How Will I Know If My Treatment Works
The goal of treatment is to reduce the amount of the hepatitis C virus in your blood to levels that cant be detected after 24 weeks of therapy. The amount of the virus in your blood is called your viral load. At the end of your treatment, your doctor will need to measure your viral load and find out how healthy your liver is. He or she may repeat many of the same tests that were done when you were first diagnosed with hepatitis C.
If your blood has so few copies of the virus that tests cant measure them, the virus is said to be undetectable. If it stays undetectable for at least 6 months after your treatment is finished, you have what is called a sustained virologic response . People who have an SVR have a good chance of avoiding serious liver problems in the future.
Treatment may not reduce your viral load. You may not have an SVR after treatment. If thats true, your doctor will discuss other treatment options with you. For example, if 1 round of treatment did not decrease your viral load enough, your doctor may recommend a second round. Even if treatment doesnt keep you from having active liver disease, lowering your viral load and controlling chronic liver inflammation may help you feel better for a longer time.
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.
Can Hepatitis C Be Cured
Considerable progress has been made by past clinical trials in the medical treatment of hepatitis C. The rate of cure has increased with the development of direct-acting, all-oral antiviral regimens, and the length of therapy is much shorter. Treatment recommendations continue to change as new medicines become available. Treatment helps to reduce progression of liver damage to cirrhosis, may prevent liver cancer, and may prevent spread of the infection to other people.
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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.
What Is Chronic Hepatitis
Hepatitis is an inflammation of the liver. In chronic hepatitis, liver inflammation continues for at least six months. This condition may be mild, causing relatively little damage, or more serious, causing many liver cells to be destroyed. Some cases lead to cirrhosis and liver failure.
Chronic hepatitis from infection is most often caused by these viruses:
- Hepatitis B and C. Often the person infected is unaware of any initial symptoms. Or the symptoms were so mild that the person did not seek medical attention. This is especially true for chronic hepatitis C. Over time, perhaps a decade or more, both types may lead to the serious complication of cirrhosis due to ongoing destruction of liver cells and resultant scarring. A minority of patients with cirrhosis develop liver cancer over time.
- Hepatitis D. Hepatitis D infects only patients already infected with hepatitis B, and it generally results in a flare of active hepatitis.
This information helps to determine the best treatment and to assess your risk of developing cirrhosis and liver failure. A liver biopsy also can help to check for other disorders, such as alcoholic liver injury or fatty liver.
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What Are The Symptoms Of Hepatitis C
Most people who have recently been infected with HCV do not have any symptoms. In general, people with chronic hepatitis C exhibit symptoms only after they suffer liver damage and develop liver cirrhosis .
The most common symptoms include:
- Bleeding and bruising easily
- Loss of appetite, nausea, and vomiting
- Weight loss
- Swelling in your legs
Ziv Ben Ari, MDDirector of the Center for Liver Diseases and of the Liver Research Laboratory
Prof. Ben Ari is an internationally renowned leader in the field of hepatology. She received advanced liver transplant and hepatology training at the Royal Free Hospital in London, and she is the current chair of the Israeli Association for the Study of the Liver. She is also a member of the Faculty of Medicine at Tel Aviv University. Prof. Ben Ari has received numerous grants for her ongoing liver research she has published more than 170 articles.
Yana Davidov-Darbianik, MDSenior Physician at the Center for Liver Diseases
Dr. Davidov is a specialist in internal medicine, with a focus on the treatment of various liver diseases, including hepatitis B and C, fatty liver, viral liver diseases, autoimmune and cholestatic liver disease , and cirrhosis. She studied medicine at the National University, School of Fundamental Medicine, Kharkov, Ukraine.
Treatment Of Chronic Hepatitis C
Chronic infection with the hepatitis C virus is extremely prevalent, averaging 1% to 2% of the world population. Fortunately, recognition of potential risk factors, changes in patterns of using injected drugs, and improved safety of the blood supply have led to a dramatic decline in the incidence of new hepatitis C virus infections in recent years. However, since most acutely infected patients become and remain chronically infected, the overall prevalence of chronic infection has not fallen. Chronic liver disease due to hepatitis C virus typically progresses slowly and usually does not result in major morbidity for many years. However, it is apparent that the large pool of patients with longstanding chronic hepatitis C is beginning to manifest the consequences of chronic infection and cirrhosis. In both the United Kingdom and the United States the incidence of hepatocellular carcinoma is increasing, deaths due to cirrhosis from chronic hepatitis C are on the rise, and hepatitis C is the leading indication for liver transplantation. In recent years, pharmacological treatment has had good results in patients with hepatitis C virus infection, with the virus being permanently eradicated in a large number of patients with a combination of interferon and ribavirin. This is a remarkable achievement in a chronic viral infection where spontaneous clearance is rare.
