Medications To Treat Hepatitis C

Contaminated Needles And Infected Blood

You can get hepatitis C from sharing contaminated needles, syringes and other injecting equipment during recreational drug use. Banknotes and straws used for snorting may also pass the virus on.

Being exposed to unsterilised tattoo and body piercing equipment can also pass hepatitis C on. Occasionally, you can get it from sharing a towel, razor blades or a toothbrush if there is infected blood on them.

Hepatitis C infection is also passed on in healthcare settings, from needle stick injuries or from medical and dental equipment that has not been properly sterilised. In countries where blood products are not routinely screened, you can also get hepatitis C by receiving a transfusion of unscreened blood and blood products.

You can prevent hepatitis C by:

• never sharing needles and syringes or other items that may be contaminated with infected blood
• only having tattoos, body piercings or acupuncture in a professional setting, where new, sterile needles are used
• following the standard infection control precautions, if youre working in a healthcare setting.

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.

Is There A Vaccine For Hepatitis C

There are no vaccinations that prevent the hepatitis C virus. Vaccinations for hepatitis A and B, however, are given to patients with HCV to prevent the possibility of acquiring another hepatitis virus. Getting hepatitis A or hepatitis B on top of hepatitis C can add liver damage or even cause severe hepatitis. People with hepatitis C should be screened for past infection with hepatitis A and B. If they have no evidence of antibodies, they should receive vaccines for hepatitis A and/or B.

Hepatitis A vaccine may be given alone or in combination with hepatitis B vaccine, depending on whether the patient needs one or both. Hepatitis A vaccine is inactivated hepatitis A virus that stimulates the immune system to develop antibodies against hepatitis A. These antibodies kill the virus before it can cause infection. It is given in 2 doses intramuscularly 6 months apart.

Hepatitis B vaccine is made with hepatitis B antigens that stimulate antibodies against the hepatitis B virus. There is no live virus in the vaccine. It is given in 3 doses intramuscularly the second dose is given 1-2 months after the first, and the last is given 6 months after the first dose. The A and B vaccine is a combination of the above and is dosed in the same way as the Hepatitis B vaccine. It is available under the brand name Twinrix.

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How Can I Prevent Spreading Hepatitis C To Others

If you have hepatitis C, follow the steps above to avoid spreading the infection. Tell your sex partner you have hepatitis C, and talk with your doctor about safe sex practices. In addition, you can protect others from infection by telling your doctor, dentist, and other health care providers that you have hepatitis C. Dont donate blood or blood products, semen, organs, or tissue.

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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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.

Initial Treatment Of Adults With Hcv Infection

Initial treatment of HCV infection includes patients with chronic hepatitis C who have not been previously treated with interferon, peginterferon, ribavirin, or any HCV direct-acting antiviral agent, whether investigational, or US Food and Drug Administration approved.

Simplification of the treatment regimen may expand the number of healthcare professionals who prescribe antiviral therapy and increase the number of persons treated. This would align with the National Academies of Science, Engineering, and Medicine strategy to reduce cases of chronic HCV infection by 90% by 2030 .

• Simplified Pangenotypic HCV Treatment Algorithm for Treatment-Naive Adults With Compensated Cirrhosis

Recommended and alternative regimens are listed in order of level of evidence. When several regimens are at the same recommendation level, they are listed in alphabetical order. Regimen choice should be determined based on patient-specific data, including drug-drug interactions. Patients receiving antiviral therapy require careful pretreatment assessment for comorbidities that may influence treatment response or regimen selection. All patients should have access to an HCV care provider during treatment, although preset clinic visits and/or blood tests depend on the treatment regimen and may not be required for all regimens/patients. Patients receiving ribavirin require additional monitoring for anemia during treatment .

