Wednesday, September 21, 2022

Hepatitis C And Treatment Options

What Are The Signs And Symptoms Of Hepatitis C

HEPATITIS C CAUSES, SYMPTOMS AND TREATMENT OPTION

As conditions go, hep C is seriously slymost people who have it dont show symptoms. In fact, about half of people with HCV don’t know they’re infected, according to the Mayo Clinic, and some people can live with it for decades before being diagnosed. If there are symptoms, theyre pretty mild. Think fatigue, muscle achescommon ailments you wouldnt automatically associate with hep C.

This is why the CDC recommends a hepatitis C screening: a simple blood test known as an HCV antibody test, for all adults aged 18 years and older at least once in their lifetime. Keep in mind, its not a standard test, so you have to ask for it. If that test is positive, youll likely be given a HCV RNA test to determine if you have an active infection.

Why is it so crucial to be diagnosed, if you don’t have any symptoms? When hep C hangs out in the system untreated for years, it starts affecting the liver and becomes chronic. More than half of people who become infected with HCV will develop chronic infection, according to the CDC. When that happens, symptoms may include:

  • Jaundiced skin

  • Confusion and slurred speech

  • Spider-like blood vessels on your skin

Chronic HCV can lead to serious complications, including cirrhosis , liver cancer, or liver failure. The liver performs a slew of vital functions, including:

When the liver is unable to deliver on even one of its important jobs, the damage wrought by hep C can be seriouswhich is why treatment is so crucial.

Hepatitis C And Hiv Prevention

Public health professionals suggest several ways to protect yourself from HIV and Hepatitis C infection. These include not sharing needles or personal hygiene items with others. Wearing a condom also reduces your risk of infection. Pregnant women infected with HIV can take medication to prevent passing the virus to their baby.

Hepatitis C and HIV infections are preventable. If you notice early symptoms of Hepatitis C or HIV, its important to get tested and start treatment as soon as possible. To learn more about Hepatitis C and HIV treatment and preventions, contact Brevard Health Alliance today.

Hcv: Symptoms And Diagnosis

People with HCV may have acute symptoms for up to 3 months that can include:

  • yellow-colored skin or eye sclera
  • weakness
  • poor appetite
  • nausea and stomach pain.

Longer-term symptoms may include weight loss, poor appetite, feeling tired, and painful joints. Fifteen to twenty percent of people may eliminate the HCV virus completely from their body, but most people remain infected and develop chronic hepatitis C.

Diagnosis involves a blood test and to determine the subtypes of HCV. It is important to know the genotypes to select the correct treatment.

In some patients, a liver biopsy is required. In those who eventually develop cirrhosis , symptoms may include stomach swelling, easy bruising, difficulty breathing, jaundice, and confusion. About 5% to 20% of HCV patients will develop cirrhosis over a period of 20 to 30 years.

About 1 to 5 out of every 100 people with HCV in the U.S. will die each year due to cirrhosis and liver cancer.

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Symptoms Of Hepatitis C

Unlike other infections, most patients who are suffering from an acute Hep C infection do not experience any symptoms or show signs of the infection, since the symptoms appear two weeks to six months after being infected. Most common symptoms related to Hepatitis C are mild and flu-like and may include:

  • Fatigue and feeling very tired
  • Aches in joints and stomach
  • Joint pain
  • A yellow discoloration of the skin and whites of the eyes, called jaundice.
  • Weight loss
  • Confusion, drowsiness and slurred speech

In most cases, patients with acute Hepatitis C go on to develop chronic Hepatitis C and still reflect no Hep C symptoms.

Reasons To Delay Treatment

Treating Hepatitis C  Midway Specialty Care Center

Pregnancy

Hepatitis C treatment is generally not recommended during pregnancy. There is not a lot of information on the effects of DAAs during pregnancy. Research is being done on taking DAAs during pregnancy so this may change in the future.

Treatment that includes ribavirin can cause severe birth defects and must not be taken during pregnancy. When a couple wants to have a baby, both partners should avoid using ribavirin for at least six months before trying to get pregnant.

A healthcare provider can help determine a treatment plan and timeline for a person who has hepatitis C and wants to have a baby.

Children and adolescents

Hepatitis C treatment for children over the age of 12 is available in Canada. It is recommended that children who require treatment for hepatitis C be connected to a specialist with experience treating the pediatric population.

