What Can People Do To Help The Medications Work Best
- Take the medications every day
- Stay in touch with pharmacy to be sure that all refills are ready on time
- Take the medications exactly as prescribed
- Do not skip doses
- Get all blood tests done on time
- Go to all visits with providers as recommended
- Tell the provider about all other medications that are being taken – including over-the-counter medicines, vitamins, herbs, and supplements
- Complete the entire course of medication
Low Response Rates And Nonresponders
Low vaccination response rates have been associated with obesity, smoking, immunosuppression, and advanced age. Approximately 25-50% of persons who initially do not have a vaccine response will show a response to 1 additional vaccine dose, and 50-75% of individuals will have a response to a second 3-dose series.
It is recommended that testing for anti-HBs be obtained 4-12 weeks following vaccination. Revaccinate nonresponders, with another series of 3-dose hepatitis B vaccine. Consider delaying revaccination for several months after initiation of antiretroviral therapy in patients with CD4 counts below 200 cells/mm3 or those with symptomatic HIV disease. The delay in these individuals is an attempt to maximize the antibody response to the vaccine.
Do not defer vaccination in pregnant patients or patients who are unlikely to achieve an increased CD4 count. Individuals at increased risk of severe complications due to HBV infection include those unlikely to achieve CD4 counts of 200 cells/mm3 or above after antiretroviral therapy and HIV-infected pregnant women.
A combined hepatitis A virus /HBV vaccine is licensed in many countries and offers the advantage of protection against both of these viruses at the same time. The vaccine seems to be safe, although some questions exist regarding neurologic complications.
Is There A Cure
Though there is no vaccine for Hepatitis C, treatments can reduce the viral load to undetectable levels which is considered cured or in remission.
The virus is considered cured when it is not detected in your blood 12 weeks after treatment is completed. This is otherwise known as a sustained virologic response .
Hepatitis C is one of the most serious hepatitis viruses. However, with newer treatments developed over the past few years, the virus is much more manageable than it was in the past.
Current antiviral drugs that help cure hepatitis C may also help prevent the health complications of chronic liver disease.
The reports less than half of people who contract the hepatitis C virus may clear it from their bodies without treatment. For this group of people, the virus will be a short-term acute condition that goes away without treatment.
But for most people, acute hepatitis C will likely develop into a chronic condition that requires treatment.
Since the virus often doesnt produce symptoms until after more significant liver damage occurs, its important to get tested for hepatitis C if you think you might have been exposed.
approved the antiviral drug Mavyret for an 8-week treatment period for people with all genotypes of hepatitis C.
This treatment is now being used for many people instead of the 12-week treatment that was previously required.
Noninvasive ways to test for liver damage caused by hepatitis C are also now available to aid in diagnosis.
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What Is Chronic Hepatitis B
You have chronic hepatitis B when the virus is active in your body for more than 6 months. The virus can damage liver cells and cause your liver to become swollen and tender.
Most people who have chronic hepatitis B dont have symptoms. But they can still pass the infection to other people, especially the people they live with or have sex with, unless they receive treatment that gets rid of the virus.
Most people with chronic hepatitis B dont develop serious problems. But about 15 to 25 people out of 100 who have the infection will die of cirrhosis or liver cancer.footnote 1 When there is a lot of the virus in your body, your chance of having these problems is greater. Sometimes, chronic hepatitis B can lead to severe liver damage. If this happens, you may need a liver transplant.
