What Are The New Hepatitis C Treatments And When Will They Be Available
Recent advances in antiviral treatment have led to the development of new highly effective drugs for the treatment of all types of hepatitis C.
The new hepatitis C treatments are sofosbuvir with ledipasvir sofosbuvir daclatasvir and ribavirin .
These new treatments will be available on the Pharmaceuticals Benefits Scheme from 1 March 2016.
Risk Of Hcv Infection
Hepatitis is an inflammation of the liver that can lead to decreased liver function. Hepatitis can be caused by toxins, including alcohol and certain medications, or it can be caused by a virus. HCV is the virus that causes hepatitis C, or hep C. It is one of the most common hepatitis viruses.
HCV is transmitted through blood-to-blood contact. Before we had a screening test for hep C in 1992, most people got infected through blood transfusions. This explains why baby boomers, those born between 1945 and 1965, are five times more likely to have the virus.
Today, most people with the virus get infected by sharing needles or other equipment for injecting drugs. Recent research has shown that the growing opioid epidemic is driving up rates of hep C infection, especially among young people. In addition, the prison population is at high risk for infection because of the high number of injection drug users who enter correctional facilities who are already living with hep C. Inside prisons, hep C is transmitted through injection drug use and unsafe practices for tattoos and piercings. It is estimated that one in three people in U.S. jails and prisons have HCV.
Hep C can be transmitted through sexual activity however, this is rare and most likely to happen if a person is already living with HIV or another sexually transmitted infection. The Centers for Disease Control and Prevention estimates that 25% of people living with HIV also have HCV.
Protease Inhibitor Antiviral Medications
Protease inhibitors work by preventing the spread of infection within the body by stopping viruses from multiplying.
Grazoprevir is a protease inhibitor for hepatitis C genotypes 1 and 4. Its only available in combination with elbasvir and sold as grazoprevir/elbasvir.
The drug combination is sold under the brand name Zepatier.
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How Does Harvoni Work
Harvoni directly blocks the ability of the hepatitis C virus to make copies of itself in the liver. Sofosbuvir interferes with the reproduction of the genetic material of the hepatitis C virus and ledipasvir works by interfering with a protein needed by the virus. Together, they greatly reduce and then stop the production of new copies of the hepatitis C virus. Over time, these actions eliminate the hepatitis C virus from the body.
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.
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Why Cure Hep C
Curing your hep C clears the virus from your body. It reduces liver inflammation and can help reverse fibrosis and even cirrhosis.
Live free from the worry of hep C knowing that you no longer have hep C can help you feel better about yourself. For example, you may no longer feel worried about passing hep C to other people. There has been no better time to think about hep C treatment.
Find out more about the benefits of clearing hep C call the Hepatitis Infoline.
Grace talks about her experience of being cured of hepatitis C with new, highly effective treatments. Theres never been a better time to be cured of hep C.
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.
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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.
Nonstructural 5b Polymerase Inhibitors
The RdRp is vital to HCV replication, acting to catalyze RNA synthesis and genome replication. Nucleoside inhibitors arrest RNA synthesis, while nonnucleoside inhibitors bind and disrupt the RdRp function.
The nucleoside inhibitors are analogues that are incorporated into the viral RNA genome by the RdRp, causing termination of further replication, and competitively bind the active polymerase site. Single mutations can lead to resistance however, there is some evidence that mutations also seem to decrease viral fitness. This class of NS5B polymerase inhibitors has a high barrier to resistance and works broadly against genotypes with intermediate potency. Sofosbuvir was the first available NS5B nucleoside inhibitor .
Nonnucleoside inhibitors inhibit the RdRp by binding an allosteric site in a noncompetitive fashion, which changes the biochemical activity of the polymerase. They have a low barrier of resistance. Beclabuvir, an indole derivative, binds the thumb I subdomain on the RdRp with potent activity but has reduced activity against HCV genotypes 2 and 6 infections. Dasabuvir, a benzothiadiazine derivative, binds the palm I site on the RdRp, causing changes to the active site and preventing transcription., Deleobuvir and radalbuvir are additional nonnucleoside inhibitors .
