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.
Hepatitis B Vs Hepatitis C
Hepatitis has many different types. HBV and the hepatitis C virus have both acute and chronic forms.
The main difference between HBV and HCV is how they spread from person to person. Although HCV is transmissible via sexual activity, this is rare. HCV usually spreads when blood that carries the virus comes into contact with blood that does not.
How To Prevent Hepatitis B
Hepatitis B is a liver infection caused by a virus . It can be serious and theres no cure, but the good news is its easy to prevent. You can protect yourself by getting the hepatitis B vaccine and having safer sex. If you have oral, anal, and vaginal sex, use condoms and dental dams to help stop the spread of hepatitis B and other STDs.
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What Are The Types Of Hepatitis B
There are two types of hepatitis B infection: acute and chronic.
An acute infection happens at the beginning, when you first get infected with hepatitis B. Many people are able to clear it from their bodies and recover. In fact, this is true of about 4 in 5 adults who are infected.
If you are not able to clear the infection within six months or longer, you have chronic hepatitis B. It is chronic hepatitis B that leads to inflammation and the serious, and possibly fatal, illnesses of cirrhosis of the liver and liver cancer. Treatment can slow disease progress, reduce the chance of liver cancer and increase your chances of surviving.
How Are Hepatitis B And C Diagnosed
Hepatitis B is diagnosed by a series of blood tests. The test may show an ongoing infection or antibodies that indicate that the patient is protected against hepatitis B. In patients who have a positive screening test that suggests the possibility of ongoing infection, further testing is done to determine the levels of the virus in the bloodstream.
Hepatitis C is diagnosed via a blood test called a Hepatitis C Antibody Test. A positive result means that hepatitis C antibodies are present in the blood. But a positive antibody test doesnt necessarily mean a person has hepatitis C. A further blood test is needed to confirm the diagnosis. This second blood test quantifies the amount of the virus or the viral load in the liver and the bloodstream.
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Hepatitis B And Pregnancy
The American College of Obstetricians and Gynecologists , the US Preventive Services Task Force , and the World Health Organization recommend routine prenatal screening for hepatitis B surface antigen in all pregnant womenduring every pregnancyregardless of previous test results or vaccinations. Pregnant women at risk for hepatitis B infections should be specifically targeted for vaccination. The risk of transmission of hepatitis B associated with amniocentesis is low. WHO further recommends all pregnant women undergo testing at least once for HIV and syphilis in addition to that for HBsAg and as early as possible in the pregnancy.
It is recommended that all infants receive their first dose of hepatitis B vaccine as soon as possible after birth , followed by two or three doses to complete the primary series.
To prevent maternal-fetal HBV transmission, a conditional WHO recommendation is that HBsAg-positive gravida who have an HBV DNA 5.3 log10 IU/mL receive tenofovir prophylaxis beginning the 28th week of pregnancy until at least birth. This is in addition to the three-dose hepatitis B vaccination in all infants, including a timely birth dose. When antenatal HBV DNA testing is not available, HBeAg testing can be used as an alternative study to determine eligibility for tenofovir prophylaxis to prevent mother-to-child transmission of HBV.
Challenges In Hepatitis B And C
Dr. Peter Kwan MD, FRCPCAssociate Professor UBCDivision of Gastroenterology VGHMember, Medical Advisory Committee, Canadian Liver Foundation
Further research on drugs to cure hepatitis C virus can be considered over as there are multiple pharmaceutical companies offering products of similar efficacy. It is however a different story for hepatitis B. To rid the mini HBV chromosome inside liver cell nucleus will call on innovative approaches and not just a pill. Although there is no shortage of interest, HBV research is underfunded internationally. Some have lamented the fact that HBV kills as many per year as tuberculosis or malaria worldwide, and it is the 13th cause of all deaths in the world but the amount of research grants does not reflect this. Just in the spring of this year, 200 scientists from over 20 countries have announced an international coalition called ICE-HBV. The goal is to achieve a lasting cure for HBV as soon as possible by sharing scientific data for all the major laboratories engage in HBV research.
Perhaps another commonality of both viruses is that only a small percentage of carriers are aware of their status somewhere around 5% for both HBV and HCV worldwide. Of course this statistic varies widely depending on the status of the health care system hence even when effective medications are available, there exists a large void in linkage to care.
