Important Side Effects And Drug Interactions
Sofosbuvir is generally well tolerated its more common side effects include mild nausea, headache, and insomnia . The combination of sofosbuvir with amiodarone can cause life-threatening bradycardia . The addition of NS5A inhibitors does not lessen tolerability to any clinically relevant extent . Therapeutic elevation of the gastric pH lessens the bioavailability of ledipasvir, and thus the concomitant administration of sofosbuvir/ledipasvir with a proton pump inhibitor in a high dose is not recommended .
The side-effect profile and drug-interaction spectrum of the NS3/4A protease inhibitors are more complex. Simeprevir can evoke both nonspecific side effects and photosensitivity reactions patients should be advised to avoid direct exposure to sunlight and to use a topical sunscreen . All of the approved NS3/4A protease inhibitors can mildly or moderately elevate bilirubin and transaminase levels . A simultaneous, clinically relevant rise of both the bilirubin concentration and the transaminase concentrations is rare but presumably reflects hepatotoxicity and must be followed by discontinuation of the the protease inhibitor. The characteristic side effects of ribavirin are hemolytic anemia, dyspnea, an irritative cough, reduced exercise tolerance, and skin rash . As hemolysis elevates the bilirubin concentration as well, rises in bilirubin levels are more pronounced when ribavirin and NS3/4A protease inhibitors are given simultaneously.
Who Can Access The Cures
Hep C cures are now available to everyone in Australia who has hep C.* The national and state governments want everyone with hep C to be cured, including prisoners and people who inject drugs. Now is a very good time to consider testing for hep C or speaking to your doctor about the hep C cures.
*Cures are available to people who have a Medicare Card or Health Care Concession Card and who arent hospital inpatients.
You might be able to access healthcare and the cures via your computer or phone.
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.
You May Like: How Do People Get Hepatitis B
Apply For Patient Assistance Programs
Another option is patient assistance programs.These are sponsored by pharmaceutical companies and give those in low-income households access to medications.
Keep in mind that youre only eligible for patient assistance programs if you arenot enrolled in Medicare, Medicaid, or another government prescription plan. These programs provide financial assistance, reducing your copays and coinsurance for medication.
Assistance varies, so youll need to contact drug companies directly to learn about their specific programs. Some examples include:
The National Viral Hepatitis Roundtable also provides information on getting financial assistance or copay relief.
Symptoms Of Hepatitis C
Hepatitis C often doesn’t have any noticeable symptoms until the liver has been significantly damaged. This means many people have the infection without realising it.
When symptoms do occur, they can be mistaken for another condition. Symptoms can include:
- flu-like symptoms, such as muscle aches and a high temperature
- feeling tired all the time
- loss of appetite
Read more about the complications of hepatitis C.
Read Also: What Kind Of Disease Is Hepatitis C
Antiviral Treatment In Pregnancy
The risk of vertical transmission in mothers with an HCV monoinfection is 5% and is not diminished by cesarean section . Mothers are not advised against breastfeeding either. Vertically acquired hepatitis C takes a mild course in childhood, with very slow progression of hepatic fibrosis . Antiviral treatment during pregnancy cannot be recommended, as there are insufficient data on the potential teratogenicity of DAAs.
Shop Health Insurance Plans
Even though health insurance can be expensive, your monthly premium through an employer might be considerably less than the cost of treating hep C without it. If thats not an option, you can research coverage options on the U.S. Health Insurance Marketplace during open enrollment periods.
Keep in mind, though, even with private or individual health insurance, your provider might not cover the cost of hep C treatment until youre very sick, and only if you dont use drugs or alcohol. Be sure to find out all you can about your coverage before applying.
Recommended Reading: How To Contact Hepatitis C
Causes And Risk Factors
HCV causes hepatitis C. People contract the virus through blood-to-blood contact with contaminated blood. For transmission to occur, blood containing HCV must enter the body of a person without HCV.
