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.
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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.
E Treatment Of Hepatitis C
The primary goal of HCV therapy is to achieve a SVR, defined as an undetectable HCV RNA 6 months after stopping antiviral therapy. Secondary goals of antiviral therapy include improvements in histology, quality of life and prevention of hepatocellular carcinoma. Antiviral therapy is approved by the Food and Drug Administration for patients with persistently abnormal liver enzymes, detectable HCV RNA and an abnormal liver biopsy. Recent data have shown that patients with normal liver enzymes, detectable HCV RNA and an abnormal liver biopsy respond to therapy at similar rates as those with abnormal liver enzymes.55
The efficacy of HCV treatment has improved over the past decade. Initial treatment consisting of interferon alpha has been replaced by pegylated interferon and now by combination therapy using pegylated interferon and ribavirin. Efficacy varies depending on multiple factors especially viral genotype, but achieving sustained viral suppression in 50% of patients can be expected .
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Helpful Tips While Taking Hepatitis C Medications
- Always follow your health care providers’ advice, particularly the instructions on taking your medicine.
- If you have to cancel an appointment, call your provider and schedule a new one as soon as possible.
- Take good care of yourself. Eat well, drink 8 to 10 glasses of water each day, and try to get a full night’s sleep.
- Learn about the hepatitis C medications you are taking. This includes special risks and warnings.
- If taking ribavirin, use sunscreen, wear long sleeves and a hat, and limit sun exposure.
- Write down your doctor’s name and phone number. Carry this information with you at all times.
- Write the names and amounts of the medicines you are taking. Carry this information with you at all times.
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
- Currently inject drugs
- Have ever injected drugs, even if it was just once or many years ago
- Have abnormal liver tests or liver disease
- Are on hemodialysis
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Hiv And Hepatitis C Coinfection
HCV infection is common among people with HIV who also inject drugs. Nearly 75% of people living with HIV who report a history of injection drug use are co-infected with HCV. All people who are diagnosed with HIV are recommended to be tested for HCV at least once. People living with HIV are at greater risk for complications and death from HCV infection. Fortunately, direct acting antivirals that are used to treat HCV work equally well in people with and without HIV infection. For more information about HIV and HCV coinfection, visit the HIV.govs pages about hepatitis C and HIV coinfection.
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.
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How Common Is Hepatitis C In The United States
In the United States, hepatitis C is the most common chronic viral infection found in blood and spread through contact with blood.14
Researchers estimate that about 2.7 million to 3.9 million people in the United States have chronic hepatitis C.13 Many people who have hepatitis C dont have symptoms and dont know they have this infection.
Since 2006, the number of new hepatitis C infections has been rising, especially among people younger than age 30 who inject heroin or misuse prescription opioids and inject them.15,16
New screening efforts and more effective hepatitis C treatments are helping doctors identify and cure more people with the disease. With more screening and treatment, hepatitis C may become less common in the future. Researchers estimate that hepatitis C could be a rare disease in the United States by 2036.17
Interpretation Of Laboratory Test Results
The two tests used primarily for hepatitis C screening and diagnosis are an antibody test and an RNA test , respectively . A description of hepatitis C laboratory markers can be found in Appendix B. Figure 4-1 describes the typical serologic course of HCV infection .
Figure 4-1. Typical serologic course of hepatitis C virus infection
In 2013, CDC provided updated guidance on the recommended testing sequence for identifying current hepatitis C . Hepatitis C testing should be initiated with an anti-HCV screening test, and if positive, an HCV RNA test should be performed. In settings serving high-risk populations , rapid anti-HCV testing can be used in lieu of laboratory-based anti-HCV testing to deliver results to the patient at the time of visit. For people who tested anti-HCV positive through rapid screening, an on-the-spot blood draw to be sent for HCV RNA testing should be performed or a referral and/or evaluation for HCV RNA testing should be provided. For blood draws collected for anti-HCV testing, all positive specimens should reflex to HCV RNA testing to reduce the number of patients lost to follow-up.
