Hcv Treatment Data In Persons With Decompensated Cirrhosis
Limited data exist for hepatitis C treatment in patients with decompensated cirrhosis, primarily because of concerns related to treatment-related toxicity.
Ledipasvir-Sofosbuvir plus Ribavirin
Sofosbuvir-Based Regimens
- Sofosbuvir Plus Ribavirin in Decompensated Cirrhosis: In an open-label, nonrandomized, phase 2 trial, 50 adults with Child-Turcotte-Pugh cirrhosis and portal hypertension were randomized to receive immediate or deferred HCV treatment with sofosbuvir 400 mg once daily plus weight-based ribavirin 1,000 to 1,200 mg divided twice daily. The immediate group received treatment for 48 weeks the deferred group was observed during the first 24 weeks and then received 48 weeks of therapy. Overall, 72% of the participants achieved an SVR12. The results were better in those with Child-Turcotte-Pugh class A than in those with Child-Turcotte-Pugh class B . For the 37 participants who had paired baseline and end-of-treatment hepatic venous gradient measurements, those who achieved an SVR12 had clinically meaningful reductions in portal pressure.
Sofosbuvir-Velpatasvir
How Are Fatty Liver Disease And Hepatitis C Connected
Recent research has begun to define the connection between fatty liver disease and hepatitis C. You can have fatty liver disease on its own, or it can accompany a hepatitis C infection. If you have hepatitis C your chances of developing fatty liver disease is higher than developing the disease by itself. According to the data, about 50% of people with hepatitis C also have fatty liver disease.
Typically, we see two types of fatty liver disease in people with hepatitis C:
- Metabolic fatty liver caused by obesity, type 2 diabetes, raised blood fat levels, or insulin resistance
- Hepatitis-C induced fatty liver disease is caused by the HCV virus itself
You can actually have both forms of fatty liver disease simultaneously. Both forms of the disease have a negative effect on hepatitis C symptoms. How are these diseases treated and when should you see a doctor?
Questions For Your Doctor
When you visit the doctor, you may want to ask questions to get the information you need to manage your hepatitis C. If you can, have a family member or friend take notes. You might ask:
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Stages Of Hepatitis C
The hepatitis C virus affects people in different ways and has several stages:
- Incubation period. This is the time between first exposure to the start of the disease. It can last anywhere from 14 to 80 days, but the average is 45
- Acute hepatitis C. This is a short-term illness that lasts for the first 6 months after the virus enters your body. After that, some people who have it will get rid of, or clear, the virus on their own.
- Chronic hepatitis C. For most people who get hepatitis C — up to 85% — the illness moves into a long-lasting stage . This is called a chronic hepatitis C infection and can lead to serious health problems like liver cancer or cirrhosis.
- Cirrhosis. This disease leads to inflammation that, over time, replaces your healthy liver cells with scar tissue. It usually takes about 20 to 30 years for this to happen, though it can be faster if you drink alcohol or have HIV.
- Liver cancer. Cirrhosis makes liver cancer more likely. Your doctor will make sure you get regular tests because there are usually no symptoms in the early stages.
Learn more about the stages and progression of hepatitis C.
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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Hcv Treatment Data In Persons With Compensated Cirrhosis
The impact of cirrhosis on the response to therapy has changed over time with evolving treatment regimens. The following summary of clinical trials involving persons with compensated cirrhosis illustrates a significant improvement in SVR rates among patients with cirrhosis with regimens that include direct-acting agents.
Elbasvir-Grazoprevir
- Integrated Analysis of Treatment in Persons with Compensated Cirrhosis: In this study, investigators performed an integrated analysis of 6 elbasvir-grazoprevir phase 2/3 clinical trials to determine SVR12 treatment responses in 402 study participants with HCV genotype 1, 4, or 6 and compensated cirrhosis. Participants received treatment with elbasvir-grazoprevir, with or without weight-based ribavirin the treatment duration was 12 weeks for treatment-naïve participants and 12, 16, or 18 weeks for treatment-experienced subjects . Notably, platelet counts less than 100,000 cells/mm3 and serum albumin less than 3.5 g/dL were present in only 25% and 6% of participants respectively. Overall, using an intent-to-treatment analysis, SVR12 occurred in 96% of treatment-naïve participants and ranged from 89 to 100% among treatment-experienced subjects. Genotype 1a patients were most likely to experience viral relapse with the strongest predictor for treatment failure being the presence of baseline NS5A resistance-associated substitutions. Asymptomatic grade 3-4 increases in hepatic aminotransferase levels were observed in 2.3%.
Hepatitis Involves An Inflammation Of The Liver Which Diminishes The Liver’s Ability To Function
Hepatitis C Rash : Disease Fact Sheets | Kent County, Michigan / Hepatitis c is a viral disease spread via blood that affects liver function and can lead to cirrhosis, canc.. Learn how to identify a hepatitis c rash here. Webmd tells you why more and more people are being cure cured without shots or toxic side effects. Hepatitis c is the no. Some people have it and may never know it as they are affected by any sorts of symptoms. Hepatic steatosis is essentially fatty liver.