Resources for service providers

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The Treatment Of Acute Hepatitis C

Antiviral drugs

The basis of current, interferon-free treatment is a combination of directly acting antiviral drugs with high antiviral efficacy, resistance barriers, and different sites of attack.

In the multicenter German Acute HCV IV trial, six weeks of treatment with sofosbuvir/ledipasvir resulted in a sustained viral eradication rate of 100% in patients acutely infected with HCV genotype 1 . It should be noted, however, that the combination of sofosbuvir and ledipasvir is available in Germany only in packages of 28 tablets, so that taking a single tablet per day for six weeks is unreasonable in terms of drug economics. Until further data are available, patients with acute hepatitis C should be treated for eight weeks, analogously to the recommendations for previously untreated patients with acute hepatitis C. As the rate of HCV transmission to health care workers via needle stick injury is very low, no post-exposure prophylaxis is recommended in this situation .

Polymerase inhibitors

RNA-dependent RNA polymerase inhibitors are categorized as either nucleotide inhibitors or non-nucleoside inhibitors . The generic names of all HCV polymerase inhibitors end in -buvir.

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

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Important Considerations When Starting Treatment

For me, there are two considerations that would drive anyones decision about hep C treatment. First, will the treatment successfully cure the disease? The CDC states, Over 90% of people infected with hepatitis C virus can be cured of their infection, regardless of HCV genotype, with 812 weeks of oral therapy.1 Thus, for most people infected with hep C, a successful treatment is available.

The second point in the cost, as treatments are expensive. The figure for the full term Epclusa treatment in the US is $55,000-75,000 and approximately $60,000.00 in Canada. The same pill that costs $750-1,000 in the US costs $4 in India when purchased from generic manufactures.2,3 These are significant and often unrealistic costs for those uninsured. For those insured, the costs are for the most part are covered by the insurer, depending on the policy. Most require a co-pay, in my case this was $75 per month for the medication. For people without insurance, there are private, state, and federal programs that offer treatments at a discounted or minimal costs Healthcare providers can link those in need to these subsidized or discounted treatment rates. For example, the Virginia Medication Assistance Program provides access to life-saving medications for the treatment of HIV and related illnesses for low-income clients through the provision of medications or through assistance with insurance premiums and medication co-payments”.4

How Hepatitis C Used To Be Treated

Current Treatment Options for HCV/HIV Co-Infected Patien

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 pegylated interferon and ribavirin together or separately may still be used in combination with newer antiviral drugs.

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How Is Hepatitis C Infection Prevented

Unfortunately, there is no vaccine to prevent hepatitis C. To reduce your risk of getting hepatitis C:

  • Injection drug use is the most common way people get hepatitis C. Avoid injecting drugs to reduce your risk. If you do inject drugs, use sterile injection equipment. Avoid reusing or sharing.
  • Avoid sharing personal care items that might have blood on them
  • If you are a health care or public safety worker, follow universal blood/body fluid precautions and safely handle needles and other sharps
  • Consider the risks if you are thinking about tattooing, body piercing, or acupuncture are the instruments properly sterilized?
  • If youre having sex with more than one partner, use latex condoms correctly and every time to prevent the spread of sexually transmitted diseases, including hepatitis C.

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

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How Will My Provider Monitor Me During The Treatment

Your provider will meet with you during treatment to review how well you are tolerating treatment and review laboratory results. Laboratory tests help keep tabs on your health, track the viral load, and determine your response to treatment. You will be given specific dates to go get your blood tested at the lab during and after the treatment.

Making A Decision About Treatment

Treatment Options in Hepatitis C (09.01.2017)

Once Epclusa became a viable option, my doctor discussed the cure rates, side effects, risks, and costs and asked that I think it over and discuss it with my family before making my decision. Once I agreed to move forward, an extensive interview with a specialty nurse was assigned to my case to oversee and manage the treatment and provide extensive information during the remainder the treatment. My doctor recommended this option given my diagnosis and we didnt really discuss other options. Later I did do some research on the internet to evaluate this and other treatments as information became available. Prior to receiving my treatment I had only told my wife of my diagnosis and hadnt discussed treatment options or other aspects of disease with any other people.