Direct Nonmedical And Indirect Costs
| Disease category | Medical leave and time off | Productivity lossMonthly cost of reduced productivity = Reported loss of productivity × monthly wage rate, where Reported loss of productivity = number of sick days due to HBV/total number working days of a month. | Transportation, meals, accommodation |
|---|
| 1,483,221,108 |
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Advantages And Mechanisms Of Ifn
For CHB patients, standard PEG-IFN monotherapy is administered once weekly as a subcutaneous injection for 48 weeks, with advantages of finite treatment duration and sustained virologic response. PEG-IFN resulted in a sustained loss of hepatitis B e antigen and nondetectable hepatitis in 30% of patients . In HBeAg-negative CHB, combination NAs plus PEG-IFN for 48 weeks is safe and could result in greater treatment efficacy than NAs monotherapy . For patients who achieve virologic suppression with NAs, such as entecavir , switching to a finite course of PEG-IFN significantly increases rates of HBsAg seroclearance to 20% of those with baseline HBsAg < 1500 IU/ml . In contrast, HBsAg seroclearance during NAs monotherapy is low . Once the HBV genome was inactivated , HBsAg seroclearance occurred in 40% of those receiving PEG-IFN therapy . In addition, treatment by PEG-IFN has been suggested to be associated with a lower incidence of HCC than NAs treatment in chronic HBV infection .
IFN- treatment can induce an antiviral state in hepatocytes by regulating gene expression and protein translation, which exert non-cytolytic antiviral effects in several stages of the HBV life cycle.
Approved Drugs For Adults
There are currently 7 approved drugs in the United States for adults living with chronic hepatitis B infection. These include 5 types of antiviral drugs that are taken as a pill once a day for 1 year or longer. And there are 2 types of immune modulator drugs called interferon that are given as an injection for 6 months to 1 year.
It is important to know that not everyone needs to be treated. A liver specialist should evaluate your health through a physical exam, blood tests, and an imaging study of your liver . Then you can discuss together whether you are a good candidate for treatment since the approved drugs are most effective when there are signs of active liver disease. In addition, talk to your provider about HBV Clinical Trials since there are several new drugs being tested that are available for infected adults.
All adults, however, should be seen regularly by a liver specialist whether they are on treatment or not.
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An Economic Evaluation Of The Costs Of
- J.L.Garcia de AncosAffiliationsHealth Services Research Unit, Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
- J.A. RobertsAffiliationsHealth Services Research Unit, Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
- G.M. DusheikoCorrespondenceCorrespondence: G.M. Dusheiko, Academic Department of Medicine, Royal Free Hospital, Pond Street, Hampstead, London, NW3 2QG, U.K..Affiliations
How Hepatitis C Used To Be Treated
Along with abstinence from alcohol , the standard treatment for chronic hepatitis C used to be a combination antiviral therapy consisting of a pegylated interferon and ribavirin, sometimes called PEG/riba therapy.
A pegylated interferon is a long-acting form of an interferon, a synthetic copy of an infection-fighting protein secreted by immune system cells in response to pathogens. Ribavirin is a drug that interferes with HCV’s ability to replicate. In some cases, pegylated interferon was used without ribavirin, but ribavirin alone isn’t effective against hepatitis C.
To treat hepatitis C, doctors prescribed weekly injections of the pegylated interferons along with twice-daily oral doses of ribavirin. PEG/riba therapy was not a cure-all.
Interferon is not an option for people with liver failure, autoimmune diseases, and psychiatric illness. It can also cause a range of life-threatening complications that prevent many people from completing their therapy.
Newer drug regimens that can cure hepatitis C have forced a change in the standard treatment for the disease, and in the United States, these medications have largely replaced interferon. But, although it is rarely used, pegylated interferon with or without ribavirin may still be used in combination with newer antiviral drugs.
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World Health Organization Recommendations
The 2015 WHO guidelines for the prevention, care, and treatment of persons with chronic hepatitis B infection indicates treatment priority for individuals of all ages who have chronic hepatitis B infection and clinical evidence of compensated/decompensated cirrhosis , regardless of their levels of ALT or HBV DNA, or their HBeAg status.
Treatment is recommended for adults with chronic hepatitis B infection without clinical evidence of cirrhosis , but who have all of the following features , and regardless of HBeAg status :
- Are older than 30 years
- Have persistently abnormal ALT levels
- Have evidence of high-level HBV replication .
In individuals with HBV/human immunodeficiency virus coinfection, the AASLD recommends initiating ART in all those with evidence of severe chronic liver disease, regardless of CD4 count, as well as those with a CD4 count of 500 cells/mm3 or below, regardless of their liver disease stage.
