How Is Monitoring Done After Treatment For Hepatitis C
Once patients successfully complete treatment, the viral load after treatment determines if there is an SVR or cure. If cure is achieved , no further additional testing is recommended unless the patient has cirrhosis. Those who are not cured will need continued monitoring for progression of liver disease and its complications.
While cure eliminates worsening of fibrosis by hepatitis C, complications may still affect those with cirrhosis. These individuals still need regular screening for liver cancer as well as monitoring for esophageal varices that may bleed.
Because hepatitis B co-infection may reactivate or worsen even after treatment for HCV, monitoring for hepatitis symptoms may be needed after the end of therapy.
Treatment If The Condition Gets Worse
Severe liver damage caused by chronic hepatitis C usually takes 20 or more years to develop.
If your hepatitis C continues to get worse, it can cause your liver to stop working, a condition called end-stage liver failure. In this case, a liver transplant may be the only way to extend your life. But if you are drinking alcohol, are sharing needles to inject drugs, or have severe depression or certain other mental illnesses, liver transplant may not be an option.
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What Are Genotypes And Do They Matter
Six different genotypes of hepatitis C have been identified. Genotypes 1 and 3 are the most common causes of hepatitis C in Australia and make up 90 per cent of all cases. They are important because they help determine the treatment you need. Unlike in the past, however, your genotype is not important in terms of the chance of cure. With the treatment drugs, all six genotypes have a very high chance of cure.
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Avoid Alcohol And Drugs
One of the most important jobs of your liver is to break down drugs and alcohol. If you have hepatitis C, one of the best things you can do is to avoid substances that may harm your liver, such as alcohol and illegal drugs. If you have cirrhosis, you also may need to avoid certain medicines.
If you use illegal drugs or drink alcohol, it is important to stop. Being honest with your doctor about your drug and alcohol use will help you deal with any substance use disorders. If you dont feel that you can talk openly with your doctor, you may want to find a doctor you feel more comfortable with. If you want to stop using drugs or alcohol and need help to do so, ask your doctor or someone else you trust about drug and alcohol treatment options.
Because many medicines can stress your liver, talk to your doctor before you take any prescription or over-the-counter medicines. This includes herbal remedies as well.
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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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Reducing Infections Among Injecting Drug Users
Among injecting drug users, the sharing of needles and syringes is the key risk factor for acquiring HCV infection, although there is considerable evidence of a potentially high risk of infection associated with sharing drug-preparation equipment such as cookers, filters, swabs and water . However, there is good evidence to show that retention in opioid substitution treatment reduces injection frequency , and that it is most effective in reducing HCV transmission when used alongside interventions that support safer injection practices . Two studies that examined the independent and combined effects of needle and syringe programmes and opioid substitution treatment on HCV incidence concluded that the combined effect of these two interventions resulted in the greatest reductions in HCV transmission .
Modelling studies have been used to explore the potential effectiveness of different hepatitis C interventions, and these indicate that it may be difficult for opioid substitution treatment and high-coverage needle and syringe programmes to greatly impact on hepatitis C prevalence. Modelling the scale-up of both interventions for the United Kingdom shows that they are unlikely to lead to substantial reductions in the prevalence of chronic hepatitis C after 10 years, unless both interventions cover 80% or more of the injecting population .
Strategies To Improve Treatment And Care
A number of the lessons learned in responding to the HIV epidemic can be transferred to managing the spread of hepatitis C among injecting drug users, including recognition of the importance of putting in place a set of comprehensive, coordinated and multidisciplinary responses. These need to include the provision of HCV testing, assessment, patient education on the long-term consequences of HCV-related liver disease. The enhancement of treatment uptake is important for injectors and effective treatment options need to be available and easily accessible for this population group. The co-location of hepatitis C treatment and opioid substitution treatment is likely to facilitate user access, and might also be linked with mental health care. Improving treatment adherence among injecting drug users is another area where improvements can be made and the use of case management, support services and provider education and training is likely to enhance care.