Table 4-1. Interpretation of hepatitis C laboratory results
| Test Outcome* |
|---|
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Can Hepatitis C Be Prevented
There is no vaccine for hepatitis C. But you can help protect yourself from hepatitis C infection by:
- Not sharing drug needles or other drug materials
- Wearing gloves if you have to touch another person’s blood or open sores
- Making sure your tattoo artist or body piercer uses sterile tools and unopened ink
- Not sharing personal items such toothbrushes, razors, or nail clippers
- Using a latex condom during sex. If your or your partner is allergic to latex, you can use polyurethane condoms.
NIH: National Institute of Diabetes and Digestive and Kidney Diseases
What Questions Should I Ask
Writing down a list of questions will help you make the best use of your time during your appointment. List your questions from most important to least important, in case time runs short. Some basic questions to ask your doctor include:
In addition to the questions youve prepared, dont hesitate to ask other questions during your appointment when you dont understand something.
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Is Hep C Curable
The latest drugs available for hepatitis C have high success rates when it comes to curing the condition.
In conversations with your doctor, you can discuss the full range of treatment options. Some of these are combination drugs.
But its important to note that not every medication may be effective for you, even if its for the right genotype.
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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Ribavirin Can Cause Birth Defects
Ribavirin may cause birth defects if its taken before or during pregnancy. If you or your partner are taking ribavirin, its important to avoid pregnancy while taking the drug. In addition, pregnant people should not have sexual intercourse with a person assigned male at birth who is taking ribavirin.
If you are planning to try to become pregnant, it is important to wait until after you have stopped taking ribavirin. People assigned female at birth must wait 9 months after stopping ribavirin before starting a pregnancy. People assigned male at birth must wait 6 months after stopping the drug before they attempt pregnancy with their partner.
Cost Of Hepatitis C Medicines
The newer direct-acting antiviral medicines for hepatitis C can be costly. Most government and private health insurance prescription drug plans provide some coverage for these medicines. Talk with your doctor about your health insurance coverage for hepatitis C medicines.
Drug companies, nonprofit organizations, and some states offer programs that can help pay for hepatitis C medicines. If you need help paying for medicines, talk with your doctor. Learn more about financial help for hepatitis C medicines.
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Alterations Of Lipid Metabolism
Lipids are required for the HCV replication and particles assembly. As mentioned above, HCV can modify the host serum lipid profile and this modification can provoke the steatosis. The steatosis is more frequent and more severe in patients with HCV gt 3 and it is correlated with a high HCV RNA levels. On one hand, in HCV-infected patients, the steatosis can be considered as a marker of the liver disease progression and, on the other hand, as an indication of the reduced response to therapy. However, if it is not metabolic or alcoholic steatosis, an efficient antiviral therapy is capable to reduce it.
What Are The Names Of The Medications For Treating Hepatitis C
Since 2014, multiple different antiviral treatments for hepatitis C have been developed. With the many options now available, often there is more than one good choice for a patient. Some of the treatments are recommended as first-line options, some are second-line options, and others are used less commonly in light of all the available choices.
- Elbasvir/Grazoprevir
Second line hepatitis C medications:
- Sofosbuvir/Velpatasvir/Voxelaprevir
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Interpretations Of Diagnostic Results
The presence of HCV RNA in the absence of anti-HCV antibodies is strongly indicative of acute hepatitis C , which can be confirmed by seroconversion a few days or weeks later .4). However, there are still other possibilities for the presence of HCV RNA in the absence of anti-HCV antibodies, e.g., CHC infection in the immunodepressed patients, hemodialysis patients or agammaglobulinemic subjects.
Possible diagnostic results for hepatitis C virus infection. Individuals are in high risk, e.g., persons who have been exposed to HCV persons with elevated alanine aminotransferase persons who are immunocompromised. HCV: Hepatitis C virus.
