Who Should Be Tested
Testing for hepatitis A is not routinely recommended.
CDC recommends hepatitis B testing for:
- Men who have sex with men
- People who inject drugs
- Household and sexual contacts of people with hepatitis B
- People requiring immunosuppressive therapy
- People with end-stage renal disease
- People with hepatitis C
- People with elevated ALT levels
- Pregnant women
- Infants born to HBV-infected mothers
CDC recommends hepatitis C testing for:
- All adults aged 18 years and older
- All pregnant women during each pregnancy
- About 24,900 new infections each year
- About 22,600 new infections in 2018
- Estimated 862,000 people living with hepatitis B
- About 50,300 new infections in 2018
- Estimated 2.4 million people living with hepatitis C
Will A Specialist Need To Be Involved
In order to prescribe, general practitioners including physicians with expertise in viral hepatitis, will be required to first consult with a gastroenterologist, hepatologist or infectious diseases physician to ensure patients with liver disease or other complex needs are appropriately referred to specialist care. A face to face consult with the specialist is not required and patients with complex needs will likely be referred to specialist care where appropriate.
Patients affected by hepatitis C with severe or advanced liver disease may still need to access the treatments under the care of a specialist – such as a gastroenterologist, hepatologist, or an infectious disease physician with experience in treating chronic hepatitis C infection.
Who Is Most At Risk Of Contracting Hepatitis C
You have a high risk of contracting hepatitis C if you:
- use or have used injection drugs even if it was just once or many years ago
- have received blood or blood products or an organ transplant before July 1990 in Canada
- have been in jail or
- have been injected or scratched during vaccination, surgery, blood transfusion or a religious/ceremonial ritual in regions where hepatitis C is common.
You have a high moderate risk of contracting hepatitis C if you:
- have tattoos or body piercing
- have multiple sexual partners
- have a sexually transmitted infection , including HIV or lymphogranuloma venereum
- have experienced traumatic sex or rough sex or have used sex toys or fisting that can tear body tissue
- have vaginal sex during menstruation
- have received a kidney treatment
- have received an accidental injury from a needle or syringe
- have another infectious disease
- were born to a hepatitis C infected mother or
- have a sexual partner infected with hepatitis C.
Hepatitis C is NOT passed from person to person by:
- coughing, sneezing
- breastfeeding unless your nipples are cracked and bleeding or
- oral sex, unless blood is present.
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Virological Response To Therapy
The therapy of HCV infection is basically aimed to eradicate the virus and prevent the ensuing disease complications. The success of therapy is monitored by SVR rate which is defined as the absence of the HCV RNA in serum post 24 weeks of stoppage of treatment. The value of SVR indicated not only eradication of virion from circulation but also correlates with symptoms. The combination of PegIFN and ribavirin has been the SOC for all patients infected with HCV irrespective of viral genotypes. This regimen produces SVR to 70%-80% in patients with HCV genotype-2 or -3 infection. However, SVR reached only 45%-70% in patients infected with other genotypes. In recent trials of boceprevir and telaprevir in patients with cirrhosis it was noted that SVR was low in comparison to that in non-cirrhotic patients.
Hepatitis C Patients Cured With Antiviral Medicines Are Less Likely To Be Hospitalized Need Er Care For Liver
Researchers at Henry Ford Health System, as part of a national hepatitis C collaborative, report that patients with chronic hepatitis C who are treated with direct-acting antiviral medicines are less likely to be hospitalized or seek emergency care for liver and non-liver related health issues.
The study, published online in Clinical Infectious Diseases, underscores the extraordinary effect of these newer antivirals, which have been shown to cure hepatitis C in 98 percent of patients who take them. Patients are said to be cured when the virus is no longer detectable in their blood.
“The findings of our study show that curing hepatitis C not only gets rid of the virus, it also improves the overall health of patients,” said Stuart Gordon, M.D., Director of the Division of Hepatology at Henry Ford and the study’s lead author. “This is consistent with our earlier studies that showed effective treatment of hepatitis C also reduces the risk of patients developing other health conditions like diabetes, kidney disease, stroke and heart attacks.”
According to federal data, at least 2.4 million people are living with hepatitis C in the United States and most don’t know they have the virus. As a result, they are at risk for life threatening liver disease and cancer. Rates of new liver cancer cases have increased 38 percent from 2003 to 2012.
Researchers analyzed data of 6,100 patientshalf who were treated with DAAs and half who were not.
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How Many Victorians Are Affected By Hepatitis C And Who Is Affected
Hepatitis C is the most common blood borne virus in Australia with approximately 230,000 people currently living with hepatitis C in Australia and around 65,000 in Victoria.
The population most at risk of acquiring hepatitis C are people who currently inject drugs including people from Aboriginal and Torres Strait Islander and culturally and linguistically diverse backgrounds, prisoners, older people, and young injectors and/or new initiates to injecting drug use.
Side Effects Of Treatment
Treatments with direct-acting antivirals have very few side effects. Most people find DAA tablets very easy to take.
You may feel a little sick and have trouble sleeping to begin with, but this should soon settle down.
