If you're wondering how to get started, you'll find the answers here
Yes, virtually everyone with Hepatitis C can be treated with the new Direct Acting Antivirals (DAAs).
For most patients, the chances of getting cured are around 95%. This does mean that 5% (1 patient in 20) will not be cured, at least at the first attempt.
Sadly, 5% (1 patient in 20) will not be cured, at least at the first attempt. Retreatment is entirely possible.
Patients who have cirrhosis, genotype 3, or who have failed past treatments have slightly lower cure rates.
Most patients with Hepatitis C can be successfully treated with 12 weeks of medication. This costs between $1250 and $1500 USD, inclusive of delivery.
Patients with cirrhosis may require a longer 24-week treatment, which doubles the cost.
To place and order you will need a prescription from a doctor specifying which medications are required and the ability to pay either by credit card or bank wire transfer.
Sorry no, however, we can help you get a prescription. Your prescription ensures you get the right treatment, for the correct duration to maximise your chances of being cured.
Please contact us for help if required.
Ideally your local doctor will write a prescription for you, however, if they are unwilling to do so there are doctors around the world who are. It is also possible to see a doctor online via video (telehealth) and get a prescription in that way.
Please contact us for help if you run into any problems.
All branches of medicine have some "secret code" and Hepatitis C is no different.
You will find all the common medical terms explained in our glossary.
No, in most countries, where personal medication importation is legal, the medications can simply be sent to you by courier.
Travelling to pick up the medications is the only practical option for patients in some countries.
We help patients to exercise their legal right to make a personal medication importation.
If your country's laws prohibit personal medication importation by mail, a very practical solution is simply to import the medication to a nearby country that does allow it, then travel there to pick up the medication.
It is almost universally permitted to bring foreign sourced medication back into your country on your person. The obvious exception to that is narcotics, but these medications have no other purpose than to treat Hepatitis C so are not prohibited.
Please contact us for help if you run into any problems accessing treatment.
When a medication is invented the originator takes it to market, often with a very high price tag.
Generic medications are less expensive copies of an originator medication.
Like any copy, generic medications come in both high and low-quality varieties. It is important to understand this and make sure any generic medication you use meets the appropriate quality standards.
In the world of generic pharmaceuticals, you do tend to get what you pay for.
If you're wondering if you can work, drink, smoke, have sex, get pregnant, etc on treatment...
Yes, you can.
The usual too much alcohol is bad for you advice applies, but drinking alcohol will not adversely impact your treatment.
Your GGT will probably remain elevated if you are drinking but that's the booze not the bug.
Yes, you can continue to smoke while taking the medications.
Less is more, but this is not a QUIT campaign.
Yes, the vast majority of people taking these medications feel the same, or better, than they did before treatment within a week of starting. These new medications do not have the harsh side effects of the old medications.
These new medications do not have the harsh side effects of the old medications, however, some people have a mild influenza-like illness during the first week of treatment.
Yes, of course.
No, the safety of these medications has not been, and never will be, established in either breastfeeding or pregnancy.
You can get pregnant after finishing your treatment but should wait 3-6 months.
Mathematically there will be no residual drugs left in your system 6 months after you finish.
What is required before starting treatment?
Given you are here, this might seem like a strange question to be asking.
But maybe you can't afford to wait, or maybe you're just sick of waiting, and if so that's fine - we are here to help.
While it is theoretically possible to treat a patient known to have Hep C with these medications with limited workup available, it is far from best practice.
There are 3 critical things to know:
Knowledge of these 3 allows the correct medication to be selected and the appropriate duration to be given.
There are several other important things to do:
Patients with Hepatitis C are more prone to diabetes and thyroid problems so these are good to check for.
With fibrosis assessment biopsy is the gold standard (but is unpleasant and risky). A fibroscan is a good non-invasive way to get a similar result, but, if needs be an assessment can be made with blood tests.
Basic blood tests:
These are sufficient to assess fibrosis and make an accurate prescription.
Extra blood tests:
A fibroscan is nice but requires special equipment. The simplest way to assess fibrosis is with the APRI score which comes from the AST in the CMP and the Platelets in the CBC. http://www.hepatitisc.uw.edu/page/clinical-calculators/apri a score over 1 suggests cirrhosis.
Find out more about how we protect your privacy here
We most certainly do not share your information with the government.
We only share information with your doctor if you ask us to.
Learn more about dealing with doctors and hospitals here
Yes and no.