The presence of both anti-HCV and HCV RNA does not allow one to distinguish AHC from an acute exacerbation of CHC. However, the anti-HCV IgG avidity index within the first 8 d following the onset of clinical symptoms may be useful in identifying actual AHC.
If the antibody test is positive and the HCV RNA test is negative, this result indicates a resolution of HCV infection or AHC during a period of low-level viremia. If the HCV RNA assay is negative and remains negative for more than 6 mo, then the individuals are recovered from a past HCV infection.
CHC is defined as the persistence of HCV RNA for more than 6 mo. In patients with clinical signs of chronic liver disease, CHC is certain when both anti-HCV antibodies and HCV RNA are present.
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.
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How Can I Best Prepare For Treatment
There are a number of things you can do to improve your health and increase your chances of being able to take your medications as prescribed:
- Avoid alcohol and drugs. If you cannot quit, seek help.
- Talk to your doctor about getting the Hepatitis A and Hepatitis B vaccines.
- Aim for 7-9 hours of sleep every night and rest when tired.
- Maintain a healthy weight.
- Eat healthy meals: Strive for a diet low in fat and high in fiber. Include fruit, vegetables, and whole grains. Avoid trans fatty acids and saturated fats.
- Avoid dietary supplements that may harm the liver, such as iron or vitamin A, kava, and valerian. Take only the medications recommended by your doctor.
- Drink 6-8 glasses of water per day.
- Exercise: Be as physically active as possible on a regular basis, balancing rest and activity.
- Avoid or reduce stress. Some people find meditation, prayer, or simply a quiet walk to be helpful.
- Engage in activities that give you pleasure and make you laugh.
- Discuss your feelings with family and close friends.
- Join a Hepatitis C support group.
In addition, its important to become an effective healthcare consumer and advocate for yourself. You can do this by:
- Learning all you can about your disease and its treatment. Seek information from Hepatitis C related organizations.
- Getting all your medical and insurance information organized in one place. This should include:
- Recent test results
- Emergency contact numbers
When To Seek Medical Advice
See your GP if you persistently have any of the later symptoms above, or if they keep returning. They may recommend having a blood test that can check for hepatitis C. Read more about diagnosing hepatitis C.
None of the symptoms above mean you definitely have hepatitis C, but it’s important to get them checked out.
You should also speak to your GP about getting tested if there’s a risk you’re infected, even if you don’t have any symptoms. This particularly includes people who inject drugs or have done so in the past.
Read about the causes of hepatitis C for more information about who’s at risk of having the infection.
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Is There A Way To Prevent Hepatitis C
Although currently theres no vaccine to protect people from contracting hepatitis C, there are vaccines for other hepatitis viruses, including hepatitis A and hepatitis B.
If you receive a hepatitis C diagnosis, your healthcare provider may advise you to get vaccinated against hepatitis A and B.
The vaccinations are recommended because these hepatitis viruses can lead to additional health and liver complications, especially in those with preexisting liver disease.
Since you cant prevent hepatitis C through a vaccine, the best prevention is to avoid exposure. Hepatitis C is a bloodborne pathogen, so you can limit your chances of exposure through these healthy lifestyle practices:
- Avoid sharing needles, razor blades, or nail clippers.
- Use proper safety precautions if youll be exposed to bodily fluids, such as when performing first aid.
- Hepatitis C isnt usually transmitted through sexual contact, but its possible. Limit your exposure by practicing sex with a condom or other barrier method. Its also important to openly communicate with sexual partners and to get tested if you suspect youve been exposed to the hepatitis C virus.
Because hepatitis C is transmitted through blood, its possible to contract it through a blood transfusion.
However, since the early 1990s, blood product screening tests have been standard protocol for minimizing the risk of this type of transmission.
Subsequent testing is based on risk. Talk to your doctor about your needs.