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Hepatitis C: New Models Of Care For Drugs Services
Hepatitis C virus infection has a high prevalence in people who inject drugs in Europe, although HCV infection is both preventable and curable. Effective interventions that target the prevention of HCV transmission and the treatment of hepatitis C are needed, particularly for socalled hard to reach and vulnerable populations. European clinical guidelines recommend that all patients with chronic liver disease as a result of HCV infection should be considered for therapy, regardless of disease stage. Furthermore, they recommend that treatment be provided to individuals at risk of transmitting the disease, including people currently injecting drugs.
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.
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Proinflammatory Cytokines Induce Depression
Mercifully, for patients with hepatitis C, treatment with the cytokine interferon IFN-alpha has been supplanted by more effective and tolerable treatment options. But during the years of its clinical hegemony, IFN-alpha provided a unique model system for understanding behavioral and biological responses to chronic inflammation relevant to depression. Results from many studies have been quite consistent in demonstrating that IFN-alpha exposure produces a widespread increase in depressive and anxious symptoms, with a sizable minority of patients meeting full criteria for major depressive disorder within a month of commencing treatment. As reviewed in Miller and Raison , IFN-alpha treatment also produces all known biological changes associated with MDD more generally, including increased circulating pro-inflammatory cytokines, disruption of the diurnal cortisol rhythm and induction of glucocorticoid resistance, altered sleep physiology, and changes in monoamine metabolism, with many of these changes associating with increased depression during treatment . Supporting these findings are studies showing that even a single exposure to inflammatory stimuli induces depressive symptoms and depressive-style social cognitions in healthy volunteers, with these effects being strongest in women .
Anton Pozniak, in, 2010
A Hep C Related Peripheral Neuropathy Case Study
Hepatitis C virus is essentially hepatotropic but its manifestations can extend beyond the liver. It can be associated with autoimmune diseases, such as mixed cryoglobulinemia, membranoproliferative glomerulonephritis, autoimmune thyroiditis, and lymphoproliferative disorders. The mechanisms that trigger these manifestations are not completely understood.
We describe a 48-year-old man with chronic HCV infection , cryoglobulinemia, and sensory and motor peripheral neuropathy. The diagnosis of multi-neuropathy was confirmed by clinical examination and electromyographic tests. A nerve biopsy revealed an inflammatory infiltrate in the perineurial space and signs of demyelination and axonal degeneration. The patient had no improvement of neurological symptoms with the use of analgesics and neuro-modulators.
He was then successfully treated for his Hepatitis C. Six months after the end of therapy, the patient had sustained viral response and remission of neurological symptoms, but cryoglobulins remained positive.
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Protease Inhibitor Antiviral Medications
Protease inhibitors work by preventing the spread of infection within the body by stopping viruses from multiplying.
Grazoprevir is a protease inhibitor for hepatitis C genotypes 1 and 4. Its only available in combination with elbasvir and sold as grazoprevir/elbasvir.
The drug combination is sold under the brand name Zepatier.
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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Exacerbation Of Chronic Viral Hepatitis
In the treatment of chronic hepatitis B, HBe seroconversion was sometimes preceded by transient and moderate worsening of serum transaminases, but severe exacerbation of chronic hepatitis B infection and fatal liver failure can occur. Such fatalities were reported in under 0.5% of patients with hepatitis B . Patients with active cirrhosis or a previous history of decompensated cirrhosis are particularly susceptible to these complications .
Acute exacerbation of hepatitis is an extremely rare complication of chronic hepatitis C treatment. An exaggerated immune response to hepatitis virus was supposedly the cause of acute icteric hepatitis in two patients .