Almost all doctors prescribe generics to their patients, either because they have to or because they are cheaper. The only difference between these generics and Hep C generics is that a doctor can write their usual script secure in that knowledge that it is routine practice and those medications are approved in their country and available at the local pharmacy.
Because of patent restrictions, Hep C generics are not available in the majority of countries in the world. They are manufactured to high standards, and approved for sale in countries like Egypt and India, and were it not for patents, meet the standards for registration anywhere in the world, but the fact remains that these medicines are not registered for sale in many countries.
Being honest with your doctor is a good idea, however, it does present them with an ethical dilemma.
For a doctor, writing a prescription for medications that cure Hep C to a patient with Hep C is more or less a no brainer.
We are aware of some patients that have taken generics and simply turned up to their doctor/clinic for bloods. The reactions to undetected results have ranged from outrage to intrigue about what's gone on.
If you doctor won't prescribe generics then finding one that will is the obvious solution.
We observe that Infectious Disease (ID) Physicians are more amenable to prescribing than Gastroenterologists and Hepatologists. This relates to the ID doctors having used generics during the HIV crisis in the past, and for PrEP currently.
We also observe, even within clinics that support generics, some doctors are not on board with the idea. The nurses will typically know who you should, or should not, see.
Your Family Doctor or General Practitioner usually has your best interests at heart so may well help.
If all that fails, please book an online appointment at https://gp2u.com.au/ where the doctors are experienced in this and do prescribe without being judgemental about what is a deeply personal decision.
In the event your doctor will not prescribe, they should be willing to monitor you. Being unwilling to monitor you would be similar to refusing to treat an overdose patient on the basis that they were not taking approved medications. Sadly, some doctors take this stance.
Find out more about the tests required before, during and after treatment
You will find an explanation of many Hep C related terms in our glossary.
Complete (Full) Blood Count (CBC/CBC)
The CBC checks the red cells, white cells and platelets in the blood. All of these can change in liver disease, and during treatment (particularly if Ribavirin is being used).
Complete Metabolic Panel (CMP)
The CMP combines liver and kidney function tests (see below)
Liver Function Tests (LFT)
The LFTs provide an idea how well the liver is functioning. Here are the tests and the normal ranges.
ALT 7 to 55 units per liter (U/L)
Renal Function Tests (Creatinine, Urea and Electrolytes)
The creatinine (from which is calculated the eGFR) assess how will the kidneys are working. A normal eGFR is > 90.
Alpha Feto Protein (AFP)
The level of this protein rises slightly in liver disease and more dramatically in patients with Hepatocellular Carcinoma.
Fibrosis Tests (Fibrosure, Hepascore, ELF score, APRI)
These tests measure a number of things in the blood to provide an estimate of liver fibrosis. THESE TESTS ARE NOT VALID IN PATIENTS ON TREATMENT because the things they are measuring in the blood are known to change.
The APRI score is calculated from the AST from the liver panel and the Platelets from the CBC. You will find a calculator here: https://www.mdcalc.com/ast-platelet-ratio-index-apri
Hepatitis B surface Antibody (HBsAb)
This is present in patients who are immune to Hepatitis B regardless of whether that immunity is from vaccination or past exposure.
Hepatitis B core Antibody (HBcAb)
This is only present in patients who have been exposed to Hepatitis B.
Hepatitis B surface Antigen (HBsAg)
This is present in patients with active hepatitis B (it is the outer part of the virus)
This is present in patients with active hepatitis B (it is the genetic code of the virus)
Hepatitis C antibody (HCVAb)
This is only present in patients who have been infected with Hepatitis C. It remains positive during infection, and for many years after the infection has been removed.
This test gives a count of how much viral RNA is in the blood. The average is around 3 million but the range is 100 to 10,000,000. There is no real significance in a higher or lower count in terms of how sick a patient is, or how hard they are to cure.
Thyroid Function Test (TFTs)
Thyroid function is assessed with TSH, T4, T3
Blood Sugar Level (BSL)
This is elevated in patients with diabetes. Diabetes is 2-3 times more common in patients with Hepatitis C.
Scans are performed for 2 reasons:
Fibroscan (Shear wave elastography)
This scan is a special type of ultrasound that uses sound waves to see how elastic the liver is. The more elastic the less fibrosis is likely to be present. A value of over 12.5 kPa typically indicated cirrhosis.
CT (Computed Tomography) uses Xrays to look at the liver. Triple phase contrast scans are usually conducted to look cancer. Doing one from time to time is low risk, but CT is not ideal for regular follow up in cirrhotic patients at high risk of liver cancer.