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Medical Treatment For Hepatitis A B & C

Treatment for hepatitis A, B, or C is based on which type of hepatitis is present in the bloodstream and the severity of the resulting liver damage. Depending on the results of diagnostic tests, our specialists at NYU Langone may recommend antiviral medication to stop the virus from replicating and protect your liver from further damage.

Sustained Viral Response: A Patient

The molecular demonstration of the absence of HCV-RNA twelve weeks after the end of a course of antiviral treatment confirms the sustained eradication of the virus. The likelihood of a late recurrence is well under 1% , and most such events are actually not recurrences but reinfections . The eradication of HCV does not generate protective immunity .

A meta-analysis of 129 studies involving a total of 34 563 patients who had undergone interferon-based treatment revealed that a sustained virological response was associated with a 62% to 84% reduction of mortality, a 68% to 79% reduction of the risk of hepatocellular carcinoma , and a 90% reduction of the risk of needing liver transplantation . As interferon-based treatment was contraindicated in patients with decompensated cirrhosis, these data are uninformative with respect to any potential clinical benefit, for these patients, of sustained viral eradication with direct antiviral agents . Initial studies have yielded clinical and laboratory evidence of improvement mainly for patients with a MELD score below 1618 points . In large-scale cohort studies, sustained viral eradication was associated both with lower liver-associated mortality and with substantially lower extrahepatic mortality . Sustained viral eradication eliminates the risk of individual transmission and is associated with a better quality of life .

HCV genotypes

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Mavyret Approved: A Pan

In August of 2017, the FDA approved AbbVie’s Mavyret , the first 8 week treatment approved for all hepatitis C virus genotypes in adult patients without cirrhosis who have not been previously treated. Glecaprevir inhibits NS3/4A protease and pibrentasvir inhibits HCV NS5A. It is also approved to be used in children 3 years and older.

In Sept. 2019, FDA also granted approval to shorten the once-daily treatment duration from 12 to 8 weeks in treatment-naïve, compensated cirrhotic, chronic hepatitis C patients across all genotypes .

Specifically, Mavyret is approved for:

  • HCV genotype 1, 2, 3, 4, 5 or 6 infection without cirrhosis and with compensated cirrhosis .
  • Patients with HCV genotype 1 infection, who previously have been treated with a regimen containing an HCV NS5A inhibitor or an NS3/4A protease inhibitor, but not both.

Studies demonstrated that 92% to 100% of patients had no virus detected in the blood after finishing treatment, denoting a cure.

Treatment For Acute And Chronic Hepatitis C Infection

Future Treatment Options for HCV/HIV Co-Infected Patient

Some people are diagnosed with hepatitis C when the infection is in the acute phase . About one in four people will clear the hepatitis C virus from their body on their own within six months. When a person is diagnosed with hepatitis C in the acute phase, a healthcare provider might recommend waiting to see if their body clears the virus on its own.

Current treatment guidelines in Canada focus on treatment for chronic hepatitis C infection . The treatment guidelines recommend that treatment of acute hepatitis C infection be assessed on an individualized basis. In many cases, a person has to progress to chronic hepatitis C infection before they can receive public or private drug coverage for hepatitis C treatments.

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How Do My Healthcare Professional And I Decide On Treatment

Your healthcare professional will look at your health history and decide if treatment is right for you. The treatment you receive and the length of treatment may depend on:

  • how much virus is in your body
  • your genotype of hep C
  • whether you have liver damage
  • whether or not youve been treated previously

Next:

Treatment For Acute Hepatitis C

There are two main categories of hepatitis C infection: acute and chronic. Chronic HCV infection is a long-term condition, while the acute form is a short-term infection. Acute HCV infection occurs within the first six months of exposure to the hepatitis C virus.

According to the Centers for Disease Control and Prevention , about 75 percent of people with acute HCV will progress to chronic HCV. That means that up to 25 percent of people with acute hepatitis C will recover from it without treatment.

For this reason, and because treatment for HCV can be expensive, doctors typically dont treat acute HCV. Theyll often monitor an acute infection to see if it progresses to the chronic form. If the chronic form does develop, treatment can be introduced at that time.

Without treatment, chronic hepatitis C can lead to liver damage and other serious complications. Treatment consists of HCV medications or surgery.

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