A 43-year-old man had a moderate rise in hepatic transaminase activities after 4 weeks of interferon alfa treatment. His liver tests normalized after withdrawal, but the aspartate transaminase activity increased dramatically shortly after treatment was restarted. His condition rapidly deteriorated, with a diagnosis of hepatorenal failure, and he finally required liver transplantation. Histological examination of the liver showed advanced micronodular cirrhosis, a feature not found on pretreatment liver biopsy.
In another study, only four of 11 241 patients treated with interferon alfa died of fulminant liver failure .
Talia B. Baker, Juan Carlos Caicedo, in, 2017
Eat Regular Nutritious Meals
Sometimes people with hepatitis C have a hard time eating. You may have no appetite, feel nauseated, or have different tastes than you are used to. Even if you dont feel like eating, its very important to eat small meals throughout the day. Some people have nausea in the afternoon. If this happens to you, try to eat a big, nutritious meal in the morning.
If you have cirrhosis, it may not be a good idea to eat salty foods or foods that are high in protein. If you want to know more about which foods to avoid and which foods are good to eat, ask your doctor about meeting with a registered dietitian to discuss a healthy eating plan.
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What Are The New Hepatitis C Treatments And When Will They Be Available
Recent advances in antiviral treatment have led to the development of new highly effective drugs for the treatment of all types of hepatitis C.
The new hepatitis C treatments are sofosbuvir with ledipasvir sofosbuvir daclatasvir and ribavirin .
These new treatments will be available on the Pharmaceuticals Benefits Scheme from 1 March 2016.
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.
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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:
How Is Hepatitis C Spread Will My Loved Ones Catch It From Me
Household transmission of hepatitis C is extremely rare. Here are some ways the virus is transmitted:
The number one risk factor for infection and transmission is sharing needles for intravenous drug use. Most people who use IV drugs become infected with HCV within one year of sharing needles. Learn more.
Managing Side Effects Of Treatment
In the past when interferon was used, management of side effects was critical to have success with Hepatitis C treatment. Side effects are much less common now with the new Hepatitis C medications, but they can still happen. Fortunately, there are many steps you can take to manage them. Its important to talk to your Hepatitis C provider to help you manage side effects and have a good experience on treatment.
Keep in mind that not everyone will experience the same side effects, nor are they necessarily severe. Developing a good support system before beginning therapy with family, friends, and peer support group members can help you cope with treatment-related side effects.
The following tips will help you manage some of the more common side effects of Hepatitis C treatment:
- Modify your work schedule if possible.
- Get regular low-impact exercise such as walking.
- Eat well-balanced meals and drink enough fluids.
- Develop a regular routine go to bed and get up the same time every day.
- Use relaxation techniques such as meditation, warm baths or massage read or listen to music.
- Avoid exercise, caffeinated products, or heavy meals close to bedtime.
- Limit fluid intake about 2 hours before bedtime so you dont have to get up to go to the bathroom.
- Take over-the-counter or prescription medications as recommended by your provider.
- Eat smaller, more frequent meals.
- Eat whatever appeals to you most.
- Eat snacks high in protein have protein drinks .
A Hidden Epidemic Of Hepatitis C
Hepatitis C is the most common infectious disease in injecting drug users, among whom it is usually transmitted through the sharing of injecting equipment such as needles and syringes. Most of those who become infected go on to develop chronic HCV infection, which can lead to severe health problems in individuals and place a major burden on health care systems. Yet hepatitis C is both preventable and curable, and interventions in this field, particularly the development of new medicines to treat hepatitis C, are making rapid progress.
Hepatitis C virus infection is highly prevalent in injecting drug users across Europe, with national infection rates for this group ranging from 18% to 80%. However, infected individuals often show no noticeable symptoms, and many are unaware that they are carrying the virus, leading to it being referred to as a hidden epidemic. Injecting opioid users in Europe constitute an ageing population, which includes many who have been living with hepatitis C for 15 to 25 years. The natural history of chronic hepatitis C virus infection and the ageing cohort effect in this population mean that a large burden of advanced liver disease can be expected over the next decade.
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