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Who Is More Likely To Get Hepatitis C

People more likely to get hepatitis C are those who

• have injected drugs
• had a blood transfusion or organ transplant before July 1992
• have hemophilia and received clotting factor before 1987
• have been on kidney dialysis
• have been in contact with blood or infected needles at work
• have had tattoos or body piercings
• have worked or lived in a prison
• were born to a mother with hepatitis C
• are infected with HIV
• have had more than one sex partner in the last 6 months or have a history of sexually transmitted disease
• are men who have or had sex with men

In the United States, injecting drugs is the most common way that people get hepatitis C.13

Will The Drugs Be Available By 1 March 2016

Although the drugs will be available for prescribing through the Pharmaceutical Benefits Scheme, it may be that not all GPs or pharmacists are fully aware of the new treatments by that date. This means there may be some delay in some areas in accessing the drugs from your local GP. However, the Victorian Government is working with doctors, services and hospitals to ensure these delays are minimised as much as possible.

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Are There Ways To Cure Hepatitis C Other Than With Medications

Patients sometimes ask whether there are ways to treat hepatitis C other than taking medicines. Currently, there are no vaccines to prevent hepatitis C. Once a person is infected, the only way to treat it is with prescribed antiviral medications.

Some patients worry that having hepatitis C means they will need a liver transplant. Only a very small fraction of people with hepatitis C require a liver transplant. By far, most people with hepatitis C never need a liver transplant. A transplant is performedonlywhen damage to the liver is extremely advanced and the liver is unable to perform its basic functions. A transplant provides a new working liver, but a transplant does not get rid of the hepatitis C virus in the patient. Patients with a liver transplant still need antiviral medication to cure their virus.

Side Effects Of Treatment

Treatments with direct-acting antivirals have very few side effects. Most people find DAA tablets very easy to take.

You may feel a little sick and have trouble sleeping to begin with, but this should soon settle down.

Your nurse or doctor should be able to suggest things to help ease any discomfort.

You need to complete the full course of treatment to ensure you clear the hepatitis C virus from your body.

If you have any problems with your medicines, speak to your doctor or nurse straight away.

Side effects for each type of treatment can vary from person to person.

For a very small number of people, more severe side effects from hepatitis C treatments may include:

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What Are The Signs And Symptoms Of Hepatitis C

As conditions go, hep C is seriously slymost people who have it dont show symptoms. In fact, about half of people with HCV don’t know they’re infected, according to the Mayo Clinic, and some people can live with it for decades before being diagnosed. If there are symptoms, theyre pretty mild. Think fatigue, muscle achescommon ailments you wouldnt automatically associate with hep C.

This is why the CDC recommends a hepatitis C screening: a simple blood test known as an HCV antibody test, for all adults aged 18 years and older at least once in their lifetime. Keep in mind, its not a standard test, so you have to ask for it. If that test is positive, youll likely be given a HCV RNA test to determine if you have an active infection.

Why is it so crucial to be diagnosed, if you don’t have any symptoms? When hep C hangs out in the system untreated for years, it starts affecting the liver and becomes chronic. More than half of people who become infected with HCV will develop chronic infection, according to the CDC. When that happens, symptoms may include:

• Jaundiced skin

• Confusion and slurred speech

• Spider-like blood vessels on your skin

Chronic HCV can lead to serious complications, including cirrhosis , liver cancer, or liver failure. The liver performs a slew of vital functions, including:

When the liver is unable to deliver on even one of its important jobs, the damage wrought by hep C can be seriouswhich is why treatment is so crucial.

Quality Of The Evidence

Due to the lack of studies on the topic that combined antiviral treatment with other interventions or RCTs that evaluate new antivirals that during last year has been demonstrated to be the goldstandard to treat HCV infection, our conclusions must be considered cautiously because of several potential limitations in the available data.

We are aware that the width of the CIs could reflect a lack of statistical power which is directly related to the sample size of the included studies that evaluated the same outcomes that could be metaanalysed.

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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.

Limitations Of Drug Treatments

Though the latest generation of hepatitis C drugs can effectively cure the disease, patients whose hepatitis C infection has progressed to the point of causing advanced cirrhosis or liver failure may require a liver transplant to fully recover.

Its important to let your doctor know what other medications and supplements youre taking so you can avoid harmful interactions. If youre nursing or pregnant, youll also want to let your healthcare provider know, as this can affect your treatment options.

