Early Detection Early Treatment For Hepatitis C
When it comes to the hepatitis C virus infection, the treatment landscape has shifted in the past few years. But patients need new models of detection to benefit from better treatments.
When it comes to the hepatitis C virus infection, the treatment landscape has shifted in the past few years.
All-oral combinations of direct-acting antiviral agents have replaced the traditional combination of interferon and ribavirin, which was associated with many side effects. Thats good news for the 2 percent to 3 percent of individuals in the United States affected by the disease, per the Centers for Disease Control and Prevention.
Our group published the first paper in 2012 showing that it is possible to cure HCV infection without the use of interferon, says Anna Suk-Fong Lok, M.D., a hepatologist at the University of Michigan Health System.
Now, Dr. Loks group is evaluating different combinations of DAAs to identify a regimen that could potentially shorten the duration of treatment, improve cure rates in patients with advanced disease, and be effective for all patient populations and all genotypes of HCV.
But even the best treatments for HCV can reach their full potential only when initiated early in the course of the disease.
Early diagnosis of HCV infection, therefore, is paramount to avoiding the serious complications of liver disease.
Genotyping And Serotyping Of Hcv
Hepatitis C genotyping is helpful in defining the epidemiology of hepatitis C, but on an individual patient basis, genotyping is crucial in regard to treatment recommendations and duration. Genotyping is based on sequence analysis by sequencing or reverse hybridization. Although viral load can vary within a 0.5- to 1-log range, HCV genotype does not change during the course of infection. In case of suspected superinfection, another genotype might rarely be detected. For reliable genotyping, 5URT alone is insufficient, including parts of the core sequence enhance genotyping reliability. Sequencing of NS5b is the gold standard.
Serotyping is the only other option to test for the type of HCV in cases of remote infection. This, however, is relevant for epidemiologic studies only and is not used clinically.
Andrea D. Branch, in, 2004
Why Is It So Important To Take Hepatitis C Drugs Correctly
Taking any medicine correctly is extremely important. Taking medicines correctly means:
For hepatitis C drugs, these issues are especially important because, if a medicine is not taken correctly, it may not kill the virus completely. Then, because the virus has “seen” the drug, it learns how to mutate and change in ways that allow it to escape the drug and avoid getting killed off. This is called drug resistance.
Developing drug resistance is a serious issue. It means that the treatment may not work and that the patient may not respond to future treatments.
To prevent drug resistance, it is important to take any medication correctly, but especially DAAs such as Harvoni, Mavyret, Epclusa, and Zepatier.
Resistance can develop quickly. It is very important to take these new antiviral medications according to instructions, on schedule, and not to skip or reduce doses.
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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.
Can I Drink Alcohol Once In A While If I Have Hepatitis C
Alcohol can clearly contribute to worsening liver disease. You must discuss with your health care provider if any amount of alcohol is safe for you.
Alcohol can cause inflammation and scarring in the liver. If you have any underlying liver condition, such as hepatitis C or hepatitis B or damage from long-term alcohol use, your liver will be more sensitive to alcohol. When you have hepatitis C virus, alcohol on top of the hepatitis C can cause the inflammation and scarring to be worse, and overall damage to the liver may happen much faster when you drink alcohol.
Here is some helpful information about alcohol and hepatitis:
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Hepatitis C Symptoms & Treatment
Hepatitis C is mainly passed on through using contaminated needles and syringes or sharing other items with infected blood on them. It can also be passed on through unprotected sex, especially when blood is present.
You can prevent hepatitis C by never sharing needles and syringes, practising safer sex, and avoiding unlicensed tattoo parlours and acupuncturists.
Hepatitis C will often not have any noticeable symptoms, but a simple blood test carried out by a healthcare professional will show whether you have hepatitis C.
In the early stages, some peoples bodies can clear a hepatitis C infection on their own, others may develop chronic hepatitis C and will need to take antiviral treatment to cure the infection.
Without treatment, chronic hepatitis C can lead to permanent liver damage.
Hepatitis C is part of a group of hepatitis viruses that attack the liver.
Some groups are more at risk of getting hepatitis C than others, including people who use drugs, people in prisons, men who have sex with men, health workers and people living with HIV.
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.
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Will The Baby Be Infected If The Mother Or Father Has Hepatitis C
The baby’s risk of becoming infected with hepatitis C in the womb varies, depending on whether the parent with hepatitis C is the father or the mother.
