Hepatitis C Blog

Greg Jefferys Hepatitis C blog deals with all the issues associated with hepatitis C

Side effects of Harvoni

Harvoni side effects

The side effects of Harvoni are normally very mild or non-existent… but there are exceptions

The Side Effects of Harvoni

I am sitting in the Singapore airport where I have just been catching up with my social media by going through discussion threads in my Facebook Hep C support group, Hepatitis C Treatment Cure and Community.

Over the past week there has been a lot of discussion about the side effects of Harvoni and other Hepatitis C treatments with Direct Acting Antivirals.

Because there has been so much discussion a few people have become fearful about doing their Hep C treatment. So in this post I will focus on the side effects of Harvoni (Sofosbuvir 400 mg + Ledipasvir 90 mg) because that is what is most of the discussion is about right now. However what I am writing can be equally applied to Mavyret or Epclusa or any of the other new Hepatitis C treatments. All Hep C drugs have about the same kind of side effects. Though it appears that Sofosbuvir + Daclatasvir produces less side effects than other Hep C treatment.

Common reported side effects of Harvoni and all other modern Hepatitis C treatments include:
  • fatigue,
  • asthenia (weakness)
  • headache,
  • nausea,
  • diarrhea,
  • insomnia

All Drugs Have Side Effects

Firstly I would point out that most people will have either: no side effects or minor side effects but that a few people, less that 5%, will have side effects that are difficult.

Secondly I would point out that whilst treatment may have some side effects for some people those side effect are less than the side effects of having chronic Hepatitis C.

Lastly I would make the point that all medication has some kind of side effects, obvious or subtle and that this will vary a lot from person to person.

For example my wife is allergic to penicillin. If she takes penicillin the side effects would be fatal.  Most people have no problem with taking penicillin. Its the same with Harvoni and other DAAs… though I have never heard of a fatal reaction to Hep C treatment with DAAs.

Severe Side Effects from Harvoni are Rare

In the time that I have been talking to people doing Hep C treatment, since 2015, I have personally communicated with many thousands of doing DAA treatment, with Epclusa, Harvoni, Sofosbuvir + Daclatasvir, Mavyret and Zepatier …. Even people doing treatment with Interferon.

In all that time (excluding Interferon) I have only come across a handful of people who had a really tough time doing their treatment. Maybe half a dozen.

(With Interferon everyone had a tough time.)

I took Sovaldi + Ribavirin for 12 weeks and the only significant side effect I had was insomnia.

Here is a graph showing the results of side effects on two groups of people who thought that they were taking Harvoni. In fact half of them were taking Harvoni and the other half were taking a chalk pill that looked like Harvoni.

Asthenia: Weakness. Lack of energy and strength. Loss of strength. Myasthenia refers to a loss of muscle strength, as in myasthenia gravis

As you will see in the graph, a significant number of the people taking the placebo also got the same range of side effects as the people taking Harvoni.

This tells us that is you expect to get side effects from Harvoni, if you get anxious about the possible side effects of Harvoni, then you may well increase your chances of having side effects from Harvoni. This is particularly true of headaches and asthenia.

Links to Clinical Trials on Harvoni

For people who wish to study the detailed results of independent trials on the side effects of Harvoni this link will take you to the FDA’s publication. It covers the effects and side effects of Harvoni is great detail but is quite easy to read.


If you want even more detail then this link will take you to numerous trials



Dealing With the Side Effects Of Harvoni and Other Hep C drugs

So, given that some people will have some side effects from treatment with Harvoni or any other Hep C medication how do we deal with these side effects, be the side effects mild or severe?


The first thing is to make sure that you are well hydrated, that you are drinking plenty of fresh water. This does not mean drinking plenty of soft drinks, sports drinks or milkshakes or tea or coffee.

Staying hydrated means drinking fresh water.

Fresh water helps the body remove toxins from the system and your body will be having to get rid of a lot of toxins and waste material over the time of your treatment and beyond. Your liver and kidneys will not only be removing the Sofosbuvir, Ledipasvir or what ever Hep C drugs you are taking, but also the “dead”viral material and by-products of your body beginning to heal once the virus is cleared.

Curing Hep C: what happens?

Let’s look at what this healing means.

By about day 7 of treatment almost all the Hepatitis C virus in your body will have  been “killed”. Its not all gone but 99.9% of the virus will be “dead” by the end of the first week.

For example, I know one guy who had a viral load of over 10 million a few weeks before he started Hep C treatment. He got a viral load test just five days into his Hep C treatment with generic Harvoni.

The viral load result came back “undetected”, after just 5 days of treatment.

That dis not mean that there was no virus left in his body, just that the virus numbers were so low that the technology could not count them.

Once your viral load drops to such a low level it means that an enormous pressure is removed from your liver, from your immune system and from your body generally.

Chronic Hepatitis C: Rust Never Sleeps

While you have a chronic Hep C infection your immune system is continually fighting the virus trying to get rid of it. Its a war, your immune system fighting the invading virus.