Skin rashes may be a sign of hepatitis c. Some people have it and may never know it as they are affected by any sorts of symptoms. 1 cause of liver cancer and liver transplants.
Webmd tells you why more and more people are being cure cured without shots or toxic side effects. Hepatitis occurs as three different viruses hepatitis a, b and c and it might happen for several different reasons. There are several different causes of fatty liver, and in many cases, it is preventable or curable.
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How Do You Get Hepatitis C
Hepatitis C spreads when blood or body fluids contaminated with the hepatitis C virus get into your bloodstream through contact with an infected person.
You can be exposed to the virus from:
- Sharing injection drugs and needles
- Having sex, especially if you have HIV, another STD, several partners, or have rough sex
- Being stuck by infected needles
- Birth — a mother can pass it to a child
- Sharing personal care items like toothbrushes, razor blades, and nail clippers
- Getting a tattoo or piercing with unclean equipment
You canât catch hepatitis C through:
- Breastfeeding
- Casual contact
- Have been on long-term kidney dialysis
- Have abnormal liver tests or liver disease
- Have HIV
- Were born to a mother with hepatitis C
Since July 1992, all blood and organ donations in the U.S. are tested for the hepatitis C virus. The CDC says it is now rare that someone getting blood products or an organ would get hepatitis C. That said, The CDC recommends that anyone over the age of 18 get tested for Hepatitis C. If you haven’t been screened, you should consider having it done.
Learn more about the risk factors for hepatitis C.
Hcv Treatment Goals In Persons With Compensated Cirrhosis
The most important immediate goal of treatment is to achieve a sustained virologic response , which is required before observing the subsequent benefit in liver-related and other outcomes. The next intermediate-term priority with therapy is to decrease the patients risk of developing hepatic decompensation. The long-term goals are to diminish the risk of developing HCV-related hepatocellular carcinoma and death.
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Who Is At Risk For Hepatitis C
You are more likely to get hepatitis C if you
- Have injected drugs
If you have chronic hepatitis C, you probably will not have symptoms until it causes complications. This can happen decades after you were infected. For this reason, hepatitis C screening is important, even if you have no symptoms.
What Are The Symptoms Of Hepatitis B And C
In most patients, hepatitis B develops slowly over the course of several decades, and thus most patients have no symptoms. People who have advanced liver disease such as cirrhosis of the liver may experience complications and symptoms that reflect liver failure. Other symptoms include:
- A buildup of fluid within the abdominal cavity
- Confusion and tremors , which are complications due to the inability of the liver to filter out toxins that are normally cleaned out by a healthy liver
- Vomiting of blood, or blood within the stool . This is a complication in which enlarged veins within the esophagus or stomach bleed as a consequence of increased pressure around the diseased liver.
Most patients with chronic hepatitis C infection report no symptoms. But some patients may have very nonspecific symptoms related to fatigue and discomfort on the right side of the abdomen. Often, symptoms that lead to a diagnosis of hepatitis C are noticeable only at the end stage of liver disease, when the patient has developed liver cirrhosis and liver failure.
Because hepatitis B and C typically have no specific symptoms, many people who have the viruses dont even know it.
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Limit Your Alcohol Intake
Drinking alcohol can negatively affect an already damaged liver. Its important to decrease the amount of alcohol you consume on a regular basis. Your doctor may even recommend that you refrain from alcohol altogether.
Your liver is the primary organ responsible for metabolizing nutrients and other substances you ingest. If theres too much alcohol in your system, your liver enzymes may be ill-equipped to process it. In turn, the excess alcohol circulates through the rest of your body.
As a rule of thumb, its important to drink in moderation. This equates to two drinks a day for men, and one a day for women .
Still, moderate alcohol consumption can be dangerous when youre living with hepatitis C. Ask your doctor for specific recommendations.
Cost Of Hepatitis C Medicines
The newer direct-acting antiviral medicines for hepatitis C can be costly. Most government and private health insurance prescription drug plans provide some coverage for these medicines. Talk with your doctor about your health insurance coverage for hepatitis C medicines.
Drug companies, nonprofit organizations, and some states offer programs that can help pay for hepatitis C medicines. If you need help paying for medicines, talk with your doctor. Learn more about financial help for hepatitis C medicines.
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How Are Hepatitis B And C Diagnosed
Hepatitis B is diagnosed by a series of blood tests. The test may show an ongoing infection or antibodies that indicate that the patient is protected against hepatitis B. In patients who have a positive screening test that suggests the possibility of ongoing infection, further testing is done to determine the levels of the virus in the bloodstream.
Hepatitis C is diagnosed via a blood test called a Hepatitis C Antibody Test. A positive result means that hepatitis C antibodies are present in the blood. But a positive antibody test doesnt necessarily mean a person has hepatitis C. A further blood test is needed to confirm the diagnosis. This second blood test quantifies the amount of the virus or the viral load in the liver and the bloodstream.
