Deciding whether to treat HCV – when DAAs are not available

New HCV drugs (called DAAs) have very high cure rates from short-course, easy-to-take treatment.

This means HCV guidelines recommend treatment for nearly everyone who has HCV. The main exception is people with very severe liver disease, whether management involved expert care.

So if DAAs are available, nearly everyone is likely to want treatment.

However, the high cost of DAAs mean that not everyone has access to treatment

In some parts of the world – not in the UK – some people are still only being offered old HCV drugs like pegylated interferon and ribavirin. So deciding whether to treat can still be difficult when DAAs are not available.

The information below is for when DAAs are not available.

The most important reason to treat is to cure HCV but there are a lot of factors involved in the decision.

  • Although HCV is more likely to become serious in people who are HIV positive, not everyone will need treatment.
  • Some people may choose lifestyle changes first, see this link and the pages that follow it.
  • Others may want to wait for new drugs, see this link.

Whether or not to treat HCV also depends on the condition of your liver.

  • People who have mild liver damage may choose to monitor their liver and wait for new HCV treatment.
  • People with advanced fibrosis or cirrhosis need to be treated for HCV sooner.
  • HCV treatment is less effective for people with serious liver scarring (cirrhosis), so it may be important to treat before it reaches this stage.

After diagnosis, I was determined to have the treatment immediately… but I had to leave the country for family reasons soon after starting the treatment and was unable to continue the treatment beyond the first month. A few years later when things had calmed down, my concern turned to my partner and I resolved to get rid of the HCV as quickly as possible.

If you are unlucky and treatment doesn’t work, you can find out within 4 to 12 weeks if it is possible to stop early.

One doctor said, “people don’t have to sign a binding contract to stay on HCV treatment for 48 weeks. If they start, and it is much worse than they were prepared for, they can stop. They can try again in the future when they feel better, or when new treatments are available.”

Some people weigh up the risks and benefits for their situation and decide to monitor rather than treat.

Over the last seven or so years, as my general health has vastly improved, my doctors have warned me my  health may be at more risk from HCV than HIV. I’ve been urged to have biopsies done of my liver and consider going on treatment for HCV. I’ve decided to delay embarking on therapy for two main reasons: firstly I have a genotype that is less responsive than others to therapy; and secondly I don’t want to take time out from work which I’d probably need to do to accommodate the side effects. I like my life at the moment and I don’t want that to change on the off-chance that I can clear the HCV. My current strategy is to wait until more effective drugs come along.

Another advocate who has been diagnosed with HCV for over 10 years said:

For me, to maintain my CD4 high is a way of protecting my liver from histological damage. Side effects are the most important reason for delaying treatment as I have seen a lot of people on treatment and in some cases it is really hard. I also know people that are doing very well on treatment and avoiding the threat of cirrhosis is a really good thing. For me though, at the moment, I don’t feel strong enough to try it.

Last updated: 1 August 2017.