Your nurse or doctor should be able to suggest things to help ease any discomfort.
You need to complete the full course of treatment to ensure you clear the hepatitis C virus from your body.
If you have any problems with your medicines, speak to your doctor or nurse straight away.
Side effects for each type of treatment can vary from person to person.
For a very small number of people, more severe side effects from hepatitis C treatments may include:
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What Does Treatment With The New Drugs Involve
The drugs are easy to take and are taken orally.
Treatment time is usually 12 weeks. However this may range between 8 and 24 weeks for a complete course of treatment, depending on the patients genotype, whether the patient has cirrhosis, treatment history and which of the drug combinations the prescriber chooses to use.
Should I Be Screened For Hepatitis C
Doctors usually recommend one-time screening of all adults ages 18 to 79 for hepatitis C. Screening is testing for a disease in people who have no symptoms. Doctors use blood tests to screen for hepatitis C. Many people who have hepatitis C dont have symptoms and dont know they have hepatitis C. Screening tests can help doctors diagnose and treat hepatitis C before it causes serious health problems.
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Where Can I Go If I Have Further Questions Or Need More Information
- Your local GP and pharmacist can provide you with more information on the new treatments, including if they are right for you. To find a GP, please click here
- The Victorian Government funds a range of community organisations to provide information, care and support to people living with hepatitis C, and on the new treatments. For more information, please visit:
- Hepatitis Victoria’s website or their Hepatitis Infoline on 1800 703 003or refer to the Hepatitis Victoria, PBS factsheets
What Is Chronic Viral Hepatitis
Patients infected with HBV and HCV can develop chronic hepatitis. Doctors define chronic hepatitis as hepatitis that lasts longer than 6 months. In chronic hepatitis, the viruses live and multiply in the liver for years or decades. For unknown reasons, these patients’ immune systems are unable to eradicate the viruses, and the viruses cause chronic inflammation of the liver. Chronic hepatitis can lead to the development over time of extensive liver scarring , liver failure, and liver cancer. Liver failure from chronic hepatitis C infection is the most common reason for liver transplantation in the U.S. Patients with chronic viral hepatitis can transmit the infection to others with blood or body fluids as well as infrequently by transmission from mother to newborn.
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Antiviral Treatment Of Hepatitis C
Helpful Tips While Taking Hepatitis C Medications
- Always follow your health care providers’ advice, particularly the instructions on taking your medicine.
- If you have to cancel an appointment, call your provider and schedule a new one as soon as possible.
- Take good care of yourself. Eat well, drink 8 to 10 glasses of water each day, and try to get a full night’s sleep.
- Learn about the hepatitis C medications you are taking. This includes special risks and warnings.
- If taking ribavirin, use sunscreen, wear long sleeves and a hat, and limit sun exposure.
- Write down your doctor’s name and phone number. Carry this information with you at all times.
- Write the names and amounts of the medicines you are taking. Carry this information with you at all times.
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Why Should People Take Antiviral Medications For Hepatitis C
The purpose of taking antiviral medications for hepatitis C is to:
- remove all the hepatitis C virus from your body permanently
- stop or slow down the damage to your liver
- reduce the risk of developing cirrhosis
- reduce the risk of developing liver cancer
- reduce the risk of liver failure and the need for a liver transplant
Antiviral Medication For Hepatitis B
Doctors may recommend antiviral medication for people with chronic hepatitis B, which occurs when the virus stays in your body for more than six months.
Antiviral medication prevents the virus from replicating, or creating copies of itself, and may prevent progressive liver damage. Currently available medications can treat hepatitis B with a low risk of serious side effects.
NYU Langone hepatologists and infectious disease specialists prescribe medication when they have determined that without treatment, the hepatitis B virus is very likely to damage the liver over time. People with chronic hepatitis B may need to take antiviral medication for the rest of their lives to prevent liver damage.
There are many different types of antiviral medications available, and your doctor recommends the right type for you based on your symptoms, your overall health, and the results of diagnostic tests. A doctor may take a wait-and-see approach with a person who has a healthy liver and whose blood tests indicate a low viral load, the number of copies of the hepatitis B virus in your bloodstream.
Someone with HIV infection or AIDS may have a weakened immune system and is therefore more likely to develop liver damage. The U.S. Centers for Disease Control and Prevention strongly recommends that people with HIV infection who are diagnosed with hepatitis B immediately begin treatment with antiviral medication.
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What Are The Symptoms And Signs Of Viral Hepatitis
The period of time between exposure to hepatitis and the onset of the illness is called the incubation period. The incubation period varies depending on the specific hepatitis virus. Hepatitis A virus has an incubation period of about 15 to 45 days Hepatitis B virus from 45 to 160 days, and Hepatitis C virus from about 2 weeks to 6 months.
Many patients infected with HAV, HBV, and HCV have few or no symptoms of illness. For those who do develop symptoms of viral hepatitis, the most common are flu-like symptoms including:
Recommended Monitoring During Antiviral Therapy
The recommended pretreatment testing assumes that a decision to treat with antiviral medications has already been made and that the testing involved in deciding to treatincluding testing for HCV genotype and assessment of hepatic fibrosishas already been completed .
