitis C treatment in Canada. These innovative therapies combine sofosbuvir with other antiviral agents to target multiple stages of the HCV lifecycle. Health Canada has approved several sofosbuvir combinations that demonstrate exceptional efficacy across different viral genotypes. These treatments offer simplified dosing regimens, typically requiring once-daily oral administration. Canadian healthcare providers favour these combinations due to their proven track record of achieving sustained virologic response (SVR) rates exceeding 95% in most patient populations, making them first-line treatment options.
Maviret, containing glecaprevir and pibrentasvir, is a pangenotypic DAA therapy approved by Health Canada for treating all major HCV genotypes. This combination targets both the NS3/4A protease and NS5A protein, providing robust antiviral activity. Maviret is particularly valuable for Canadian patients because it offers shorter treatment durations, often requiring only 8-12 weeks of therapy. The medication is well-tolerated with minimal drug interactions, making it suitable for patients with various comorbidities. Provincial drug formularies across Canada typically cover Maviret for eligible patients.
Epclusa combines sofosbuvir with velpatasvir to create a highly effective pangenotypic treatment option available through Canadian pharmacies. This single-tablet regimen simplifies HCV treatment by targeting all six major genotypes with consistent efficacy. The combination works by inhibiting both the NS5B polymerase and NS5A proteins essential for viral replication. Canadian treatment guidelines recommend Epclusa as a preferred option due to its proven effectiveness in diverse patient populations, including those with cirrhosis and treatment-experienced individuals.
Zepatier, combining elbasvir and grazoprevir, is specifically indicated for HCV genotypes 1 and 4 in Canada. This targeted DAA therapy inhibits the NS5A protein and NS3/4A protease, providing effective treatment for these prevalent genotypes. Canadian physicians may prescribe Zepatier for patients who require alternative treatment options or have specific contraindications to other DAA therapies. The medication offers a well-established safety profile with predictable treatment outcomes.
Canadian HCV treatment guidelines specify standardized durations based on viral genotype, treatment history, and patient factors. Most treatment-naïve patients require 8-12 weeks of DAA therapy, while treatment-experienced individuals may need extended courses. Genotype 1 typically requires 8-12 weeks, genotypes 2 and 3 generally need 8-12 weeks, and genotypes 4, 5, and 6 usually require 8-12 weeks of treatment. Patients with cirrhosis or previous treatment failure may require longer durations up to 24 weeks. Canadian hepatologists follow these evidence-based guidelines to optimize treatment outcomes.
Canadian healthcare providers implement comprehensive monitoring protocols throughout HCV treatment and follow-up periods. Patients undergo regular blood tests to assess viral load, liver function, and potential side effects during therapy. The primary goal is achieving sustained virologic response (SVR12), defined as undetectable HCV RNA 12 weeks post-treatment. Follow-up visits typically occur at weeks 4, 8, end of treatment, and 12 weeks post-treatment. Provincial healthcare systems support this monitoring through covered laboratory services and specialist consultations.
Modern DAA therapies available in Canada achieve remarkable cure rates exceeding 95% across all patient populations. Treatment success is measured by sustained virologic response (SVR12), which indicates functional cure of HCV infection. Canadian real-world data consistently demonstrates these high success rates, with minimal treatment failures typically attributed to non-adherence or drug resistance mutations.
Canadian treatment guidelines address specific considerations for diverse patient populations requiring HCV therapy. Special attention is given to patients with HIV co-infection, chronic kidney disease, liver transplant recipients, and those with decompensated cirrhosis. Treatment modifications may include:
Modern direct-acting antivirals (DAAs) for hepatitis C are generally well-tolerated compared to older treatments. Common side effects may include fatigue, headache, nausea, and occasional diarrhea. Most patients experience mild symptoms that improve as treatment progresses. Skin rashes and sleep disturbances occur less frequently. These side effects are typically manageable and rarely require treatment discontinuation.
HCV medications can interact with several common drugs, potentially reducing treatment effectiveness or causing adverse reactions. Proton pump inhibitors, certain antacids, and some heart medications may interfere with DAA absorption. St. John's wort, rifampin, and certain seizure medications can significantly reduce HCV drug levels. Always inform your healthcare provider and pharmacist about all medications, supplements, and herbal products you're taking before starting HCV treatment.
Regular monitoring ensures treatment safety and effectiveness. Blood tests typically occur at weeks 4, 8, and 12 of treatment to check liver function and viral levels. Your healthcare provider may adjust monitoring frequency based on your individual health status and treatment response.
Contact your healthcare provider immediately if you experience severe fatigue, yellowing of skin or eyes, dark urine, or unusual bleeding. Report any new medications or concerning symptoms promptly.
HCV spreads through blood-to-blood contact, making prevention crucial even after successful treatment. Avoid sharing needles, razors, toothbrushes, or other personal items that may contain blood. Practice safe sex and ensure proper sterilization of tattoo and piercing equipment. Healthcare workers should follow standard precautions. Reinfection is possible, so continued prevention measures are essential for maintaining your health.
Achieving sustained virologic response (SVR) indicates cure, but ongoing monitoring remains important. Follow-up testing occurs 12 weeks after treatment completion to confirm viral clearance. Annual liver function assessments help monitor long-term liver health. Patients with cirrhosis require more frequent monitoring and screening for liver complications.
Supporting liver health involves several lifestyle changes:
Hepatitis A and B vaccinations are strongly recommended for HCV patients to prevent additional liver damage. These vaccines are safe and effective, providing long-term protection against co-infection complications.
