Starting Treatment Adjusting To Treatment
Many antiretroviral drugs that keep HIV under control have side effects, causing changes of various kinds. But not all people with HIV who take antiretroviral therapy or other medications for HIV-related conditions will experience side effects from their drugs. We are lucky to be living in an era in which many of the newer medications used to treat HIV cause far fewer side effects than were seen in the early years of the HIV epidemic.
Many people are able to stay on their medications for years with few, if any, side effects. When side effects do occur, they are often only temporary and will disappear after a few days or weeks. There can, however, be side effects that last as long as the drugs are continued in some cases, these side effects will remain even after the drugs are stopped.
People who are considering antiretroviral therapy are often concerned about side effects. Heres something to consider: If you talk to your doctor about possible side effects before starting treatment, you will be better prepared to deal with temporary, minor problems that can happen as you adjust to treatment. If there is a side effect that can be severe or life-threatening, you will know what to watch for.
Many people who start antiretroviral therapy find the side effects to be much more manageable than they expected. At the least, knowing the side effect will improve over time can make it easier to convince yourself to stick with a particular medication.
How Long Does It Take To Cure Hepatitis C
Depending on the drug combination, the specific genotype of hepatitis C that is to be treated, any prior treatment, and whether the person has cirrhosis, the duration of medical therapy may be as few as 8 weeks, or up to 24 weeks. Most regimens are for 12 consecutive weeks. This is much shorter than the interferon-based treatments years ago that lasted up to 48 weeks. Generally, a person is not considered “cured” until the “RNA viral load” is undetectable for 24 weeks after therapy is stopped. This is called “sustained virologic response” or SVR.
The presence of cirrhosis or liver fibrosis is determined by liver biopsy, noninvasive fibrosis scans, or formulas that estimate liver fibrosis based on blood tests, such as AST-to-platelet Ratio Index or Fibrosis-4 Index.3
A very important aspect of treatment is the elimination of all alcohol consumption. Alcohol adds fuel to the fire when it comes to chronic hepatitis. Drinking alcohol greatly worsens liver fibrosis and speeds progression to cirrhosis, and there is no “safe” amount to drink for someone with chronic hepatitis. Drinking alcohol also makes it harder for the medications to be effective and may interfere with proper dosing.
Boxed Warning: Reactivation Of Hepatitis B Virus
Epclusa has a boxed warning . This is the most serious warning from the Food and Drug Administration . A boxed warning alerts doctors and patients about drug effects that may be dangerous.
Taking Epclusa has caused reactivation of the hepatitis B virus in people with both HBV and hepatitis C. Reactivation of HBV can cause liver failure and, in rare cases, death. HBV reactivation may occur while youre taking Epclusa or after you finish treatment.
Before you begin taking Epclusa, your doctor will typically order blood tests to check for hepatitis B . If you have HBV or have had it in the past, you may need to be treated before its safe for you to take Epclusa.
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How Should I Take Epclusa
Take Epclusa exactly as prescribed by your doctor. Follow all directions on your prescription label and read all medication guides or instruction sheets.
Take with or without food.
Place the oral pellets in your mouth and swallow without chewing. Read and follow all Instructions for Use about mixing the pellets with food to improve the taste. Ask your doctor or pharmacist if you need help.
Doses are based on weight in children and teenagers. The dose may change if the child gains or loses weight.
If you’ve had hepatitis B, it may come back or get worse. You may need liver function tests while using this medicine and for several months after you stop.
You should not stop using Epclusa suddenly, or your hepatitis C could become harder to treat with antiviral medicine.
Use all medications as directed. Do not change your dose or stop using a medicine without your doctor’s advice. Remain under the care of a doctor.
Store Epclusa in the original container at room temperature away from moisture and heat.
What About Patients With Hepatitis C Who Also Have Hepatitis B
Hepatitis B virus can flare in patients who are co-infected with hepatitis B and hepatitis C and are taking medication for hepatitis C. This has been reported as a potential risk for patients who are taking hepatitis C treatment and have underlying hepatitis B as well. The flare usually occurs within a few weeks after the patient starts taking medication for hepatitis C. Therefore, patients who have both hepatitis B and hepatitis C should be seen by a hepatitis expertbeforestarting treatment of the hepatitis C they may need to start taking hepatitis B treatment to avoid a hepatitis B flare.
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What Are The Names Of The Medications For Treating Hepatitis C
Since 2014, multiple different antiviral treatments for hepatitis C have been developed. With the many options now available, often there is more than one good choice for a patient. Some of the treatments are recommended as first-line options, some are second-line options, and others are used less commonly in light of all the available choices.
- Elbasvir/Grazoprevir
Second line hepatitis C medications:
- Sofosbuvir/Velpatasvir/Voxelaprevir
Figuring Out The Cause Of What You Are Feeling
Always seek a full diagnosis from your doctor regarding all symptoms. What youre feeling could be from your medication, but it could also be a hormone problem, a nutrient deficiency, an infection, depression, HIV infection itself or something else.