A speck of blood, invisible to the naked eye, can carry hundreds of hepatitis C virus particles, and the virus is not easy to kill.
The report the following risk factors for developing hepatitis C:
- using or having used injectable drugs, which is currently the most common route in the U.S.
- receiving transfusions or organ transplants before 1992, which is before blood screening became available
- having exposure to a needle stick, which is most common in people who work in healthcare
- being born to a mother who has hepatitis C
The CDC offer advice on cleaning syringes if it is not possible to use clean and sterile ones. Although bleach can kill the HCV in syringes, it may not have the same effect on other equipment. Boiling, burning and using alcohol, peroxide, or other common cleaning fluids to wash equipment can reduce the amount of HCV but might not stop a person from contracting the infection.
It is extremely dangerous to inject bleach, disinfectant, or other cleaning products, so people should make sure they rinse the syringe thoroughly. A person should only ever use bleach to clean equipment if new, sterile syringes and equipment are not available.
People who are at risk due to these factors can have screening to rule out HCV.
- peginterferon alfa-2a
How Effective Is Treatment
Direct-acting antivirals cure 9 out of 10 patients with hepatitis C.
Successful treatment does not give you any protection against another hepatitis C infection. You can still catch it again.
There’s no vaccine for hepatitis C.
If treatment does not work, it may be repeated, extended, or a different combination of medicines may be tried.
Your doctor or nurse will be able to advise you.
You May Like: Hepatitis C Antibody Blood Test
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 .
Testing For Hepatitis C
Hepatitis C is usually diagnosed using 2 blood tests: the antibody test and the PCR test. These can be as part of a routine blood test or are often combined as a dried blood spot test. The dried blood spot test is similar to a blood sugar test in pricking the finger to get a blood spot that is put on a testing card. This is then sent to a laboratory to be tested.
Another similar test is an antigen test, which if used can often get the results back in 90 minutes. This is very expensive and not many services have access to the machine needed.
You May Like: Hepatitis C Viral Load Labcorp
What Will My Doctor Need To Know To Treat Me
If you want to be assessed for treatment, you need to make an appointment with a doctor. They will be mostly interested in the condition of your liver. Your doctor will organise, if possible, for you to have a Fibroscan examination. If Fibroscan is not available, your doctor will probably use an APRI test. This is an online calculator that estimates the health of your liver. It involves a blood test called a liver function test.
Dont forget, its very important to get a PCR test 12 weeks after finishing treatment this will mean the doctor can make sure you are cured.
Enroll In A Government Health Plan
If you cant get private health insurance, explore U.S. government health benefits. Besides looking into the Health Insurance Marketplace, if youre 65 or older or have a disability, you might qualify for Medicare, which is a federal health insurance program. Also, your income could qualify you for your states Medicaid program. Veterans can research VA health benefits, too.
Recommended Reading: Hepatitis A Curable Or Not
The Treatment Of Acute Hepatitis C
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 .
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.
What Are The Symptoms Of Hepatitis C
Most people infected with hepatitis C have no symptoms. Some people with an acute hepatitis C infection may have symptoms within 1 to 3 months after they are exposed to the virus. These symptoms may include
If you have chronic hepatitis C, you most likely will have no symptoms until complications develop, which could be decades after you were infected. For this reason, hepatitis C screening is important, even if you have no symptoms.
Also Check: Hepatitis A Is It Curable
What Causes Hepatitis C
The hepatitis C virus causes hepatitis C. The hepatitis C virus spreads through contact with an infected persons blood. Contact can occur by
- sharing drug needles or other drug materials with an infected person
- getting an accidental stick with a needle that was used on an infected person
- being tattooed or pierced with tools or inks that were not kept sterilefree from all viruses and other microorganismsand were used on an infected person before they were used on you
- having contact with the blood or open sores of an infected person
- using an infected persons razor, toothbrush, or nail clippers
- being born to a mother with hepatitis C
- having unprotected sex with an infected person
You cant get hepatitis C from
- being coughed or sneezed on by an infected person
- drinking water or eating food
- hugging an infected person
- shaking hands or holding hands with an infected person
- sharing spoons, forks, and other eating utensils
- sitting next to an infected person
A baby cant get hepatitis C from breast milk.18
Causes Of Hepatitis C
You can become infected with hepatitis C if you come into contact with the blood of an infected person.