If the mother is infected, whether or not the father is infected, there is a 5% chance that the baby will be born with hepatitis C. The risk is the same regardless of whether the birth occurs by vaginal delivery or by cesarean section. The risk is higher if the mother is also living with HIV.
If the father has hepatitis C but the mother does not, the baby cannot become infected because a father cannot pass the virus directly to a baby. If the father first passes the virus to the mother through sex, then the baby possibly could be infected by the mother. However, the chance of the virus being transmitted both from father to mother and then from mother to baby is almost zero.
All children born to HCV-infected women should be tested for HCV infection. Testing is recommended using an antibody-based test at or after 18 months of age. Approximately 25-50 % infants with hepatitis C will clear the infection without any medical help by age 4. For those who become chronically infected, most have no symptoms .
Discovery To Cure In 25 Years
Hepatitis C is a viral, blood-borne disease that progresses slowly over time. If left untreated, it can cause life-threatening damage to the liver. An estimated 71 million people have chronic hepatitis C infection with almost 400,000 deaths each year. The hepatitis C virus is the leading cause of liver cancer and the main reason for liver transplantation.
Prior to the identification of HCV in 1989, so little was known about the virus that it was simply called non-A, non-B hepatitis. Since identification, effective treatments have been relatively rapidly developed. Compared to the first-ever HCV treatment approved in 1991, in which a patient faced cure rates of around 6%, drugs today have more than a 95% success rate over short treatment courses. That makes HCV the fastest viral disease ever to be identified and cured. It remains the only chronic viral illness that can be completely cured, allowing millions of people to regain their health and live full and productive lives.
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Spread Of Hepatitis C
Hepatitis C is spread through blood-to-blood contact when blood from a person with hepatitis C enters another persons bloodstream.
The most common way people become infected with hepatitis C in Australia is by sharing injecting equipment such as needles, syringes, spoons and tourniquets. It is possible to be infected with hepatitis C after only one risk event.
Hepatitis C may also be spread through:
- tattooing and body piercing with equipment that has not been properly cleaned, disinfected or sterilised such as backyard tattoos’. Registered parlours with appropriate infection control procedures are not a risk
- needlestick injuries in a healthcare setting
- receiving blood transfusions in Australia prior to 1990 before hepatitis C virus testing of blood donations was introduced
- medical procedures, blood transfusions or blood products and mass immunisation programs provided in a country other than Australia
- pregnancy or childbirth there is a 5% chance of a mother with chronic hepatitis C infection passing on the virus to her baby during pregnancy or childbirth.
Breastfeeding is safe, however if nipples are cracked or bleeding cease breastfeeding until they have healed.
Less likely possible routes of transmission of hepatitis C include:
Hepatitis C cannot be transmitted by:
- sharing food, cups or cutlery
- shaking hands or day-to-day physical contact.
Is Liver Cancer Curable
Successful liver transplants can cure liver cancer, but not everyone who needs a liver transplant will be healthy enough to go through a transplant or able to find a donor. Studies show people who have surgery to remove part of their liver tend to live longer than people whose illness prevents surgery. When that happens, healthcare providers focus on treatments to help people live with quality of life for as long as possible.
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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
- yellowish eyes and skin, called jaundice
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.
Who Should Get Tested
Some people are at increased risk for having hepatitis C, including:
- Current or former injection drug users, including those who injected only once many years ago
- Those born from 1945 through 1965 this group is five times more likely to have been infected before the blood supply was screened.
- Recipients of clotting factor concentrates made before 1987, when less advanced methods for manufacturing those products were used
- Recipients of blood transfusions or solid organ transplants prior to July 1992, before better testing of blood donors became available
- Hemodialysis patients
- People with known exposures to the hepatitis C virus, such as: Healthcare workers after needle sticks involving blood from someone who is infected with the hepatitis C virus or Recipients of blood or organs from a donor who tested positive for the hepatitis C virus
- People with HIV infection
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Are There Ways To Cure Hepatitis C Other Than With Medications
Patients sometimes ask whether there are ways to treat hepatitis C other than taking medicines. Currently, there are no vaccines to prevent hepatitis C. Once a person is infected, the only way to treat it is with prescribed antiviral medications.