Complications Of Hepatitis C
If the infection is left untreated for many years, some people with hepatitis C will develop scarring of the liver .
Over time, this can cause the liver to stop working properly.
In severe cases, life-threatening problems, such as liver failure, where the liver loses most or all of its functions, or liver cancer, can eventually develop.
Treating hepatitis C as early as possible can help reduce the risk of these problems happening.
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How Do I Get Hepatitis A
Hepatitis A is spread through close contact with an infected person, or by eating hepatitis A contaminated food or drinking water. Because the virus is found in the stool of infected people, eating food prepared by an infected person, who does not wash his/her hands properly after using the washroom, is one way of getting the virus.
Eating raw or undercooked seafood and shellfish from water polluted with sewage, or eating salad greens that are rinsed in contaminated water are other ways of becoming infected. Sharing drug-use equipment, or having sexual contact with an infected person can also give you hepatitis A.
While often considered to be a travellers disease, hepatitis A can be contracted in Canada. Hepatitis A outbreaks or scares in Canada are most often associated with infected food handlers in restaurants and grocery stores or with contaminated produce.
Disease Burden And Epidemiology
Many patients with chronic HCV infection are asymptomatic and it is estimated that 45%-85% are unaware they are even infected. Large population studies testing for positivity of anti-HCV antibody in non-institutionalized population in the United States have shown the prevalence to be approximately 1.8% in the general population. In these studies, the strongest risk factors predicting a positive HCV infection were illegal drug use, blood transfusions prior to 1992 and high risk sexual behavior with high number of lifetime sexual partners. Other risk factors associated with a positive HCV infection included poverty, having less than twelve years of education and having been divorced or separated. Surprisingly the study also showed that 15%-30% of infected patients reported no risk factors for the transmission of HCV infection. Additional studies examining the burden of HCV infection in the United States, show that by 2007, HCV had superseded human immunodeficiency virus as a cause of death in the United States. Several additional United States studies have also predicted a two-fold increase in HCV related deaths with direct medical expenditure exceeding $6.7 billion USD between 2010 and 2019 and without intervention, suggest that morbidity and mortality from HCV will peak between 2030 and 2035 forecasting for 38600 incident cases of end-stage liver disease, 3200 referrals per year for liver transplant and 36100 deaths.
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Hepatitis C Can Be Invisible
There may be few symptoms after initial HCV infection. Many people with hepatitis C dont even know they have the life-threatening disease.
HCV attacks the liver. Many people exposed develop a chronic infection after initial infection with HCV. Chronic HCV infection slowly causes inflammation and damage in the liver. Sometimes the condition may not be diagnosed for 20 or 30 years.
- yellow discoloration in eyes and skin
- swelling in legs
- abnormal blood tests, such as bilirubin, albumin, and coagulation parameters
- enlarged veins in the esophagus and upper stomach that may bleed
- impaired mental function due to buildup of toxins
- infection of the abdominal lining and ascites
- combined kidney and liver failure
A liver biopsy will show scarring, which can confirm the presence of cirrhosis in people with HCV.
Lab tests and a physical exam may be enough for your doctor to diagnose advanced liver disease without a biopsy.
Less than a quarter of people with HCV will develop cirrhosis. But, certain factors can increase your risk of cirrhosis, including:
- alcohol use
- infection with HCV and another virus
- high levels of iron in the blood
Anyone with chronic HCV infection should avoid alcohol. Cirrhosis can also accelerate in people older than 45 as fibrosis and scarring increase. Aggressively treating HCV infection in younger people may help prevent progression to cirrhosis.
Its important to stay healthy if you have cirrhosis. Be sure to keep all immunizations up to date, including:
How Do People Get Hepatitis C
Hepatitis C virus is found in the blood of people with HCV infection. It enters the body through blood-to-blood contact.
Until reliable blood tests for HCV were developed , people usually got hepatitis C from blood products and blood transfusions. Now that blood and blood products are tested for HCV, this is no longer the typical means of infection.
Currently, people usually get hepatitis C by sharing needles for injection drug use. An HCV-infected woman can pass the infection to her baby during birth. It is also possible to get hepatitis C from an infected person through sexual contact, an accidental needlestick with a contaminated needle, or improperly sterilized medical, acupuncture, piercing, or tattooing equipment.
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Treatment And Medication For Hepatitis C
If you have acute hepatitis C, there is no recommended treatment. If your hepatitis C turns into a chronic hepatitis C infection, there are several medications available.
Interferon, peginterferon, and ribavirin used to be the main treatments for hepatitis C. They can have side effects like fatigue, flu-like symptoms, anemia, skin rash, mild anxiety, depression, nausea, and diarrhea.
Now youâre more likely to get one of these medications:
Find out more on treatment options for hepatitis C.