Other bodily fluids can also contain the virus, but blood contains the highest level of it. Just a small trace of blood can cause an infection. At room temperature, it’s thought the virus may be able survive outside the body in patches of dried blood on surfaces for up to several weeks.
The main ways you can become infected with the hepatitis C virus are described below.
Recommended Reading: What Is Hepatitis B Or C
How Many People Have Hepatitis C
During 2013-2016 it was estimated that about two and half million people were chronically infected with HCV in the United States. The actual number may be as low as 2.0 million or as high as 2.8 million.Globally, hepatitis C is a common blood-borne infection with an estimated 71 million people chronically infected according to the World Health Organization .
Other Funding Resources Available To People With Hepatitis C
If an individual cannot rely on Medicaid to cover their expenses for hepatitis C treatment, there are other potential sources of funding, including:
- The American Liver Foundation :ALF provides a financial assistance resource support guide where people may find helpful information. It also offers a free drug discount card that may lower the cost of some prescription medications.
- NeedyMeds: An organization that provides details of assistance programs for medication costs. People can also access a database of free and low cost medical clinics.
- Help-4-Hep: This helpline from a hepatitis nonprofit organization provides counselors who can help people locate financial resources. The number is 877-HELP-4-HEP .
- The HealthWell Foundation: This foundation may provide financial assistance for individuals living with hepatitis C.
- The Patient Advocate Foundation: This organization helps people cover co-pays and provides resources that may help with medical expenses.
- Pharmaceutical programs: Some pharmaceutical companies offer free of charge or lower cost medications to low income individuals without insurance or who do not receive government support. A person can ask their doctor to contact these companies directly.
Recommended Reading: Can Hepatitis B Be Cured With Antibiotics
Getting Tested Is The Only Way To Know If You Have Hepatitis C
A blood test called a hepatitis C antibody test can tell if you have been infected with the hepatitis C viruseither recently or in the past. If you have a positive antibody test, another blood test is needed to tell if you are still infected or if you were infected in the past and cleared the virus on your own.
- Are 18 years of age and older
- Are pregnant
- Currently inject drugs
- Have ever injected drugs, even if it was just once or many years ago
- Have HIV
- Have abnormal liver tests or liver disease
- Are on hemodialysis
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.
Also Check: Tenofovir Hepatitis B Side Effects
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
Interferons And Pegylated Interferons
The two most frequently used recombinant interferon preparations in clinical trials have been IFN alfa-2b and IFN alfa-2a , which differ from each other by only a single amino acid residue. IFN alfacon-1 , or consensus IFN, is a genetically engineered compound synthesized by combining the most common amino acid sequences from all 12 naturally occurring IFNs. Roferon-A was discontinued from the market in 2007 and Infergen was discontinued from the market in 2013.
The addition of propylene glycol molecules to IFN has led to the development of long-lasting IFNs that have better sustained absorption, a slower rate of clearance, and a longer half-life than unmodified IFN, which permits more convenient once-weekly dosing. The FDA has approved PEG-IFNs for the treatment of chronic hepatitis C.
Two PEG-IFN preparations are available for the treatment of chronic hepatitis C. PEG-IFN alfa-2b consists of IFN alfa-2b attached to a single 12-kd PEG chain it is excreted by the kidneys. PEG-IFN alfa-2a consists of IFN alfa-2a attached to a 40-kd branched PEG molecule it is metabolized predominantly by the liver.
Recommended Reading: Where Can I Get Hepatitis B Vaccine