Determining what could be contributing to a given side effect can be difficult, and an obvious place to start is by discussing the problem with your doctor. Doctors who have worked with many people living with HIV are usually familiar with the majority of likely drug side effects.
You can also look at the information available on a particular drug. The product monograph or prescribing information for a drug the official, approved document that summarizes what is known about it will normally contain a fairly comprehensive list of all known side effects. In some cases, these lists can be very long and seem to include every possible side effect known. However, if you see a symptom you are experiencing listed as one of the common side effects, this is a hint your drug could be the cause.
Two other things are important to remember. First, it is always possible that you could be the first patient to ever experience a particular side effect. This isnt likely, but it is possible. The fact you dont see a side effect listed does not mean it is impossible the drug is causing this problem in you.
In each section of this guide, we discuss the possible contributing causes of symptoms to help you untangle whats causing what.
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Hepatitis C And Blood Spills
When cleaning and removing blood spills, use standard infection control precautions at all times:
- Cover any cuts or wounds with a waterproof dressing.
- Wear single-use gloves and use paper towel to mop up blood spills.
- Clean the area with warm water and detergent, then rinse and dry.
- Place used gloves and paper towels into a plastic bag, then seal and dispose of them in a rubbish bin.
- Wash your hands in warm, soapy water then dry them thoroughly.
- Put bloodstained tissues, sanitary towels or dressings in a plastic bag before throwing them away.
Do Follow Your Doctors Exact Instructions For Treatment
For hepatitis C medications to be effective, they need to be taken as prescribed. Missing doses increases the risk of the virus becoming resistant to medications, according to the American Liver Foundation. If you have side effects that make it difficult to take your medication, share this information with your doctor so they can make adjustments to your treatment plan.
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Can Hepatitis C Be Treated
Yes, since 2010 enormous progress has been made in the treatment of chronic hepatitis C. New therapies called direct-acting antivirals are pills that act on the virus itself to eradicate it from the body, unlike older medicines like interferon injections which work by stimulating an immune response. These new treatments are very effective and can achieve cure rates of over 90%. In most situations now, there is no need for interferon, which was responsible for many of the side effects previously associated with HCV treatment. The new treatment combinations require shorter treatment durations , have reduced side effects and appear to be effective at all stages of the disease.
Because these new therapies are very new, they remain very expensive. As such, drug coverage from both government and private companies may require that your liver disease has progressed to a certain stage before they are willing to cover the cost of these drugs.
Your primary care physician may refer you to a specialist to determine whether you are eligible for treatment. A specialist will help you decide which drug therapy is best for you based on the severity of your liver disease, your virus genotype and whether or not you have been treated in the past.
Sofosbuvir May Cause Side Effects Tell Your Doctor If Any Of These Symptoms Are Severe Or Do Not Go Away:
- diarrhea
- difficulty falling asleep or staying asleep
- irritability
- sore throat, fever, chills, and other signs of infection
- rash, with or without blisters
- swelling of the face, throat, tongue, lips, eyes, hands, feet, ankles, or lower legs
- hoarseness
- difficulty swallowing or breathing
Sofosbuvir may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.
If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration’s MedWatch Adverse Event Reporting program online or by phone .
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The Benefits Of Subduing Side Effects
The goal here is to create an approach that will allow you to benefit from your drugs while avoiding the side effects that can make taking them difficult. There are two potentially huge benefits to this approach:
First, you are much more likely to properly adhere to your antiretroviral therapy, which means sticking to your drug schedule and taking your drugs exactly as prescribed and directed. Always taking your drugs as directed means youre much less likely to experience drug resistance. That means the ability of your drugs to keep you healthy can remain effective for years.
And last, but most assuredly not least, your quality of life can be immensely improved when difficult side effects are eliminated or lessened. Its all about living well with HIV, not just longer.
Dont Take Vitamins And Supplements Without Talking To Your Doctor
Dietary supplements havent been shown to be effective treatments for hepatitis C, according to the National Center for Complementary and Integrative Health, and some may even have harmful side effects and interact poorly with medications. If you take vitamins or supplements, or are considering taking them for other health reasons, make sure your doctor knows. In some cases, your doctor may recommend a particular brand or suggest a different approach if the potential interactions or risks are too high.
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Determinants Of Hrql Before Treatment
HRQL varied with age, participating center, severity of liver disease and income in Euros . As might be expected, younger patients had a better performance compared to older patients, especially on the physical components of HRQL. Surprisingly, cirrhotic patients had a better performance than non-cirrhotic patients, having significantly higher scores on several dimensions of the SF-36, mostly on mental components. Higher income in Euros had a weak positive effect on the physical component summary scale and role limitation because of physical health scale of HRQL, with a correlation coefficient of 0.30 and 0.23 respectively. Finally, HRQL differed among the different participating centers: the mental component summary scale and the dimensions physical functioning, role limitation because of physical health, general health, bodily pain, vitality, social functioning and mental health were all significantly different between the participating centers .