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Important Side Effects And Drug Interactions

Sofosbuvir is generally well tolerated its more common side effects include mild nausea, headache, and insomnia . The combination of sofosbuvir with amiodarone can cause life-threatening bradycardia . The addition of NS5A inhibitors does not lessen tolerability to any clinically relevant extent . Therapeutic elevation of the gastric pH lessens the bioavailability of ledipasvir, and thus the concomitant administration of sofosbuvir/ledipasvir with a proton pump inhibitor in a high dose is not recommended .

The side-effect profile and drug-interaction spectrum of the NS3/4A protease inhibitors are more complex. Simeprevir can evoke both nonspecific side effects and photosensitivity reactions patients should be advised to avoid direct exposure to sunlight and to use a topical sunscreen . All of the approved NS3/4A protease inhibitors can mildly or moderately elevate bilirubin and transaminase levels . A simultaneous, clinically relevant rise of both the bilirubin concentration and the transaminase concentrations is rare but presumably reflects hepatotoxicity and must be followed by discontinuation of the the protease inhibitor. The characteristic side effects of ribavirin are hemolytic anemia, dyspnea, an irritative cough, reduced exercise tolerance, and skin rash . As hemolysis elevates the bilirubin concentration as well, rises in bilirubin levels are more pronounced when ribavirin and NS3/4A protease inhibitors are given simultaneously.

Drug interactions

Question 1

Medical Treatment For Hepatitis A B & C

Treatment for hepatitis A, B, or C is based on which type of hepatitis is present in the bloodstream and the severity of the resulting liver damage. Depending on the results of diagnostic tests, our specialists at NYU Langone may recommend antiviral medication to stop the virus from replicating and protect your liver from further damage.

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What Medications Treat Or Cure Hepatitis C

Hepatitis C treatments once involved months of injected interferons with up to 50% cure rates, and serious side effects. With newer medications, hepatitis C can be treated with oral combinations of medicines for several weeks. These are generally well-tolerated and yield sustained cure of virus from the blood in over 90% of cases.

The goal of treating HCV-infected persons is to reduce the risk of death, end-stage liver disease, and other liver-related adverse events by the achievement of a virologic cure which is determined by the sustained virologic response . Sustained virology response means complete disappearance of the HCV for at least 12 weeks after stopping treatment.

Hepatitis C Symptoms & Treatment

FAST FACTS:

• Hepatitis C is found in infected blood. It is also rarely found in semen and vaginal fluids.

• Hepatitis C is mainly passed on through using contaminated needles and syringes or sharing other items with infected blood on them. It can also be passed on through unprotected sex, especially when blood is present.

• You can prevent hepatitis C by never sharing needles and syringes, practising safer sex, and avoiding unlicensed tattoo parlours and acupuncturists.

• Hepatitis C will often not have any noticeable symptoms, but a simple blood test carried out by a healthcare professional will show whether you have hepatitis C.

• In the early stages, some peoples bodies can clear a hepatitis C infection on their own, others may develop chronic hepatitis C and will need to take antiviral treatment to cure the infection.

• Without treatment, chronic hepatitis C can lead to permanent liver damage.

Hepatitis C is part of a group of hepatitis viruses that attack the liver.

Its mainly passed on through contaminated needles, either from injecting drugs or from needle stick injuries in healthcare settings. It can also be transmitted sexually, especially during anal sex or other types of sex that may involve blood.

Some groups are more at risk of getting hepatitis C than others, including people who use drugs, people in prisons, men who have sex with men, health workers and people living with HIV.

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How Do Doctors Treat The Complications Of Hepatitis C

If hepatitis C leads to cirrhosis, you should see a doctor who specializes in liver diseases. Doctors can treat the health problems related to cirrhosis with medicines, surgery, and other medical procedures. If you have cirrhosis, you have an increased chance of liver cancer. Your doctor may order an ultrasound test to check for liver cancer.

If hepatitis C leads to liver failure or liver cancer, you may need a liver transplant.

Antiviral Treatment In Pregnancy

The risk of vertical transmission in mothers with an HCV monoinfection is 5% and is not diminished by cesarean section . Mothers are not advised against breastfeeding either. Vertically acquired hepatitis C takes a mild course in childhood, with very slow progression of hepatic fibrosis . Antiviral treatment during pregnancy cannot be recommended, as there are insufficient data on the potential teratogenicity of DAAs.

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