Some patients worry that having hepatitis C means they will need a liver transplant. Only a very small fraction of people with hepatitis C require a liver transplant. By far, most people with hepatitis C never need a liver transplant. A transplant is performedonlywhen damage to the liver is extremely advanced and the liver is unable to perform its basic functions. A transplant provides a new working liver, but a transplant does not get rid of the hepatitis C virus in the patient. Patients with a liver transplant still need antiviral medication to cure their virus.
Sharing Toothbrushes Scissors And Razors
There’s a potential risk that hepatitis C may be passed on through sharing items such as toothbrushes, razors and scissors, as they can become contaminated with infected blood.
Equipment used by hairdressers, such as scissors and clippers, can pose a risk if it has been contaminated with infected blood and not been sterilised or cleaned between customers. However, most salons operate to high standards, so this risk is low.
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Are Alternative Medicines Available
Some people believe certain forms of alternative medicine help cure hepatitis C.
However, the National Center for Complementary and Integrative Health reports that there are no effective, research-proven forms of alternative treatment or complementary medicine for hepatitis C.
Silymarin, also known as milk thistle, is an herb commonly suggested to help cure hepatitis C liver disease. But a rigorous did not find any beneficial effects from this supplement.
What Are The Side Effects Of Treatment
The direct acting antiviral regimens used to treat hepatitis C today are extremely well tolerated. You may experience mild side effects like headache or fatigue. For details on the side effects, review the handout specific to medication you take.
In rare instances, providers may recommend the addition of the medication ribavirin for more difficult cases of hepatitis C. Ribavirin may cause additional side effects such as fatigue, shortness of breath, cough, anemia, or rash. Patients who receive ribavirin may need more frequent monitoring for side effects as well as adjustment of the dose if side effects are experienced. For detailed information on ribavirin, patients should review the ribavirin handout.
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Heading Towards Hcv Elimination
The introduction of DAA therapy is linked to tremendous changes in HCV epidemiology today and in the future. In countries with wide access to DAA therapy, the number of patients with HCV infection presenting at liver units has been continually decreasing, whereas treatment uptake has markedly increased. Some studies have already reported a substantial decrease in the proportion of patients with HCV infection among those presenting with compensated or decompensated liver cirrhosis and/or at-need of liver transplantation. It was calculated that the role of HCV for liver-related morbidity, hospital admissions and mortality might be only marginal in the near future in such countries, for example, Spain.
Fig. 6: Cascade of care.
Overview of the various steps required to cure patients with hepatitis C virus infection. It becomes obvious that an increase in sustained virological response has only a minor efficacy on the overall proportion of patients with HCV infection who are cured: 12% for patients treated with interferon- monotherapy, and 8% for patients treated with modern direct-acting antiviral agents. For a substantial change, other parts of the cascade need to be markedly improved.
What About Sex And Hepatitis C
Hepatitis C can be spread through sexual intercourse, but the risk is considered to be low. It is extremely rare among monogamous couples, meaning couples who only have sex with one another. The risk increases if you:
- Have multiple sex partners
- Have a sexually transmitted disease
- Are infected with HIV
There is no evidence that Hepatitis C is spread by oral sex.
To reduce the chance of getting or giving Hepatitis C through sexual contact, follow these guidelines:
- Use latex condoms every time you have sex, particularly if you have:
- More than one partner
- Rough sex that might make one of you bleed
- Sex during your or your partners menstrual period
- Sex when you or your partner has an open sore on either of your genitals
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What Is The Difference Between Relapse And Nonresponse
The goal of treating chronic hepatitis C is to completely clear the virus. This means that your “viral load” is zero or so low that the virus can’t be detected with standard blood tests.
Without treatment, the hepatitis C virus in liver cells constantly makes copies of itself, and the virus ends up not just in liver cells but also in the bloodstream. Treatment is intended to completely stop reproduction of the virus so that it doesn’t continue to enter the bloodstream or cause any more injury to liver cells.
Successful treatment results in a “sustained virological response.” This means the virus becomes completely undetectable before the treatment is finished, and it remains undetectable for 6 months after treatment is stopped.
A “relapse” means the viral load drops to an undetectable level before treatment is completed, but becomes detectable again within 6 months after treatment is stopped. Even if the virus returns at a level that is lower than it was before treatment, a relapse is still considered to have occurred. A relapse can be determined if the viral load starts to rise during treatment, or at any time after the virus becomes undetectable.
A “nonresponse” means the viral load never drops significantly and the virus remains detectable throughout the course of treatment.