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What Can People Do To Help The Medications Work Best
- Take the medications every day
- Stay in touch with pharmacy to be sure that all refills are ready on time
- Take the medications exactly as prescribed
- Do not skip doses
- Get all blood tests done on time
- Go to all visits with providers as recommended
- Tell the provider about all other medications that are being taken – including over-the-counter medicines, vitamins, herbs, and supplements
- Complete the entire course of medication
Opioid Epidemic Homeless Lead To Rise In Hepatitis B And C Infections
In the United States, the number of new hepatitis B virus and hepatitis C virus infections has been decreasing for many years, but this trend has been reversed during recent years due to the opioid epidemic as more people use injection drugs, share needles or other paraphernalia and practice high-risk sexual behavior. This is particularly true for hepatitis C, where the number of new cases in the past 10 years has more than doubled, highlighting the need for a preventive vaccine, which is a vital tool to eliminate hepatitis C. The increase in number of new cases of hepatitis B is smaller and mainly seen in adults in their 30s because most younger persons have benefited from hepatitis B virus vaccination.
When we talk about viral hepatitis, the focus is on hepatitis B and C because they can cause chronic infection, while hepatitis A causes only acute infection and will not lead to cirrhosis or liver cancer. However, since 2016, many states in the U.S. have witnessed outbreaks of hepatitis A. The Centers for Disease Control and Prevention received more than 2,500 reports of hepatitis A between January 2017 and April 2018 associated with person-to-person transmission, with risk factors in two-thirds of these cases being drug use or homelessness or both. In Michigan, where I live, 859 cases of hepatitis A, including 27 deaths, were reported between July 2016 and June 2018. We can prevent hepatitis A through vaccination and improved hygienic conditions.
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Diseases That Damage Destroy Or Block Bile Ducts
Doctors usually treat diseases that damage, destroy, or block bile ducts with medicines such as ursodiol . Doctors may use surgical procedures to open bile ducts that are narrowed or blocked. Diseases that damage, destroy, or block bile ducts include primary biliary cholangitis and primary sclerosing cholangitis.
Prevalence And Transmission Of Hepatitis C Virus Infection
Hepatitis C virus is transmitted by parenteral or permuscosal exposure to infected blood or body fluids. Many patients will give a history of injecting drug use or transfusion of blood products before the implementation of antihepatitis C virus screening of blood donors in 1992. Seroprevalence among injecting drug users is more than 80%, and this remains a major risk factor for newly acquired hepatitis C virus infection in the developed world. Community based strategies for prevention of infection in these high risk groups are needed urgently but depend on resources . Screening of volunteer blood donations in developed nations has significantly reduced transfusion related hepatitis. Most countries in the developing world do not, however, have adequate screening procedures, and only about 40% of donated blood is tested for the virus. Occupational, vertical, and sexual transmission account for only a minority of new cases of hepatitis C virus infection. Sexual transmission of hepatitis C virus among monogamous partners is rare, but testing is often carried out for reassurance . See bmj.com for contact details for information on screening recommendations.
Box 1 Prevention strategies to reduce transmission of hepatitis C virus through injecting drug use
Complications of liver disease related to hepatitis C virus infection are expected to increase over the next 10 to 20 years
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Antiviral Medication For Hepatitis B
Doctors may recommend antiviral medication for people with chronic hepatitis B, which occurs when the virus stays in your body for more than six months.
Antiviral medication prevents the virus from replicating, or creating copies of itself, and may prevent progressive liver damage. Currently available medications can treat hepatitis B with a low risk of serious side effects.
NYU Langone hepatologists and infectious disease specialists prescribe medication when they have determined that without treatment, the hepatitis B virus is very likely to damage the liver over time. People with chronic hepatitis B may need to take antiviral medication for the rest of their lives to prevent liver damage.
