Hepatitis C is a viral infection that primarily targets the liver, causing inflammation and potentially leading to serious liver damage over time. The hepatitis C virus (HCV) is a blood-borne pathogen that can cause both acute and chronic infections, with the chronic form being particularly concerning for long-term health outcomes.
Acute hepatitis C occurs within the first six months of infection and often goes unnoticed as symptoms may be mild or absent. Approximately 15-25% of people clear the virus naturally during this stage. However, 75-85% of infected individuals develop chronic hepatitis C, where the virus persists in the body for years or decades, gradually damaging liver tissue and potentially leading to cirrhosis or liver cancer.
HCV transmission occurs through contact with infected blood. Common transmission methods include:
In Canada, approximately 250,000 people are living with hepatitis C, representing about 0.7% of the population. Globally, an estimated 71 million people have chronic HCV infection. Early detection and treatment are crucial because modern direct-acting antiviral medications can cure over 95% of cases, preventing serious liver complications and reducing transmission risk.
Many people with acute hepatitis C experience no symptoms or only mild, flu-like symptoms that may include fatigue, nausea, loss of appetite, and joint pain. When symptoms do appear, they typically occur 2-12 weeks after infection and may be easily mistaken for other common illnesses.
Chronic hepatitis C often remains "silent" for years, but warning signs may include persistent fatigue, abdominal pain, dark urine, jaundice (yellowing of skin and eyes), and unexplained weight loss. As liver damage progresses, more serious symptoms like fluid retention, confusion, and easy bruising may develop.
In Canada, hepatitis C diagnosis involves blood tests including HCV antibody screening and RNA testing to confirm active infection. Healthcare Canada recommends seeking medical consultation if you have risk factors or symptoms. Screening is particularly important for individuals born between 1945-1975, people who inject drugs, those with HIV, and individuals who received blood products before 1992. Early diagnosis enables timely treatment, preventing liver damage and reducing transmission to others.
Canadian patients have access to highly effective sofosbuvir-based combination therapies, including Epclusa (sofosbuvir/velpatasvir) and Harvoni (ledipasvir/sofosbuvir). These medications are approved by Health Canada and represent the gold standard for HCV treatment across all genotypes. Epclusa offers pan-genotypic coverage, making it suitable for patients with any HCV genotype, while Harvoni is specifically indicated for genotypes 1, 4, 5, and 6.
Maviret, containing glecaprevir and pibrentasvir, is another pan-genotypic DAA combination available in Canada. This medication offers excellent efficacy across all HCV genotypes and is particularly valued for its shorter treatment duration in many patients. Maviret is covered under most provincial drug formularies and provides an alternative option for patients who may not be suitable candidates for sofosbuvir-based regimens.
Velpatasvir, available in combination with sofosbuvir as Epclusa, demonstrates exceptional effectiveness with sustained virologic response (SVR) rates exceeding 95% across all genotypes. This NS5A inhibitor provides robust antiviral activity and has shown consistent results in Canadian clinical practice. The combination is well-tolerated and suitable for both treatment-naïve and treatment-experienced patients.
Current DAA regimens available in Canada typically require 8-12 weeks of treatment, depending on the specific medication, HCV genotype, and patient factors. Cure rates with these modern therapies consistently exceed 95%, with many studies showing SVR rates of 97-99%. The shorter treatment duration and exceptional cure rates represent a significant advancement over previous interferon-based therapies.
While brand name DAA medications remain the primary options in Canada, Health Canada continues to evaluate generic alternatives as patents expire. Currently, most provincial drug plans provide coverage for brand name DAAs through special authorization programs. Patients should consult with their healthcare providers and pharmacists about available options and coverage under their specific provincial drug plan or private insurance.
Canadian treatment guidelines, developed in collaboration with the Canadian Association for the Study of the Liver (CASL), provide specific recommendations based on HCV genotype. The pan-genotypic approach using Epclusa or Maviret has simplified treatment decisions, eliminating the need for genotype-specific regimen selection in most cases. However, genotype testing remains important for determining treatment duration and monitoring requirements.
Current Canadian guidelines recommend the following first-line therapies:
Special populations require careful consideration in medication selection and dosing. Patients with decompensated cirrhosis may require ribavirin addition and extended treatment duration. Those with chronic kidney disease need dose adjustments or alternative regimens. Pregnant women require specialized care, as current DAAs are not recommended during pregnancy. HIV/HCV co-infected patients can generally use the same regimens but require careful monitoring for drug interactions with antiretroviral therapy.
DAA medications can interact with various commonly prescribed medications, including proton pump inhibitors, certain cardiac medications, and anticonvulsants. Healthcare providers must carefully review all concurrent medications before initiating HCV therapy. Particular attention is required for patients taking warfarin, as DAA therapy may affect anticoagulation levels. St. John's Wort and certain herbal supplements should be avoided during treatment.
Canadian guidelines recommend baseline laboratory testing including HCV RNA quantification, genotype determination, complete blood count, comprehensive metabolic panel, and hepatitis B surface antigen testing. During treatment, monitoring typically includes HCV RNA testing at treatment completion and 12 weeks post-treatment to confirm SVR. Patients with cirrhosis or other complicating factors may require more frequent monitoring throughout the treatment course.
Most Canadian provinces provide coverage for hepatitis C treatments through their public drug programs, though eligibility criteria and formulary listings may vary. Patients typically need prior authorization from their provincial health plan, which requires documentation from a specialist confirming the diagnosis and treatment necessity.
Private insurance plans often complement provincial coverage, helping with copayments and deductibles. Several pharmaceutical manufacturers offer patient assistance programs that can significantly reduce out-of-pocket costs for eligible Canadians. These programs may cover gaps in public or private insurance coverage.
To obtain HCV medication, patients should consult their family physician for initial assessment and referral to a hepatologist or infectious disease specialist. The specialist will complete necessary paperwork for provincial drug coverage approval, ensuring patients can access these life-saving treatments affordably.
Patients undergoing HCV treatment should maintain a healthy lifestyle by avoiding alcohol, eating a balanced diet, and staying hydrated. Regular communication with healthcare providers about side effects is essential for successful treatment completion.
Preventing transmission involves avoiding sharing personal items that may contain blood, practicing safe injection techniques if applicable, and using barrier protection during sexual activity. Post-treatment monitoring includes regular blood tests to confirm sustained virologic response.
The Canadian Liver Foundation, provincial hepatitis organizations, and local support groups provide valuable resources for patients and families. Many provinces offer specialized hepatitis clinics that provide comprehensive care and education throughout the treatment journey.