This is going on 24 hours a day, 7 days a week, year in year out.

The virus is never dormant, and your body never stops fighting the virus. The continual fight against the Hep C virus takes a lot of your body’s resources.

As the Harvoni kicks in and clears the virus those resources can then be diverted to healing, rebuilding.

Ending the War

Its like when a war ends and the people of a country can divert the energy and resources being spent waging war to firstly cleaning up the damage and debris left by the war and then rebuilding and improving infrastructure.

Another thing that happens when the viral load drops is that your liver starts to heal.

How the Hep C Virus “breeds”

Hepatitis C breeds in your liver. It burrows into your liver cells where it uses your liver’s own DNA to replicate itself. Then the Hep C virus causes the liver cell to explode and the new Hep C RNA strands float off into your blood to find another liver cell to destroy.

If you have a viral load of 4 million, that means that there are 4 million virus RNA strands in every drop of your blood. But Hep C does not breed in your blood, it uses your blood as a transportation system to get into your liver where it breeds.

The numbers of actual virus in your body could easily be in the tens of billions

Repairing Years of Damage

So when the antiviral medication kicks in and the Hep C virus is no longer blowing up your liver cells then your liver will start to repair the damage that has built up over the years. This involves removing dead sections of the liver, scar tissue and the like. Imagine it like your skin healing a wound, first there is the scab and then the scab falls off and leaves a scar. Then the skin begins to grow new skin cells and replace the scar tissue with good skin.
The skin and the liver are the only two organs that can repair such damage.

Repairing the damage will take time… the same as scar tissue on your skin.

If we go back to the comparison with the end of a war we understand that the healing process takes lots of energy and raw materials.

It is super important that you give your body the things it needs to maintain and continue the healing process. This mean a very health diet and plenty of fresh air and sunshine and exercise.

Giving Your Self the Best Chance

If you set things up well before you start treatment that will give you the best chance.

Before you start your Hep C treatment, which ever drug combination you are using, get your lifestyle in order. Start eating healthy, plenty of fresh fruit and vegetables. Start the day with a big drink of water of freshly squeezed juice.

Cut out excess fat and eliminate cane sugar from your diet.

Start an exercise program, even if it is just a half hour walk every day.

Get out in the fresh air and the sunshine.

Maybe include a multi vitamin pill if you think it will help. Vitamin D is important and a great many people a D deficient.

Do everything that you can to maximise the healing and minimise the side effects.

For people who wish to study the detailed results of independent trials on the side effects of Harvoni this link will take you to the FDA’s publication. It covers the effects and side effects of Harvoni is great detail but is quite easy to read.


If you want even more detail then this link will take you to numerous trials



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Greg Jefferys

Greg Jefferys


  •    Reply

    Interesting. Good work Greg.
    Speaking of side effects. I had many things happen to me. I also question, were my reactions due to the Harvoni or to my liver and every cell in my body that has been affected with the virus.
    I would like to point out that I have been susceptible to drug sensitivity before.

    Just my opinion, but not much is said about relapses and how to protect yourself from reinfection. A toothbrush should be changed weekly, I would assume. Tips like this could possibly help someone who did not consider certain behavior.

    •    Reply

      HI Wayne
      Thanks for your comments.
      In answer to your first question the many things that happened to you during treatment were probably the result of both the things you mentioned.
      The actual effects of the drugs and also the “destabilizing” effect of the healing process on your body.
      There is a word in biology called homeostatis “The tendency toward a relatively stable equilibrium between interdependent elements, especially as maintained by physiological processes.”
      Basically the body tries to keep everything in balance. All the processes, the various hormones and enzymes etc. ect. The liver plays a major role in maintaining homeostatis. When we have Hep C there are all kinds of corrections made to compensate for the effects of the virus. When the virus is removed, quite suddenly in most cases. homeostatis is lost.
      I imagine it would take the body at least a couple of weeks to regain homeostatis and it is this people where most people report their most difficult phase of treatment.
      With regards to relapse. Definitely all precautions should be taken to prevent re-infection. In most cases a mild bleach will sterilize any household surface or implement.
      The question of relapses is a very interesting one that I have studied for a long time.
      The points you raise are valid

  •    Reply

    Thank you so much Greg., so important to pas this information especially since doctors do not warn their patients to what to expect. With your permission I’d like to translate it into Portuguese.

    •    Reply

      I am glad you found it useful Micky. I would be grateful if you would translate it to Portuguese
      best wishes to you

  •    Reply

    A great overview of the side effects of the drug.
    I was one of the few receiving the treatment in S Africa 4 years ago and my 12 weeks were not trouble free. Within 2 weeks an ulcer i never knew that I had burst and a kidney stone the size of a planet made its journey within my body rather untimely. Was it the medication or not who knows but the immediate loss of close up reading vision was too coincidental to not be the medication, i do not think it was the age of 44 that overnight said “it is time”. Generally the head fuzz was manageable and i am free from the virus so all ended well.

  •    Reply

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