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.
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.
Whats The Current Status Of A Hepatitis C Vaccine
Currently, theres not a vaccine available that can prevent hepatitis C. Developing a hepatitis C vaccine has been tough because the virus changes frequently, which makes it harder for our immune system to respond to it. In fact, weve currently identified seven main genotypes, or virus strains, and 67 estimated subtypes.
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Hepatitis C Virus Strains
There are different strains of the hepatitis C virus. These are called genotypes. In New Zealand, it is estimated that of those infected with hepatitis C virus:
- 55% have genotype 1
- 35% have genotype 3
- 8% have genotype 2
- 1% have genotype 4 or 6.
It used to be important to know the genotype as it used to determine which treatment option was best. We now have a funded treatment called Maviret that treats all genotypes .
Sustained Investment Is Needed To Eliminate Hepatitis C By 2030
A new national report released today highlights a decline in hepatitis C testing and treatment uptake, putting Australia at risk of not achieving its target of eliminating hepatitis C as a public health threat by 2030.
The report “Australia’s progress towards hepatitis C eliminationAnnual Report 2021′ notes an ongoing decline in testing in 2020 for both hepatitis C antibody and RNA testing used to detect infections.
The same trend has been observed for the uptake of direct-acting antiviral treatment for hepatitis C, with 2020 the first year since the DAA program commenced where less than 10,000 people were treated. Critically, COVID-19 is also likely to be impacting on both testing and treatment uptake.
Since DAA treatment was introduced in 2016, close to 50 percent of people with chronic hepatitis C infection at that time have been treated. However nearly 120,000 Australians living with hepatitis C still need treatment. There is an urgent need to engage with this group who have not accessed treatments and some of whom may not know they have the infection.
Burnet Deputy Director and one of the report’s co-authors Professor Margaret Hellard AM said: “Australia has an opportunity to eliminate a deadly virus. The focus now is on getting 120,000 people who live with hepatitis C on treatments which are highly effective, well-tolerated and easily accessible.”
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The Bodys Immune Response To Hepatitis C Virus
This immune response is not fully understood. What we do know is that at first the immune system detects the virus in the liver cell as foreign matter and responds by producing many proteins, including interferons. These proteins are able to slow down virus production in the cell but not stop it.23 Some of the proteins attract immune cells, called natural killer cells, which are able to identify and kill the virus-infected cells.
After approximately six to eight weeks, the immune system is able to better figure out how to identify the hepatitis C virus and launches a more targeted response.24 Some of the bodys immune cells start to make hepatitis C antibodies, which identify and bind to the hepatitis C virus. These antibodies are like a flag that help other immune cells find and destroy the hepatitis C virus before they can infect other cells.25 More immune cells, called CD4 cells, are also critical in the immune system fight because they support the B cells and CD8 cells to maintain their responses.25
What Might Not Help
This herb is widely used for liver disorders, including hepatitis B. Its active ingredient, silymarin, is thought to lower inflammation and spur new liver cells to grow. But the evidence is mixed on whether milk thistle works. Side effects can include nausea, bloating, and diarrhea.
This treatment has long been used for ongoing pain. You may find it helpful for your hep C-related pain and fatigue. But several studies found that acupuncture needles can get contaminated with the hepatitis virus and pass it to other people. Make sure your acupuncturist uses disposable needles. And check that theyâre state licensed and certified by the National Certification Commission for Acupuncture and Oriental Medicine.
This compound comes from the plant or its relative, hemp. CBD is legal in some states for both recreational and medical uses, and most other states allow it with a prescription. But despite its popularity for all sorts of ailments, not much research has been done to show that CBD helps with hep C or if itâs safe.
This product has tiny particles of silver that some people claim can help heal wounds and infections. But itâs not safe if you have hep C and may actually harm you. It can cause argyria, which is a permanent discoloration of the skin. The FDA warned consumers against taking it back in 1999.
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Awareness Prevention And Early Diagnosis Are Essential
There’s a good reason why hepatitis C is known as a “silent killer.”
According to the U.S. Centers for Disease Control and Prevention, an estimated 3.2 million Americans live with chronic hepatitis C infection, which is transmitted through infected bodily fluids like blood and semen, and causes inflammation of the liver. Yet up to 75% of people who have hepatitis C aren’t aware they have it.
Most of those living with the virus experience only mild symptoms or don’t have any symptoms at all until they develop serious liver damage or another life-threatening liver disease. Unfortunately, that means they aren’t getting diagnosed and treatment is delayed until the later stages when irreversible liver damage has occurred.
Here, hepatologistNancy Reau, MD, associate director of the Solid Organ Transplant Program at Rush University Medical Center, explains who is at risk for hepatitis C and offers advice to help you protect yourself.
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
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Key Messages For Service Providers
Encourage people to practise safer drug use, safer sex and other prevention strategies
Service providers can support people who inject, snort or inhale drugs to prevent them from getting hepatitis C by encouraging them to use new equipment every time they use drugs.
Service providers can support gay and bisexual men who are vulnerable to the sexual transmission of hepatitis C by encouraging them to:
- use a new condom for each partner
- use a new glove each time for fisting
- use a new condom on sex toys for each partner
- use individual lube containers
What Fluids Are Implicated In Hepatitis C Transmission
For someone to get hepatitis C there must be an exposure to the hepatitis C virus. This exposure occurs when body fluids from someone with hepatitis C that contain enough virus for transmission to occur, get into the blood of another person. The primary body fluid that is responsible for hepatitis C transmission is blood. This occurs by direct blood-to-blood contact. Hepatitis C virus has also been found in the semen and rectal fluid of some men with hepatitis C and HIV.
