Symptoms May Not Develop For Many Years
An acute hepatitis C infection occurs within the first 6 months after exposure to the virus. Symptoms, which can sometimes appear weeks or months after infection, may include nausea, vomiting, loss of appetite, diarrhea, fever, headache, and abdominal pain.
Up to 25% of people with an acute infection clear the virus from their blood without treatment. In most people, however, the virus remains in the bloodstream, and the infection becomes chronic. A chronic hepatitis C infection causes liver damage and inflammation. Healthy liver tissue dies and is replaced by scar tissue. If left untreated, hepatitis C infection can lead to permanent liver failure, making liver transplantation necessary.
New Oral Hepatitis C Drugs: Faq
Dec. 9, 2013 Experts call two new drugs for hepatitis Cgame changers that they expect will dramatically improve treatment for many of the 3 million Americans with a chronic infection. Hepatitis C can lead to liver failure.
Both new pills Olysio and Sovaldi work better than the current treatment for hepatitis C. They cure it more often and in less time. They also have fewer side effects.
In a major advance, the drugs could eliminate the need for some patients to take interferon, which is injected and can have unpleasant, even intolerable side effects.
Most hepatitis C patients and most physicians would like never to use interferon again, says Henry Masur, MD, past president of the Infectious Diseases Society of America.
The FDA approved both new oral drugs in combination with other drugs, he says. Neither can be taken alone. The next question, he says, is What is the best combination?
Doctors hope and predict that the combinations deemed best will often exclude the need for interferon for more and more patients. But the new drugs are expected to be more expensive.
Here, three experts address questions they get from patients about the new options.
How do Olysio and Sovaldi work?
Both Olysio and Sovaldi prevent the virus from copying itself, Masur says.
What is each drug approved for?
Olysio is approved for people with genotype 1 infection in combination with the medicines ribavirin and interferon.
How effective is each drug?
How Effective Is Treatment
Direct-acting antivirals cure 9 out of 10 patients with hepatitis C.
Successful treatment does not give you any protection against another hepatitis C infection. You can still catch it again.
There’s no vaccine for hepatitis C.
If treatment does not work, it may be repeated, extended, or a different combination of medicines may be tried.
Your doctor or nurse will be able to advise you.
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Meeting With Your Healthcare Provider
Keeping your medical appointments and regularly communicating with your healthcare provider is important to staying healthy, minimizing treatment-related side effects and maximizing your chance of treatment success. Here are some things you can do to get the most out of your medical appointments:
If you run out of time during your appointment and still have questions, ask if theres someone else on your healthcare team who can talk with you. If not, ask if you can leave a copy of your questions and request a time to discuss them on the phone.
Medication Regimens According To Hcv Genotype
The good news is that there are now more medications available to treat Hepatitis C than ever before. Based on your medical history, physical exam, laboratory and other test results, your healthcare provider will suggest which medications are right for you, as well as determine the length of time you need to be treated. This decision will depend upon a number of factors including:
- Your Hepatitis C virus genotype
- Whether or not you have cirrhosis, and if its mild or severe
- If youve received treatment before and which medications were used
- If youre waiting for or youve already had a liver transplant
- Other health conditions you may have
Treatment regimens are usually 8 to 24 weeks, but sometimes longer, depending on your particular circumstances.
What follows is a basic outline of recommended treatment protocols organized by HCV genotype. HCV genotypes are 1 , 2, 3, 4, 5, and 6. About 75% of the people with HCV in the U.S. have either genotype 1a or 1b. Between 10% 20% of people with HCV in the U.S. have either genotype 2 or 3.
Use this information as a starting point to talk with your healthcare provider about which treatment protocol is best for you. Keep in mind that these are general guidelines and they do not cover alternative treatment protocols or special situations. Its important to follow your healthcare providers instructions regarding what, when, how and for how long to take your medication, as this will depend upon your specific circumstances.
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Traveling While On Treatment
If you plan to travel while on treatment, there are several considerations you need to think about when making arrangements:
- If youre traveling by car, do not leave medications in a hot vehicle.
- If youre traveling by air, carry on all medications with you in the cabin. Keep them in their original containers with the prescription label.
- Make sure to bring contact information for your healthcare providers with you in case you need to contact them with a question or concern.
- Keep a card in your wallet that indicates who to call in an emergency. This should include contact information for a family member and your doctor.
Potential Outcomes Of Treatment
In order to adequately monitor your response to treatment, youll need to visit your healthcare provider so he or she can examine you in person and discuss how youre feeling. The level of Hepatitis C virus in your bloodstream will be checked to monitor your response to treatment. The potential outcomes of treatment are the following:
- Sustained virologic response : You are considered cured if the Hepatitis C virus is not detected when measured with a blood test three months after youve completed treatment. This is called a sustained virologic response and data suggest that you will stay virus free indefinitely.