Find out more about the medications, their side effects, and what you can take with them here
In the bad old days, the treatment for Hepatitis C involved the use of Interferon and Ribavirin. This treatment was harsh, had relatively low success, often took one year to complete, and is no longer recommended. Sadly, it remains the only treatment available in some countries.
The new treatments use medications called Direct Acting Antivirals (DAA's) and achieve high success rates, with minimal side effects, and usually only require 12 weeks of treatment with daily tablets.
You will find the names of all the new medications, and the genotypes they are used to treat in the table here.
All medications have two names. The brand name, and the generic name. The generic name is the actual name of the medication ingredients.
Routine antibiotics and pain killers do not interact with the DAA medications.
This Interactions Checking Tool from the University of Liverpool is recommended:
To use it simply select the DAA combination you are taking, and then any other medications. Please note that you need to use the GENERIC name for your medication, not the brand name.
You will find the consumer medication for the DAAs here.
All medications have side effects. In general the DAA class has relatively few, and is similar to other antiboitics.
Skin rash and stomach upsets are common to all medications, but relatively uncommon with DAAs
About 1 in 5 patients will get headaches, usually only at the start of treatment during the first week.
About 1 in 5 patients will suffer from insomnia and this is likely to last the entire duration of treatment.
Most patients feel better, rather than worse on treatment, however fatigue is noted in some patients, particularly those with insomnia.
A freedom of information request to the FDA disclosed this list of reported adverse drug reactions for Harvoni. This list is sorted by order of frequency.
Find out which countries permit delivery of generic medications
Country: Aland Islands
Country: American Samoa
Country: Antigua and Barbuda
Country: Bosnia and Herzegovina
Country: Bouvet Island
Country: British Indian Ocean Territory
Country: British Virgin Islands
Country: Brunei Darussalam
Country: Burkina Faso
Country: Cape Verde
Country: Cayman Islands
Country: Central African Republic
Country: Christmas Island
Country: Cocos (Keeling) Islands
Country: Congo (Brazzaville)
Country: Congo (Kinshasa)
Country: Cook Islands
Country: Costa Rica
Country: Cote d'Ivoire
Country: Czech Republic
Country: Dominican Republic
Country: El Salvador
Country: Equatorial Guinea
Country: Falkland Islands (Malvinas)
Country: Faroe Islands
Country: French Guiana
Country: French Polynesia
Country: French Southern Territories
Country: Heard and Mcdonald Islands
Country: Holy See (Vatican City State)
Country: Hong Kong, SAR China
Country: Iran, Islamic Republic of
Country: Isle of Man
Country: Korea (North)
Country: Korea (South)
Country: Lao PDR
Country: Macao, SAR China
Country: Macedonia, Republic of
Country: Marshall Islands
Country: Micronesia, Federated States of
Country: Netherlands Antilles
Country: New Caledonia
Country: New Zealand
Country: Norfolk Island
Country: Northern Mariana Islands
Country: Palestinian Territory
Country: Papua New Guinea
Country: Puerto Rico
Country: Russian Federation
Country: Saint Helena
Country: Saint Kitts and Nevis
Country: Saint Lucia
Country: Saint Pierre and Miquelon
Country: Saint Vincent and Grenadines
Country: Saint-Martin (French part)
Country: San Marino
Country: Sao Tome and Principe
Country: Saudi Arabia
Country: Sierra Leone
Country: Solomon Islands
Country: South Africa
Country: South Georgia and the South Sandwich Islands
Country: South Sudan
Country: Sri Lanka
Country: Svalbard and Jan Mayen Islands
Country: Syrian Arab Republic (Syria)
Country: Taiwan, Republic of China
Country: Tanzania, United Republic of
Country: Trinidad and Tobago
Country: Turks and Caicos Islands
Country: United Arab Emirates
Country: United Kingdom
Country: United States of America
Subsidised Access: Patients unable to pay for generic medication should try all the alternative options listed here: https://www.hepmag.com/basics/hepatitis-c-basics/paying-hepatitis-c-treatment
Country: US Minor Outlying Islands
Country: Venezuela (Bolivarian Republic)
Country: Viet Nam
Country: Virgin Islands, US
Country: Wallis and Futuna Islands
Country: Western Sahara
Find out how we deliver, and how long it takes for your medication to arrive
The first thing you will get is an acknowledgement of your order.