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What Drugs Cure Hepatitis C Infection
Most hepatitis C is currently treated with all-oral medical regimens of “direct-acting antivirals” or DAAs. DAAs is a term used to distinguish these hepatitis C drugs from an older generation of injected medicines that act indirectly on the immune response to the hepatitis C virus. DAAs act directly on the virus to block different steps in its life cycle. There are several DAAs that are used in combinations that have been scientifically proven to cure hepatitis C. They are not interchangeable, and some are only available combined in one pill or dose pack as a specific combination. DAAs are not used as single-drug therapy because of the high risk of the virus developing resistance and because they work best in combinations. The choice of which regimen to use depends upon the genotype of the virus, the level of liver fibrosis , and any drug resistance that may be present .
Examples of combination DAAs with cure rates between 91%-100% include:
Genotype 1a and 1b are the commonest genotypes in the United States. Of all the genotypes, genotype 3 has been the most difficult to treat with DAAs alone and required the use of ribavirin, which has significant side effects. All genotypes can now be treated with oral DAAs without ribavirin. Some genotypes may still require the use of injected pegylated interferon and/or ribavirin if there is no response to DAAs.
How Much Will It Cost Patients To Access The New Drugs
The Pharmaceutical Benefits Scheme listing means that hepatitis C patients will only pay the normal co-payment for the new drugs. The co-payment is currently worth $6.20 for patients with concessional healthcare cards and $38.30 for general patients without concessional healthcare cards, per drug, per month. For some patients needing three drugs, for example, the co-payment will therefore be $114.90 per month, or $18.60 per month concession.
More information on co-payment charges can be found on the Commonwealth Department of Healths website
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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 Does Treatment With The New Drugs Involve
The drugs are easy to take and are taken orally.
Treatment time is usually 12 weeks. However this may range between 8 and 24 weeks for a complete course of treatment, depending on the patients genotype, whether the patient has cirrhosis, treatment history and which of the drug combinations the prescriber chooses to use.
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Where Can I Go If I Have Further Questions Or Need More Information
- Your local GP and pharmacist can provide you with more information on the new treatments, including if they are right for you. To find a GP, please click here
- The Victorian Government funds a range of community organisations to provide information, care and support to people living with hepatitis C, and on the new treatments. For more information, please visit:
- Hepatitis Victoria’s website or their Hepatitis Infoline on 1800 703 003or refer to the Hepatitis Victoria, PBS factsheets
What Is The Dosage For Daas
- 800 mg is taken three times a day, and simeprevir 150 mg is taken once daily with food, combined with ribavirin.
- Technivie is given with ribavirin for 12 weeks for genotype 4 chronic hepatitis C virus infection without cirrhosis.
- Each tablet contains 12.5 mg ombitasvir, 75 mg paritaprevir and 50 mg ritonavir.
- Two tablets are taken every morning, with ribavirin dosed by weight: 1000 mg per day for patients weighing less than 75 kg, and 1200 mg per day for those 75 kg and over this is divided into a twice-daily dose with food.
- Viekira is used for genotype 1a or 1b chronic hepatitis C, including people with or without cirrhosis and no liver failure symptoms.
- Viekira Pak is ombitasvir 12.5 mg, paritaprevir 75mg, ritonavir 50 mg in each tablet, packaged with dasabuvir 250mg tablets.
- It is dosed as two ombitasvir, paritaprevir, ritonavir tablets once daily and one dasabuvir tablet twice daily , along with a meal.
- It is given with or without ribavirin .
- Genotype 1a is most resistant to treatment, so Viekira is given with ribavirin for 12 weeks if there is no cirrhosis, or 24 weeks if there is cirrhosis.
- Genotype 1b is usually treated with Viekira alone for 12 weeks if no cirrhosis with cirrhosis it must be given with ribavirin for 12 weeks.
- Viekira may also be used in liver transplant recipients.
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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.
