What Type of Hepatitis C Do You Have? The Difference Matters

Hepatitis C affects over 3 million Americans—but did you know there are different types of hepatitis C? Here, Mehment Oz, MD explains.

What Type of Hepatitis C Do You Have? The Difference Matters

Hepatitis C is the number one cause of chronic liver damage and transplant in the United States, but it doesn’t have to be. It’s not too often that doctors are able to actually cure a deadly chronic disease, but hepatitis C is one of the exceptions. In the last four years, a series of breakthrough antiviral drugs have hit the market. We can now eliminate the virus in up to 99 percent of cases with minimal side effects. If you are one of the millions of Americans with chronic hepatitis C, you’re probably wondering just how these drugs work and how your doctor can choose the best one for you.

Hepatitis C is a virus spread through contact with infected blood. Needles are the biggest source of infection, but many cases also come from blood transfusions, since blood banks didn’t screen for the disease before 1992. This means many people who have hepatitis C today got the disease from a blood transfusion before 1992. However, they are not the only ones at risk for hep C. The U.S. Preventive Services Task Force recommends everyone between 18 and 79 years old get screened for hep C.

Unlike most living things, viruses can’t actually reproduce without outside help. That’s because while a virus like hepatitis C contains the instructions for replication (RNA) and a protective shell, it doesn’t have any of the machinery it needs to make a copy of itself. The hepatitis C virus solved this problem by evolving to be able to hijack the machinery in our livers to help it reproduce. When the virus gets into a person’s blood, it travels until it finds the cells that make up the liver, attaches itself and then uses the machinery inside to copy itself. The process may damage the liver cells and these copies go back out into the blood, where they can infect other liver cells or other people.

Drugs used to treat hepatitis C work by blocking steps in the copying process, the equivalent of throwing a wrench into the machinery, to block the gears. If the virus can’t replicate, it can’t spread and will eventually die off. The first drugs used to treat hepatitis C blocked this pathway in a non-specific way, meaning they would generally rev up the immune system’s response to viruses, but weren’t targeted to attack hepatitis C specifically. As a result, they could only cure the virus up to half the time and could also cause significant side effects since they would attack machinery all around our bodies, not just in hepatitis C. The new drugs are much more specialized and designed to get themselves into very specific gears, so they don’t interfere with the rest of the machinery. In medical jargon, we call these “direct acting antivirals.”

Since the new drugs are more specific, it’s now more important than ever to know exactly what type of hepatitis C you have. There are actually at least six main types of the virus (called “genotypes” by scientists). And within each of those types there are several subtypes. What makes them different is that genetic code we talked about, the instructions for replicating what we call RNA. The main genotypes of hepatitis C are cleverly named 1, 2, 3, 4, 5 and 6.

Type 1 is by far the most common in United States, representing about 75 percent of cases, followed by types 2 and 3, which together account for 20 percent. Types 4, 5 and 6 occur here as well, but are much more likely to be found in the Middle East, Africa and parts of Asia.

It’s vital for your doctor to know the type of hepatitis C you have. Most of the direct acting antivirals are specific to certain genotypes—for example, the medications recommended for types 2 and 3 (which share similar RNA) are different than the meds recommended for Type 1. Other combination drugs can treat all the genotypes, but your treatment regimen may vary depending on your type and other factors, like what treatments you’ve tried before.

Before you can be treated, you have to know if you have the disease. For most people with hepatitis C there are no symptoms until signs of liver disease show up. Advanced liver disease results in symptoms like yellow skin and eyes, abdominal pain and swelling, itchy skin and easy bruising. If you have any of these, make sure you go to your doctor right away. But the best outcome is to catch the disease in its early stages.

If you test positive, your doctor can prescribe one of the direct acting antivirals we discussed. Depending on your health, the typical course is between eight and 12 weeks. The most important thing during treatment is to take your medication as directed. If you do, the odds are great that you won’t have to worry about hepatitis C ever again.

Medically reviewed in January 2020.

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