- Nonresponse: The Hepatitis C virus does not become undetectable as a result of treatment. This can be further categorized as partial response, when the viral levels become lower but not undetectable, or null-response which is when the viral level never drops significantly.
- Relapse: The Hepatitis C virus becomes undetectable on treatment, but then is detectable again, either during treatment or after treatment is stopped.
- Incomplete treatment: Treatment ended earlier that the prescribed duration.
The goal of treatment is to have an SVR. This is when you are considered cured. Taking your medication as prescribed will increase your chance of being cured and decrease the long-term complications of Hepatitis C.
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Who Should Get Tested
You should consider getting tested for hepatitis C if you’re worried you could have been infected or you fall into one of the groups at an increased risk of being infected.
- Hepatitis C often has no symptoms, so you may still be infected if you feel healthy.
- The following groups of people are at an increased risk of hepatitis C:
- ex-drug users and current drug users, particularly users of injected drugs
- people who received blood transfusions before September 1991
- recipients of organ or tissue transplants before 1992
- people who have lived or had medical treatment in an area where hepatitis C is common high risk areas include North Africa, the Middle East and Central and East Asia
- babies and children whose mothers have hepatitis C
- anyone accidentally exposed to the virus, such as health workers
- people who have received a tattoo or piercing where equipment may not have been properly sterilised
- sexual partners of people with hepatitis C
If you continue to engage in high-risk activities, such as injecting drugs frequently, regular testing may be recommended. Your doctor will be able to advise you about this.
Combination Drug Therapy For Patients With Hepatitis C
|The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.|
|First Posted : November 4, 1999Last Update Posted : March 4, 2008|
During the first 6 months of the study, subjects will be asked to return to the outpatient clinic for routine check-ups and blood tests every 2 to 4 weeks. Blood tests will include tests for hepatitis C virus. If the virus test becomes negative on treatment, the therapy will be considered successful and will be continued for a full 6 or 12 months .
If the virus test does not become negative during the first six months of treatment, subjects will be considered non-responders and will stop taking interferon but will continue on ribavirin alone or an identically appearing placebo tablet. These non-responsive subjects will continue this therapy for an additional 12 months. .
Upon completion of the drug therapies, subjects will be requested to submit blood samples and undergo a liver biopsy to determine if the therapy was successful. Test results that reveal a loss of hepatitis C antibodies or normal levels of liver enzymes will be deemed successful.
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How Is Hepatitis B Diagnosed
There are three main ways to diagnose HBV infection. They include:
- Blood tests: Tests of the blood serum shows how your bodys immune system is responding to the virus. A blood test can also tell you if you are immune to HBV.
- Abdominal ultrasound: An ultrasound uses sound waves to show the size and shape of your liver and how well the blood flows through it.
- Liver biopsy: A small sample of your liver tissue is removed though a tiny incision and sent to a lab for analysis.
The blood test that is used to diagnose hepatitis B is not a test that you get routinely during a medical visit. Often, people whove become infected first learn they have hepatitis B when they go to donate blood. Blood donations are routinely scanned for the infection.
The virus can be detected within 30 to 60 days of infection. About 70% of adults with hepatitis B develop symptoms, which tend to appear an average of 90 days after initial exposure to the virus.
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The Place Of Regimens In Therapy
The decision of which agent to use in the setting of HCV should be based largely on individual patient factors, such as comorbid disease states, potential drugdrug interactions, and insurance coverage and affordability, because the available medications have relatively similar rates of cure. Comorbidities to consider include cirrhosis status, HIV, and CKD. The efficacy and tolerability of the available regimens are especially comparable in GT 1 patients who are noncirrhotic and treatment naïve. Prior to starting any patient on medication, a thorough analysis for drugdrug interactions should be conducted, ideally by a pharmacist trained in infectious diseases. Multiple types of interactions may exist aside from typical CYP-mediated interactions, such as altered gastric pH affecting bioavailability, P-gp inhibition or induction, or RAVs affecting medication efficacy in experienced patients.
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History And Physical Exam
To diagnose hepatitis, first your doctor will take your history to determine any risk factors you may have for infectious or noninfectious hepatitis.
During a physical examination, your doctor may press down gently on your abdomen to see if theres pain or tenderness. Your doctor may also feel to see if your liver is enlarged. If your skin or eyes are yellow, your doctor will note this during the exam.