How Do You Treat Hepatitis C
People with acute infection do not always need treatment, because their immune system may clear hepatitis C on its own. If you test positive during the acute stage, your doctor may ask you to come back after a few months to re-test and to see if you need any treatment.
If people develop chronic infection, they will need treatment to help clear the virus. Where available, treatment with drugs called direct-acting antivirals can cure hepatitis in most cases. These are usually taken for 8-12 weeks. Your doctor will also check your liver for any damage.
If youve had hepatitis C in the past, youre not immune to future infections which means you can get it again. You can also still get other types of hepatitis, and having hepatitis C together with another type is more serious.
If youve already had hepatitis C, its advisable to have the vaccination against hepatitis A and B to protect your liver from further damage.
Whether you have symptoms or not, dont have sex until your healthcare professional says you can.
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How Will My Provider Monitor Me During The Treatment
Your provider will meet with you during treatment to review how well you are tolerating treatment and review laboratory results. Laboratory tests help keep tabs on your health, track the viral load, and determine your response to treatment. You will be given specific dates to go get your blood tested at the lab during and after the treatment.
Antiviral Medication For Hepatitis C
For people with hepatitis C, the goal of treatment with antiviral medication is to prevent the virus from replicating, or copying itself, and to eliminate the virus from the bloodstream. If the hepatitis C virus has been in the body for more than six months, the infection is considered chronic. Without treatment, most people with acute hepatitis C develop the chronic form of the disease.
Your doctor decides which antiviral medicationor combination of medicationsto prescribe based on the results of a blood test called a genotype test. There are six genotypes, or strains, of the hepatitis C virus, and people with certain genotypes respond more quickly to medical treatment.
For many years, the standard treatment for chronic hepatitis C consisted of the antiviral medications pegylated interferon and ribavirin. Ribavirin is taken by mouth every day, and interferon is an injection that you or a caregiver can administer once a week at home.
In 2013 and 2014, the U.S. Food and Drug Administration approved a group of new medications for the treatment of hepatitis C. These medications, which include sofosbuvir, are very effective and have fewer side effects than older medications, particularly interferon.
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What Are The Symptoms Of Hepatitis C
Symptoms of Acute Hepatitis C Infection
The majority of newly-infected patients identified with HCV do not have symptoms. The minority of patients who have symptoms typically have complaints of
How do protease inhibitors work?
Protease Inhibitors are termed direct-acting antiviral agents . They directly act on the virus by inhibiting certain enzymes and proteins necessary for replication of the HCV virus.
How do nucleotide polymerase inhibitors work?
Nucleotide analog polymerase inhibitors are another type of direct-acting antiviral agents . They block the action of proteins that HCV uses for making new viruses.
How do NS5A inhibitors work?
These are direct-acting antivirals that block the action the HCV NS5A protein and interfere with making new viruses.
Who should not use these medications?
The contraindications, warnings, and precautions for ribavirin apply when ribavirin is combined with these agents.
- Zepatier, Viekira Pak, and Technivie should not be used by people with moderate to severe liver disease.
- Harvoni is indicated for people with moderate to severe cirrhosis, including those who have received liver transplants.
Combination Drug Therapy For Patients With Hepatitis C
|The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.|
|First Posted : November 4, 1999Last Update Posted : March 4, 2008|
- Study Details
During the first 6 months of the study, subjects will be asked to return to the outpatient clinic for routine check-ups and blood tests every 2 to 4 weeks. Blood tests will include tests for hepatitis C virus. If the virus test becomes negative on treatment, the therapy will be considered successful and will be continued for a full 6 or 12 months .
If the virus test does not become negative during the first six months of treatment, subjects will be considered “non-responders” and will stop taking interferon but will continue on ribavirin alone or an identically appearing placebo tablet. These non-responsive subjects will continue this therapy for an additional 12 months. .
Upon completion of the drug therapies, subjects will be requested to submit blood samples and undergo a liver biopsy to determine if the therapy was successful. Test results that reveal a loss of hepatitis C antibodies or normal levels of liver enzymes will be deemed successful.
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