However, the AASLD does not recommend antiviral therapy, indicating it can be deferred, in individuals with all of the following , regardless of HBeAg status or age :
- No clinical evidence of cirrhosis
- Persistently normal ALT levels
- Low levels of HBV DNA replication . ]
Why The High Costs
At this time, theres a short list of blockbuster HCV drugs. Because the FDA only recently approved these drugs, the companies that manufacture them have market exclusivity. That means only these companies can promote and sell the drugs. It also means there are no generic versions of these drugs yet. Generics are typically much cheaper than brand-name versions.
The FDA determines how long this period of exclusivity will last. During this time, the pharmaceutical companies have a lot of freedom in establishing prices. And those who developed the new HCV drugs have set the pricing bar high.
The table below highlights the average cost of treatment for the combination DAAs currently available. Most of these drugs take at least 12 weeks to cure HCV, while the most recently approved drug, Mavyret, can take only eight weeks.
| Generic name |
| $94,800 |
These costs are averages derived from information provided by www.goodrx.com. They were current at the time this article was published.
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What Does It Mean To Have A Successful Treatment What Is A Sustained Virologic Response
In an untreated state, the hepatitis C virus infects the cells of the liver and then continuously lives there, making copies of itself that circulate in the bloodstream. Antiviral medications can destroy the ability of the virus to reproduce, so the amount of virus in the bloodstream then decreases. The amount of virus in the blood is measured by aviral load.
Treatment is successful when the viral load drops toundetectablelevels, which means the virus cannot be detected in the bloodstream at all. The viral load becomes undetectable during treatment and remains undetected after treatment has ended. If there is still no detectable virus in the blood 12 weeks after the end of the treatment, the treatment was successful. This is called a Sustained Virologic Response .
A patient who has achieved an SVR is considered to be cured of the hepatitis C virus.
Hepatitis B Treatment Centres In Nigeria
Apart from the Lagos University Teaching Hospital, your hepatitis b infection can be effectively managed in the following centres in Nigeria.
- University of Benin Teaching Hospital, Edo State
- Irrua Specialist Hospital, Irrua, Edo
- National Hospital, Abuja
- University of Calabar Teaching Hospital
- University of Maiduguri Teaching Hospital, Borno
- Lagos State University Teaching Hospital, Lagos
- Nnamdi Azikiwe Teaching Hospital, Anambra.
- University of Nigeria Teaching Hospital, Enugu
- Federal medical Centre, Lokoja
- Ahmadu Bello Teaching Hospital, Zaria, Kaduna
- Obafemi Awolowo University Teaching, Ife, Osun
- Federal Medical Centre, Ebutte Meta, Lagos
- Federal Medical Centre, Owerri
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Strategies To Improve The Efficacy Of Ifn
Given the unique advantages of but relatively low response rates to IFN therapy, there is an urgent need to improve its efficacy .
Figure 1 Predictors and strategies for improvement of the efficacy of IFN-based therapy for chronic hepatitis B.
In addition to type I IFN, type III IFNs, consisting of four IFN- subtypes , has been considered as an alternative in treatment of CHB . IFN-III signals through a heterodimeric receptor composed of IFN- receptor-1 and interleukin-10 receptor subunit beta . IFNLR1 is expressed primarily on epithelial cells, such as hepatocytes, and on select immune cells, including pDCs and some B-lymphocytes, which may indicate better cell-type specific activity . One of the most impactful findings about IFN- is the strong association of IFN- polymorphisms with chronic HCV clearance during the acute stage of infection and of achieving HCV cure with IFN-I-based therapy in chronic infection . Unfortunately, the similar association cannot be identified in HBV patients with high confidence and good reproducibility among various studies . Although IFN- can activate IFN signaling pathways and lower HBV viral load, pegylated IFN-1 was less efficient than PEG-IFN-2 24 weeks post-treatment because fewer patients achieved HBeAg seroconversion .