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Differences In Hepatitis B And C Treatments
Guidelines for the medical treatment of a co-infection with hepatitis B and C have not been clearly set, according to Ibrahim Hanouneh, MD, a hepatologist at the Cleveland Clinic. There are scant data and no standard-of-care recommendations, he says. But limited research suggests treatment for hepatitis C is still effective even in the presence of the hepatitis B virus, he adds.
Medications for hepatitis C have improved dramatically in recent years. Not only are newer hepatitis C drugs easier for people to take, with fewer and less severe side effects, but they’re also effective, Alqahtani says, and cure rates are excellent.
For chronic hepatitis B infection, however, there’s currently no cure. Treatment involves slowing the progression of the virus and monitoring people for signs of liver damage, according to the CDC.
For this reason, Alqahtani says, doctors try to determine which virus is dominant in people with co-infection. We check the liver to see which virus is more active,” he says. “If its hepatitis C, we treat that virus first.” Once it’s cured, he says, the focus of treatment shifts to controlling hepatitis B.
Treatment for co-infection comes with specific concerns that should be monitored by your healthcare team, including:
- Liver transplant may be an option: People who develop severe cases of co-infection that result in liver failure may be candidates for liver transplant, Alqahtani says.
A Pricey Drug And New Generics
The first combo pill with two drugs that inhibits different steps in hepatitis C replication was approved by the FDA in 2014. This pill is taken once a day for 8-12 weeks, has little to no side effects and improved the cure rate to 90-95%. It was hailed as a magical cure, but it came with a price tag of US$94,500 for a 12-week course of treatment. That led many insurers in the United States and national health departments in other countries to limit access to treatment.
Since then, several othercombo pills withsimilar cure rates that are equally well-tolerated have become available, and the cost has markedly decreased. In addition, low-cost generics and special pricing arrangements are available in many resource-limited countries.
While the current price of hepatitis C virus drugs is still very high, one needs to remember that for 95 percent of patients, this is a cure. It is unlike medicines for many illnesses that need to be taken for a long time, sometimes for the rest of the patients lives. Indeed, a cure for hepatitis C virus has allowed some patients who were on the liver transplant waiting list to reverse their liver failure, making transplantation unnecessary. This is good news not only for these patients but also for others on the waiting list.
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How Common Is Hepatitis Co
About 2.7 million people living in the United States have chronic hepatitis C, while some 1.2 million have hepatitis B, according to the CDC. Far fewer have both infections. An found that only about 1.4 percent of U.S. veterans who had hepatitis C were also infected with hepatitis B.
The main reason that people may develop both infections, Dr. Alqahtani says, is that they can be transmitted in similar ways. Since these viruses share similar methods of transmission, co-infection can become more common, he points out. That includes exposure to contaminated blood.
Both hepatitis B and C can be spread through blood transfusions or injections during medical procedures, according to the World Health Organization , if blood has not been effectively screened. Sharing needles is a common method of transmitting hepatitis C in the United States, but its also a method for transmitting hepatitis B, says Alqahtani. In addition to blood, hepatitis B can be spread through other body fluids like semen.
You are at a higher risk of having a hepatitis C infection if you are in any of the following groups listed by the CDC:
- Injection drug user
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Low Response Rates And Nonresponders
Low vaccination response rates have been associated with obesity, smoking, immunosuppression, and advanced age. Approximately 25-50% of persons who initially do not have a vaccine response will show a response to 1 additional vaccine dose, and 50-75% of individuals will have a response to a second 3-dose series.
It is recommended that testing for anti-HBs be obtained 4-12 weeks following vaccination. Revaccinate nonresponders, with another series of 3-dose hepatitis B vaccine. Consider delaying revaccination for several months after initiation of antiretroviral therapy in patients with CD4 counts below 200 cells/mm3 or those with symptomatic HIV disease. The delay in these individuals is an attempt to maximize the antibody response to the vaccine.
Do not defer vaccination in pregnant patients or patients who are unlikely to achieve an increased CD4 count. Individuals at increased risk of severe complications due to HBV infection include those unlikely to achieve CD4 counts of 200 cells/mm3 or above after antiretroviral therapy and HIV-infected pregnant women.
A combined hepatitis A virus /HBV vaccine is licensed in many countries and offers the advantage of protection against both of these viruses at the same time. The vaccine seems to be safe, although some questions exist regarding neurologic complications.