If you paid by credit card then you will receive a confirmation of payment and a transaction id.
If you paid by wire transfer this will take about 3-7 days to arrive, depending how long the transfer takes.
Within 24-48 hours you will receive a tracking ID that allows you to follow the progress of your medication being couriered to you.
You medications will be shipped within 24-48 hours of your payment being confirmed.
You will get a tracking ID at this time.
It takes about 24 hours for shipments to turn up on the tracking systems used by the couriers.
If you received your tracking ID more than 24 hours ago, and your shipment is still not trackable, please contact us.
What to do, and what to expect on treatment
Absolutely. While the old treatments, using PEG-interferon and Ribavirin did make patients very unwell, most patients taking the new Direct Acting Antivirals feel better than they did prior to starting treatment, so, if you are working now, you should have no trouble continuing to work.
Generally speaking no special changes are required during treatment, however you should:
You should store your medication out of reach of children, in a cool dry place.
The consumer medication information for your medication will provide more details, typically stating things like < 30°C.
Your body does not typically need supplements. A normal diet consisting of a variety of foods is sufficient.
While most supplements will be harmless, and will not interact with your medications, they have not been studied, so we recommend you do not take them during treatment.
If you insist, take them at the opposite end of the day to the time you take your medication.
Please use the drug interaction checker here to check anything you are taking, or plan to take will not interact with your treatment.
You should eat a normal varied diet.
On Daclatasvir you should not eat Grapefruit as it can cause the levels of the medication to rise due to its inhibition of CYP3A4. You should not take medications, food or supplements that inhibit CYP3A4.
As a general rule, provided you don't eat the same thing every single day, you are unlikely to run into any issues.
No, absolutely not. 78% of patients will be undetected by week 4, but if you stop taking the medications at this point then you will almost certainly relapse.
The weeks of treatment after being undetected are the time when the last stragglers are killed off and are critical to treatment success. That said, 75% of patients who are still detected at the end of treatment will still go on to SVR12 (but have obviously cut things very fine).
If you forget a tablet, and you are less than 18 hours late take it now.
If you forget a whole day simply continue as usual. Do not double up.
Plan a system to remember - an alarm on your phone is good, putting the medication with other medications is good.
Regular dosing maximises your chances of success, but most patients will forget at least one tablet during treatment so don't panic. It's not ideal, but does not cause problems for most people.
If you are still detected at a point 4 weeks or more into treatment then your response is a little slow, or your virus is a little more resistant than usual.
While only 22% of patients are still detected at the 4-week point they go on to make up 44% of the failures. If this happens it might be worth considering extending treatment by 4 or more weeks, or adding a booster like Ribavirin.
When the last pill is taken we have to wait 12 weeks to confirm cure
When you finish your course of tablets, you enter a frustrating waiting period.
Although 99.5% of patients become undetected on treatment it is possible that there is still a small quantity of virus left.
Most patients will notice this within 4 weeks, and we can also see it in their blood results with a rise of the AST and ALT.
We have to wait a full 12 weeks to be sure that the virus is completely gone.
It is possible to test before the 12 week waiting period is up. Just testing liver function is cheaper than doing a viral load.
Patients who are still undetectable at 4 weeks after treatment have a 96% chance of being cured, at 12 weeks that is 99.7% and at 24 weeks it is 99.99%+.
Yes, it is entirely normal to feel anxious while you wait to see if the treatment has succeeded.
Keep in mind that the odds are 20:1 in your favour that you will be cured.
Also remember that in the unlikely event your first treatment does not work, retreatment is entirely possible, and generally very successful.
Ok, so you are now cured of Hepatitis C - what now?
When you finish taking the treatment the medications rapidly leave your system. Within a day there is only 1/2 as much left, in 2 days 1/4, 3 days 1/8, 4 days 1/16, 5 days 1/32, 6 days 1/64 and so on.
If there is no medication in your system, and the virus does not grow back there is only one reason - there is no virus to grow back. We call this SVR (Sustained Virological Response) but we really should call it CURE.
For most patients, that is it. You don't have the virus. It's gone. It's over. You are non-infectious and although your Hep C antibody will still mark the fact that you did once have the infection, there is and will remain, no virus in your system.
If you had cirrhosis, we need to continue to monitor things. Please see the next question.
The Hep C PCR RNA test proves that there is no virus present and should be done at the same time as the antibody test in the context of that being done for work or visa related reasons. This shows you are cured and non-infectious.