Hepatitis C virus has been isolated in semen and rectal fluid,1 menstrual fluid,2,3 vaginal fluid,4 saliva5 and breastmilk,6 which means there is a theoretical risk for hepatitis C transmission. However, the risk of transmission through these fluids is very low to non-existent.5,6,7,8,9
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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.
Deaths From Hepatitis B And C Infections Rising Worldwide
Learning from the hepatitis C experience and with better understanding of the biology of hepatitis B virus and improved animal models, pharmaceutical companies are developing drugs that target different steps of the hepatitis B virus life cycle. While a cure for hepatitis B will be more challenging because it can integrate into the patients DNA, enabling it to evade the patients immune response, I am optimistic that we will witness the availability of new combinations of drugs that will move us nearer the goal of a hepatitis B cure.
Members of Delhi Network of Positive People, a support group for HIV-positive people, in 2014 urged the Indian government to allow production of generic versions of direct-acting antivirals that could help thousands get affordable oral doses of medicine to control hepatitis C. Infection progresses more rapidly to damage the liver in HIV-positive patients.Saurabh Das/AP Photo
But the news is not all positive. While weve seen mortality rates from HIV, tuberculosis and malaria decline in recent years, deaths from hepatitis B and C have risen. Globally, an estimated 257 million people have chronic hepatitis B virus infection, and 71 million have chronic hepatitis C virus. Together hepatitis B and C caused more than 1.34 million deaths in 2015. This led the World Health Organization to challenge countries around the world to develop national plans to eliminate these two viruses by 2030.
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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.
Tests To Diagnose Hepatitis C
How is Hepatitis C diagnosed?
There are two main blood tests typically used to diagnose Hepatitis C. First, youll have a screening test that shows if youve ever had Hepatitis C at some point in your life. If this test is positive, youll have a second test to see if you have Hepatitis C now. These blood tests are described below:
Hepatitis C antibody test
This is the screening test used by doctors to show whether or not you have ever been exposed to Hepatitis C at some time in your life, by detecting antibodies in your blood. Antibodies are substances your body makes to fight off all kinds of infections. If you were ever infected with Hepatitis C, your body would have made antibodies to fight the virus.
If the test result is:
- Negative, it means you have not been exposed to Hepatitis C and further testing is usually not needed.
- Positive, you have had Hepatitis C at some point. However, it does not tell you whether you have it now. Youll need to see your doctor for another test the Hepatitis C RNA test to determine if the virus is still active and present in your blood.
Hepatitis C RNA Qualitative Test
This test will determine whether or not you are currently infected with Hepatitis C. It is often called the PCR test because of the process used . It looks for the genetic material of the Hepatitis C virus in your blood.
If the test result is:
Hepatitis C RNA Quantitative Test
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Is There A Cure For Hepatitis C
Hepatitis C treatment with direct-acting antiviral medications cures most people with the virus. Treatments are simple to take, have few side effects and are usually taken for 12 weeks or less. If a person is cured through treatment it means the virus is no longer in their body. The earlier that someone is treated, the less likely they are to develop advanced liver damage.
When a person is cured, the liver damage usually stops progressing and the liver will begin to heal in some people.34 This is less likely to happen for people who have advanced cirrhosis.35 For a small proportion of people who are cured of hepatitis C, the liver continues to become injured and progresses to cirrhosis. This is usually linked to other factors such as alcohol use or fatty liver disease.34 Being cured of hepatitis C decreases the likelihood of a person getting liver cancer, liver failure or dying from liver problems.36 People with advanced liver disease will need to be followed up with regular ultrasound scans after cure because there is still a risk of liver cancer developing. There are also many non-liver related health benefits from being cured of hepatitis C, including a reduced risk of diabetes mellitus, mixed cryoglobulinaemia , glomerulonephritis , porphyria cutanea tarda , and possibly non-Hodgkin lymphoma .37
Being cured of hepatitis C does not give a person immunity. A person can become infected again if they are exposed to the hepatitis C virus.
Can You Drink Alcohol If You Have Hepatitis C
Hepatitis is inflammation of the liver. Hepatitis C viral infection causes this inflammation. There are several risk factors for contracting HCV infection due to the hepatitis C virus. One serious risk factor is drinking alcohol with HCV infection. The combination of HCV and alcohol can cause complications, and may result in more severe and serious liver injury including chronic cirrhosis . It also increases your chances of developing liver cancer having an alcohol induced increase in viral replication and rapid mutation of the hep C virus,which creates complications like:
- Greater viral capacity
Hepatitis refers to any cause of liver inflammation, with or without scarring of the liver . It is contagious, and is spread from person-to-person by blood-to-blood contact. Other viral causes of hepatitis include hepatitis A, B, C, and E. Other types of noninfectious causes of hepatitis include:
- Excessive alcohol intake
- Medications such as some prescription medications or even acetaminophen, for example, Tylenol liver damage and drug induced liver disease.
- Bacteria and viruses other than the hepatitis viruses
How are hepatitis A, B, and E spread?
- Transmission of hepatitis A and E: These forms of the virus are acquired from improper hygiene during food or drink preparation by someone who’s infected.
- Transmission of hepatitis B: This form is spread by blood-to-blood or sexual contact.
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