American Association For The Study Of Liver Diseases Recommendations
The 2016 AASLD guidelines for the treatment of chronic hepatitis B as well as select recommendations from the 2018 AASLD guidance update on the prevention, diagnosis, and treatment of chronic hepatitis B are outlined below and in the Guidelines section.
Adults with immune-active chronic hepatitis B infection
Administer antiviral therapy to lower the risk of morbidity and mortality associated with chronic hepatitis B infection.
The recommended initial agent for adults is PEG-IFN, entecavir, or tenofovir.
Adults with immune-tolerant chronic hepatitis B infection
Antiviral therapy is not recommended.
The AASLD suggests obtaining ALT levels at least every 6 months to monitor for potential transition to immune-active or -inactive chronic hepatitis B.
For select patients older than 40 years, the AASLD suggests antiviral therapy in the setting of normal ALT levels, elevated HBV DNA , and significant necroinflammation or fibrosis on liver biopsy specimens.
Adults with HBeAg-positive immune-active chronic hepatitis B who seroconvert to anti-HBe on nucleoside analog therapy
After a period of treatment consolidation , consider discontinuing NA therapy in noncirrhotic HBeAg-positive adults who seroconvert to anti-HBe while on NA treatment. If antiviral therapy is stopped, monitor the patient every 3 months for a minimum of 1 year for recurrent viremia, ALT flares, seroreversion, and clinical decompensation.
Adults with HBeAg-negative immune-active chronic HBV infection
Inpatient care
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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.
Factors That Influence Ifn Response
HBV has been called a stealth virus since it does not induce a significant IFN response in the liver. Besides, sustained off-treatment response to exogenous IFN- therapy can be achieved only in a minority of CHB patients. Both host and viral factors influence the IFN response during HBV infection and IFN- therapy , some of which could be used as predictors to improve the cost-effectiveness of IFN- therapy.
Table 1 Viral and host factors that affect IFN response during HBV infection and IFN therapy.
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Cost Of Drug Treatments
The newer direct-acting antiviral medicines for hepatitis C can be very expensive listed at tens of thousands of dollars.
While pricing is often negotiated by insurance companies and other agencies, the process is not especially transparent and can be confusing.
If you need help paying for medicines, speak with your doctor. For more information about available financial assistance, visit the American Liver Foundation.
Additional reporting by Deborah Shapiro.
Increased Use Of Higher
High-cost drugs accounted for over one third of total drug costs in 2019-20 but were only used by 2% of beneficiaries. November 9, 2021 Ottawa, ON Patented Medicine Prices Review Board A new Patented Medicine Prices Review Board report finds that prescription drug expenditures by Canadian public drug plans increased by 3.
Canada
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Are Alternative Medicines Available
Some people believe certain forms of alternative medicine help cure hepatitis C.
However, the National Center for Complementary and Integrative Health reports that there are no effective, research-proven forms of alternative treatment or complementary medicine for hepatitis C.
Silymarin, also known as milk thistle, is an herb commonly suggested to help cure hepatitis C liver disease. But a rigorous did not find any beneficial effects from this supplement.
How Is Hepatitis C Treated
Hepatitis C virus is treated with all-oral medications. These pills, calledantiviral medications, are usually taken once per day. These antiviral medications are extremely good at attacking the virus and preventing it from multiplying.
Antiviral medications were not the original treatment for hepatitis C. Before 2014, the only treatment for hepatitis C was called interferon and ribavirin, taken as weekly injections under the skin, plus pills. Interferon treatment caused many unpleasant side effects and was not usually successful. Then a new generation of medications became available. These antiviral treatments are extremely successful at curing the virus and have very minimal side effects.
Ribavirin is still sometimes prescribed to be taken along with the new antiviral medicines, but it has become more and more uncommon that ribavirin is needed at all. Ribavirin has some mild-moderate side effects. Ribavirin is a pill taken twice per day, as 2 or 3 pills in the morning plus 2 or 3 pills at night, depending on the patient’s body weight. Most patients do not need ribavirin.
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