Table 1 Determinants of Health Related Quality of Life on t = 0 and course of Health Related Quality of Life
In the multivariate analysis, individualized treatment had a significantly negative influence on the course of HRQL on the dimensions physical component summary scale, bodily pain, vitality and social functioning, compared to patients treated with standard treatment .
How Often To Use
You may be wondering how long you have to take Epclusa to treat hepatitis C. Youll likely use the drug once daily for 12 weeks. This is the amount of time it takes for Epclusa to clear the hepatitis C virus from your body.
Its extremely important to not miss or skip doses of Epclusa. Missed or skipped doses can lower the level of the drug in your blood, which may cause Epclusa to work less well than usual. As a result, the drug may not clear the hepatitis C virus from your system.
To avoid missing a dose, try setting a reminder on your phone. If you do miss a dose of Epclusa, its important that you call your doctor right away. Theyll advise you on the best action for you to take.
Hepatitis C is an infection caused by the hepatitis C virus. The virus is transmitted through blood or body fluids, which can occur in several ways, including:
- sharing needles with a person who has the virus
- getting pricked by a needle that has the virus, which can be common in a healthcare setting
- having sex with someone who has the virus without using a condom or other barrier method
Once inside your body, hepatitis C virus attacks cells in your liver, causing inflammation.
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How Can I Treat Other Side Effects
If you develop other side effects from treatment, let your doctor know. Depending on your specific symptoms, they might:
- order tests to determine the cause of your symptoms
- encourage you to adjust your daily habits to prevent or relieve the symptoms
- advise you to use over-the- counter medications to treat symptoms
- make changes to your treatment plan
Other Types Of Therapy That Can Help With Hep C
As with any medical condition, complementary therapies can be used to potentially relieve some of the symptoms that come with a hep C infection. The Liver Foundation reports that people have used relaxation techniques like meditation and visualization, as well as physical techniques like massages, yoga, and tai chi. Overall, these two forms of complementary treatment come without much risk and may prove to help individuals deal with pain and distress, especially when combined with prescription medication.
In contrast, common herbal medicines and supplements often suggested to hepatitis c patients, such as milk thistle and zinc, must be examined much more carefully. Research on the impact of dietary supplements in treating hepatitis C patients is still in the early stages and has not yet proven to help in any way. What’s more, supplements aren’t regulated by the Food and Drug Administration. If you’re interested in trying something, always speak with your doctor first.
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Treatment Of Patients With Decompensated Cirrhosis
Treatment of patients with decompensated cirrhosis ) is limited to regimens containing sofosbuvir and NS5A inhibitors. Protease inhibitors are not recommended due to the hepatic metabolization and subsequently significantly higher drug exposure in this group of patients. Thus, grazoprevir/elbasvir, glecaprevir/pibrentasvir or SOF/VEL/VOX should not be administered. To improve efficacy the remaining combination of sofosbuvir and NS5A inhibitor should be combined with RBV . Many studies and real-world data have shown that IFN-free antiviral therapy is safe in patients with advanced liver disease. However, patients are still at risk of hospitalization during therapy, mainly because of complications from liver disease . The efficacy of sofosbuvir/ledipasvir plus RBV was studied in the SOLAR-1 and -2 study. In GT 1 patients, SVR rates ranged between 87 and 96% and between 72 and 85% in CPS B and CPS C patients, respectively . The ASTRAL-4 study evaluated the use of sofosbuvir/velpatasvir in patients with CPS B, but not CPS C. Treatment duration of 12 weeks showed high rates of SVR for patients with GT 1, 2, 4 and 6 infection. SVR rates of GT 3 were low at 50% but could be increased to 85% by the addition of RBV . Even though the rate of treatment discontinuations is higher in patients treated with RBV, the additional antiviral substance significantly increases SVR rates .
Symptoms Of Hepatitis C
It is very important to know that not everyone with hepatitis C has symptoms. The only way to know if you have hepatitis is by talking to your doctor and getting a blood test.
Many people living with hepatitis C feel well and only have symptoms once the disease has progressed and there is serious liver damage.
If you do not have symptoms this does not mean that the virus isnt causing damage.
When first infected, some people may find:
- their urine becomes dark
- their eyes and skin turn yellow
- they experience a minor flu-like illness.
These symptoms may disappear within a few weeks, but this does not necessarily mean that the infection has been cleared.
Over time, symptoms that may develop include:
- tiredness and fatigue
- flu-like symptoms
- pain in the abdomen where the liver is located
- not feeling hungry and indigestion.
Around 30% of people who have been infected may clear the virus from their blood naturally, with no treatment, within 6 months. These people no longer have the hepatitis C virus and are not infectious, but will always have hepatitis C antibodies in their blood. The presence of hepatitis C antibodies shows that someone has been exposed to the virus, but does not offer any immunity against hepatitis C. People can become reinfected after clearing the virus naturally, or after treatment.
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