Prior to starting treatment, patients should be evaluated for potential drug-drug interactions with selected antiviral medications by consulting the prescribing information and using other resources . The table below lists known drug-drug interactions between HCV DAAs and selected medications.
Table. Drug Interactions with Direct-Acting Antivirals and Selected Concomitant Medications
| Rifaximin | Rifaximin |
|
H2RA=Histamine H2 Antagonist PPI=proton pump inhibitor DHP CCB=dihydropyridine calcium channel blocker Non-DHP CCB=non-dihydropyridine calcium channel blocker Green indicates co-administration is safe yellow indicates a dose change or additional monitoring is warranted red indicates the combination should be avoided. Specific concomitant medications or medication classes with actual or theoretical potential for interaction are listed in the box. |
Pregnancy and Nursing Mothers
Reactivation of Hepatitis B Virus Infection
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Recommended Monitoring For Pregnancy
RECOMMENDED RATING Women of childbearing potential and their partners should not receive ribavirin during or for at least 6 months prior to pregnancy. I, C Women of childbearing potential should be counseled not to become pregnant while receiving a ribavirin-containing antiviral regimen, and for at least 6 months after stopping the regimen. I, C Male partners of women of childbearing potential should be cautioned to prevent pregnancy while they are receiving a ribavirin-containing antiviral regimen, and for up to 6 months after stopping the regimen. I, C Serum pregnancy testing is recommended for women of childbearing potential prior to beginning treatment with a regimen that includes ribavirin. I, C Assessment of contraceptive use and of possible pregnancy is recommended at appropriate intervals during ribavirin treatment for women of childbearing potential, and for female partners of men who receive ribavirin treatment. I, C
Ribavirin causes hemolysis. Patients receiving ribavirin should have hemoglobin levels checked during treatment, often after 2 weeks, and the ribavirin dose reduced if the patient develops significant anemia, often defined as hemoglobin < 10 g/dL.
Antiviral Medication For Hepatitis C
For people with hepatitis C, the goal of treatment with antiviral medication is to prevent the virus from replicating, or copying itself, and to eliminate the virus from the bloodstream. If the hepatitis C virus has been in the body for more than six months, the infection is considered chronic. Without treatment, most people with acute hepatitis C develop the chronic form of the disease.
Your doctor decides which antiviral medicationor combination of medicationsto prescribe based on the results of a blood test called a genotype test. There are six genotypes, or strains, of the hepatitis C virus, and people with certain genotypes respond more quickly to medical treatment.
For many years, the standard treatment for chronic hepatitis C consisted of the antiviral medications pegylated interferon and ribavirin. Ribavirin is taken by mouth every day, and interferon is an injection that you or a caregiver can administer once a week at home.
In 2013 and 2014, the U.S. Food and Drug Administration approved a group of new medications for the treatment of hepatitis C. These medications, which include sofosbuvir, are very effective and have fewer side effects than older medications, particularly interferon.
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Will Community Pharmacies Be Able To Dispense These New Hepatitis C Drugs
Community pharmacists will be able to dispense the drugs. However, because these are new drugs, it may take time for pharmacies to order in sufficient stock to meet demand.
This means that patients may need to wait a couple of days after providing their script for the drugs to be available from their local pharmacy.
How Long Does It Last
Hepatitis A can last from a few weeks to several months.
Hepatitis B can range from a mild illness, lasting a few weeks, to a serious, life-long condition. More than 90% of unimmunized infants who get infected develop a chronic infection, but 6%10% of older children and adults who get infected develop chronic hepatitis B.
Hepatitis C can range from a mild illness, lasting a few weeks, to a serious, life-long infection. Most people who get infected with the hepatitis C virus develop chronic hepatitis C.
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What About Patients With Hepatitis C Who Also Have Hepatitis B
Hepatitis B virus can flare in patients who are co-infected with hepatitis B and hepatitis C and are taking medication for hepatitis C. This has been reported as a potential risk for patients who are taking hepatitis C treatment and have underlying hepatitis B as well. The flare usually occurs within a few weeks after the patient starts taking medication for hepatitis C. Therefore, patients who have both hepatitis B and hepatitis C should be seen by a hepatitis expertbeforestarting treatment of the hepatitis C they may need to start taking hepatitis B treatment to avoid a hepatitis B flare.
The Following Monitoring Is Not Recommended During Or After Therapy
NOT RECOMMENDED RATING Monitoring for HCV drug resistance-associated substitutions during or after therapy is not recommended unless retreatment will be performed. RAS testing is recommended in advance of retreatment therapy. See the Retreatment section for recommendations regarding RAS testing prior to retreatment. Additional information about RAS testing can be found in the HCV Resistance Primer. IIb, C
Patients who do not achieve SVR retain the possibility of continued liver injury, progression of hepatic fibrosis, and the potential to transmit HCV infection to others. Such patients should be considered for retreatment per the Retreatment of Persons in Whom Prior Therapy Has Failed section.
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