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Is Hepatitis B Curable
Theres no cure for hepatitis B. The good news is it usually goes away by itself in 4 to 8 weeks. More than 9 out of 10 adults who get hepatitis B totally recover.
However, about 1 in 20 people who get hepatitis B as adults become carriers, which means they have a chronic hepatitis B infection. Carriers are more likely to pass hepatitis B to other people. Most carriers are contagious meaning they can spread hepatitis B for the rest of their lives.
Hepatitis B infections that last a long time may lead to serious liver diseases like cirrhosis and liver cancer. About 1 in 5 people with chronic hepatitis B die from it. There are medicines that can help treat chronic hepatitis B infections.
Most babies who get hepatitis B during birth develop chronic infection, unless they get treated right away. But treatments are almost always effective if your baby gets them quickly. Thats why its important for pregnant people to get tested for hepatitis B.
Are Hepatitis B And C Preventable
Hepatitis B is a vaccine-preventable disease.
There is a three-shot vaccination series that is very effective in protecting people against the virus if theyre exposed. In the United States, all newborns are vaccinated for hepatitis B and all pregnant women are screened for hepatitis B during pregnancy. This way, mothers infected with hepatitis B can take protective steps to decrease the risk of transmission of the virus to the child.
There is no vaccine for hepatitis C.
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Hepatitis B During Pregnancy
If a woman with HBV becomes pregnant, they may transmit the virus to their baby. Women should inform the doctor who delivers their baby that they have HBV.
The infant should receive an HBV vaccine and HBIG with 1224 hours of birth. This significantly reduces the risk that they will develop HBV.
The HBV vaccine is safe to receive while pregnant.
People with a high risk of HBV include:
- the infants of mothers with HBV
- the sexual partners of people with HBV
- people who engage in sexual intercourse without contraception and those who have multiple sexual partners
- men who have sex with men
- people who inject illicit drugs
- those who share a household with a person who has a chronic HBV infection
- healthcare and public safety workers who are at risk of occupational exposure to blood or contaminated bodily fluids
- people receiving hemodialysis, which is a type of kidney treatment
- people taking medications that suppress the immune system, such as chemotherapy for cancer
- those who come from a region with a high incidence of HBV
- all women during pregnancy
People can prevent HBV infection by:
- wearing appropriate protective equipment when working in healthcare settings or dealing with medical emergencies
- not sharing needles
- following safe sexual practices
- cleaning any blood spills or dried blood with gloved hands using a 1:10 dilution of one part household bleach to 10 parts water
A vaccine against HBV has been available since 1982.
People who should receive this vaccine include:
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.
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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.
Who Is Most At Risk Of Contracting Hepatitis C
You have a high risk of contracting hepatitis C if you:
- use or have used injection drugs even if it was just once or many years ago
- have received blood or blood products or an organ transplant before July 1990 in Canada
- have been in jail or
- have been injected or scratched during vaccination, surgery, blood transfusion or a religious/ceremonial ritual in regions where hepatitis C is common.
You have a high moderate risk of contracting hepatitis C if you:
- have tattoos or body piercing
- have multiple sexual partners
- have a sexually transmitted infection , including HIV or lymphogranuloma venereum
- have experienced traumatic sex or rough sex or have used sex toys or fisting that can tear body tissue
- have vaginal sex during menstruation
- have received a kidney treatment
- have received an accidental injury from a needle or syringe
- have another infectious disease
- were born to a hepatitis C infected mother or
- have a sexual partner infected with hepatitis C.
Hepatitis C is NOT passed from person to person by:
- coughing, sneezing
- breastfeeding unless your nipples are cracked and bleeding or
- oral sex, unless blood is present.
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Choosing The Right Treatment
Treatments for hepatitis C continuously evolve in response to new research and improvements in medical technology. Today, people have access to numerous medicines that can cure the infection quickly and safely.
The number of available treatments can seem overwhelming to people. However, with the help of a doctor, a person can narrow down the treatment options best suited to their needs.
A doctor will consider several factors before prescribing treatment. These include:
- the viral load, or amount of virus in the body
- the extent of liver damage, such as scarring, or cirrhosis
- a persons response to any previous hepatitis C treatments
- the presence of other health conditions
- the genotype of the hepatitis C virus
Hepatitis C has six distinct genotypes. A genotype refers to the combination of genes in an organism, including viruses. Identifying the genotype of the hepatitis C virus is a crucial first step in the treatment process.