Healthcongress May Be To Blame For High Drug Prices
People can be cured of hepatitis C but they are not immune from getting it again. Some states fear that people who had been infected through risky behavior, such as injecting drugs, might get re-infected, and theyd end up treating the same patients over and over.
That is a shortsighted policy, argued Alyson Harty, clinical nurse manager for Mt. Sinais liver institute.
Even if a patient doesnt need a transplant, the cost of cirrhosis care for a patient thats in and out of the hospital over even a year is way more than the cost of treatment, she said.
And the cure rate is high. In my office, more than 93 percent of patients treated for hepatitis are cured, Bordon said.
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Risk Of Hcv Infection
Hepatitis is an inflammation of the liver that can lead to decreased liver function. Hepatitis can be caused by toxins, including alcohol and certain medications, or it can be caused by a virus. HCV is the virus that causes hepatitis C, or hep C. It is one of the most common hepatitis viruses.
HCV is transmitted through blood-to-blood contact. Before we had a screening test for hep C in 1992, most people got infected through blood transfusions. This explains why baby boomers, those born between 1945 and 1965, are five times more likely to have the virus.
Today, most people with the virus get infected by sharing needles or other equipment for injecting drugs. Recent research has shown that the growing opioid epidemic is driving up rates of hep C infection, especially among young people. In addition, the prison population is at high risk for infection because of the high number of injection drug users who enter correctional facilities who are already living with hep C. Inside prisons, hep C is transmitted through injection drug use and unsafe practices for tattoos and piercings. It is estimated that one in three people in U.S. jails and prisons have HCV.
Hep C can be transmitted through sexual activity however, this is rare and most likely to happen if a person is already living with HIV or another sexually transmitted infection. The Centers for Disease Control and Prevention estimates that 25% of people living with HIV also have HCV.
Viral Infection That Attacks The Liver
Hepatitis C is caused by a virus that infects the liver. Unlike most viruses, it is spread only through contact with infected blood. Most people infected with the hepatitis C virus do not have symptoms for many years, so they are unaware of their condition. Several drugs for treating hepatitis C are very effective, and new treatments cause fewer side effects than older drug regimens. Hepatitis C affects more than 3 million people in the United States and causes thousands of deaths each year from liver-related diseases. This infection increases a persons risk of developing cirrhosis and liver cancer.
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Costs And Other Considerations
Much of the discussion about HCV treatment has focused on the costs of therapy given the large up-front prices. Based on average wholesale prices , the cost of 12 weeks of treatment can range from approximately $65,000 to $113,000. The AWPs for a single days therapy and a full 12-week course of treatment are provided in Table 3.67 If the patient requires a regimen that also necessitates the use of RBV, additional drug acquisition costs need to be considered however, as a variety of dosage formulations and manufacturers is available, this product is not included in the pricing table. It is important to consider additional monitoring costs or medical costs that may arise from the adverse effects of RBV therapy, such as hemolytic anemia, which may require use of an erythropoietin-stimulating agent or increased laboratory monitoring.
Treatment For Chronic Hbv Infection
For chronic HBV infection, antiviral medications are available.
This is not a cure for chronic HBV. However, it can stop the virus from replicating and prevent its progression into advanced liver disease.
A person with a chronic HBV infection can develop cirrhosis or liver cancer rapidly and without warning. If a person does not have access to adequate treatment or facilities, liver cancer can be fatal within months of diagnosis.
People with a chronic HBV infection require ongoing medical evaluation and an ultrasound of the liver
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What Is Hepatitis C Again
Hepatitis C is a viral liver infection that’s classified into six strains known as genotypes. Each can help predict distinctly different treatment outcomes. Genotype 1 is the most prevalent in the United States followed by types 2, 3, and 4. Type 5 is almost always found in South Africa, while type 6 is commonly found in Southeast Asia.
If you have been diagnosed with hepatitis C, know that youre far from alone. According to the U.S. Department of Health and Human Services, anywhere from 2 million to 2.8 million people in America currently live with chronic hepatitis C. The tricky part in estimating how many people have it is that many are asymptomatic and unaware that they are even infected. In fact, the Health and Human Services estimates 40% of Americans living with hep C don’t know they have it.
Hep C is blood-borne, which means in order to contract it, your blood needs to come in direct contact with blood tainted with the virus. The risk factors for getting hep C include being over age 50 sharing needles and, less frequently, through having sex with an infected individual. Most patients with an acute hepatitis C infection are asymptomatic. However, between 50% and 85% of these acutely infected patients progress to chronic hepatitis C, meaning that the virus has been present for more than six months. Individuals that have additional diseases such as diabetes, alcoholism, HIV, and obesity, have an increased risk of liver damage.