There are many different types of antiviral medications available, and your doctor recommends the right type for you based on your symptoms, your overall health, and the results of diagnostic tests. A doctor may take a wait-and-see approach with a person who has a healthy liver and whose blood tests indicate a low viral load, the number of copies of the hepatitis B virus in your bloodstream.
Someone with HIV infection or AIDS may have a weakened immune system and is therefore more likely to develop liver damage. The U.S. Centers for Disease Control and Prevention strongly recommends that people with HIV infection who are diagnosed with hepatitis B immediately begin treatment with antiviral 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.
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Monitoring While On Treatment
Patients who do not achieve virologic suppression or a 2-log decrease in HCV RNA at 12 weeks may have therapy discontinued, although factors such as degree of fibrosis and tolerability of therapy should be considered.
Patients should have a CBC and chemistry evaluations 2 weeks after initiation of treatment to assess for potential toxicities. CBC, chemistry evaluations, and pregnancy tests in women should be done routinely at each follow-up visit and not less often then every 4-6 weeks during treatment.
Patients who achieve an end-of-treatment virological response should have HCV RNA testing performed 24 weeks after stopping treatment to evaluate for a SVR.
Erythropoetin alfa and granulocyte colony stimulating factor may be used to treat anemia and neutropenia, respectively, in order to maintain the patient on full medication doses.
Providers should reference the full discussion of side effects of hepatitis C treatment in Appendix A.
Pegylated interferon and ribavirin have been found to be safe and effective in HCV mono-infection and in co-infection with HIV.2,61 Safety and efficacy has not been established in patients who have received liver or other organ transplants, in patients who have failed other alpha interferon treatments and in patients under the age of 18.56,57
Clinical Course And Disease Progression
Acute hepatitis C virus infection is usually subclinical, and there are no reliable predictive factors for chronic infection. The relatively small size of the virus’s RNA polyprotein, rapid viral replication, and high mutation rates all contribute to the virus’s genetic heterogeneity and allow it to escape the host’s immune response, resulting in chronic infection for most patients . Progression of the disease is variable, and despite inherent limitations, histological evaluation of serial liver biopsy specimens remains the only reliable method to determine changes in severity of disease over time. On the basis of various study designs and models that predict rates of fibrosis progression, 20% to 30% of patients may be expected to develop cirrhosis over 20-30 years. This is reflected in the steady rise in the incidence of complications related to chronic liver disease, such as hepatocellular carcinoma, in many countries that are beginning to reach peak hepatitis C virus seroprevalence, such as Japan. Several host and viral factors affect disease progression, although determinants of individual risk and precise mechanisms of liver injury have yet to be determined . Better understanding of host-viral interactions may allow for targeted antiviral or other therapy aimed primarily at those at greatest risk of disease progression.
Box 2 Screening recommendations for hepatitis C virus infection
History of injecting drug use
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What The Cdc Recommends
Were you born between 1945 and 1965? If so, then youre a member of the Hepatitis C generation. The CDC recently recommended that all people born between during this time have a 1-time screening test for Hepatitis C. We now have new drugs that can treat and cure Hepatitis C so you should go get tested today.
The life you save may be your own! Please contact your local healthcare provider.
A Revolution In Hep C Treatment
More than 3 million Americans have a long-lasting hepatitis C infection. Most donât know it, because there usually aren’t symptoms.
Sofosbuvir was one of the first direct-acting antivirals to target hep C,the viru a disease spread through direct blood-to-blood contact. DAAs work in different ways to stop hep C from making copies of itself.
These drugs are kinder and gentler than the old standard of care — interferon shots and ribavirin alone. That route could take as long as a year, it only cured about half of the people, and the side effects were brutal.
âImagine taking an injection and a pill that made you feel — every day — worse than you ever felt from the infection that was being treated,â says Alexea Gaffney-Adams, MD, an infectious disease specialist in Smithtown, NY.
Side effects included flu-like symptoms, joint pain, anemia, and depression.
Limes says the old treatment felt like pouring gasoline into his system. âIt was like killing me to keep me alive.â In fact, it made his hep C worse, so his doctors took him off it.
Todayâs therapies are pills only and donât need interferon. They have very few side effects and double the cure rate — to 90% to 100%. They work in as little as 8 or 12 weeks.
âMy who had been on the older regimens — and failed, and now have the luck of being able to experience these new medications — canât believe the difference,â says Gaffney-Adams.
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