Medications Used For Hepatitis C

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

Factors That Affect Treatment Success

A number of factors can help predict how well hepatitis C treatment is likely to work for you.

Before starting treatment, it is important to have a test to see what genotype of hepatitis C you have. This determines which DAAs will work and predicts treatment response. Some DAAs are ‘pangenotypic’ or active against all genotypes.

There are at least six major hepatitis C genotypes. Genotype 1 is the most common type in the UK, Europe and the US. It has two subtypes, 1a and 1b. Genotype 1 was hard to treat with interferon-based therapy, but it can be successfully treated with all approved DAAs. However, genotype 1a is harder to treat than 1b.

effectiveness

How well something works . See also ‘efficacy’.

Hepatitis C genotype 2 is less common worldwide. It responded best to interferon-based treatment, but is susceptible to fewer DAAs than genotype 1. Genotype 3 is the most common type in the Indian sub-continent and south-east Asia, but it is also found in the UK. Genotype 3 has been the hardest to treat with DAAs, but newer pangenotypic drugs are highly effective against it.

Genotype 4 is the most common type of hepatitis C in the Middle East and North Africa, but it has also been seen in hepatitis C outbreaks in the UK and Europe. Genotype 4 generally responds to the same DAAs as genotype 1. Genotype 5 and 6 are less common and less well studied.

Will Community Pharmacies Be Able To Dispense These New Hepatitis C Drugs

Community pharmacists will be able to dispense the drugs. However, because these are new drugs, it may take time for pharmacies to order in sufficient stock to meet demand.

This means that patients may need to wait a couple of days after providing their script for the drugs to be available from their local pharmacy.

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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

Approved Drugs For Adults

There are currently 7 approved drugs in the United States for adults living with chronic hepatitis B infection. These include 5 types of antiviral drugs that are taken as a pill once a day for 1 year or longer. And there are 2 types of immune modulator drugs called interferon that are given as an injection for 6 months to 1 year.

It is important to know that not everyone needs to be treated. A liver specialist should evaluate your health through a physical exam, blood tests, and an imaging study of your liver . Then you can discuss together whether you are a good candidate for treatment since the approved drugs are most effective when there are signs of active liver disease. In addition, talk to your provider about HBV Clinical Trials since there are several new drugs being tested that are available for infected adults.

All adults, however, should be seen regularly by a liver specialist whether they are on treatment or not.

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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.

What Do Hepatitis C Symptoms Look Like

Hepatitis C infection can go through two stages: acute and chronic. In the early, or acute stage, most people don’t have symptoms. If they do develop symptoms, these can include:

• flu-like symptoms, tiredness, high temperature and aches and pains
• loss of appetite
• tummy pain
• jaundice, meaning your skin and the whites of your eyes turn yellow

While for some people, the infection will clear without treatment, in most cases, acute infection will develop into long-term chronic infection. Chronic infection may not become apparent for a number of years until the liver displays signs of damage. These symptoms can include:

• mental confusion and depression these are specific to hepatitis C
• constantly feeling tired
• nausea, vomiting or tummy pain
• dark urine
• feeling bloated
• joint and muscle pain

Without treatment, chronic hepatitis C can cause scarring of the liver , which can cause the liver to stop working properly. A small number of people with cirrhosis develop liver cancer and these complications can lead to death. Other than a liver transplant, theres no cure for cirrhosis. However, treatments can help relieve some of the symptoms.

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What Happens If Hep C Meds Dont Work

In rare cases , the body wont respond to either medication. If this happens, your doctor may prescribe a more potent combination of antivirals such as those found in Vosevi.

This medication blends three anti-viral meds: sofosbuvir, velpatasvir, and voxilaprevir. Because its more powerful, it may have a higher burden of side effects like headache, fatigue, diarrhea, and nausea.

Dosage entails one pill taken once a day with food for 12 weeks. Your doctor may also keep you on the meds longer to clear the infection.

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.

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How Hepatitis C Used To Be Treated

Along with abstinence from alcohol , the standard treatment for chronic hepatitis C used to be a combination antiviral therapy consisting of a pegylated interferon and ribavirin, sometimes called PEG/riba therapy.

A pegylated interferon is a long-acting form of an interferon, a synthetic copy of an infection-fighting protein secreted by immune system cells in response to pathogens. Ribavirin is a drug that interferes with HCV’s ability to replicate. In some cases, pegylated interferon was used without ribavirin, but ribavirin alone isn’t effective against hepatitis C.

To treat hepatitis C, doctors prescribed weekly injections of the pegylated interferons along with twice-daily oral doses of ribavirin. PEG/riba therapy was not a cure-all.

Interferon is not an option for people with liver failure, autoimmune diseases, and psychiatric illness. It can also cause a range of life-threatening complications that prevent many people from completing their therapy.

Newer drug regimens that can cure hepatitis C have forced a change in the standard treatment for the disease, and in the United States, these medications have largely replaced interferon. But pegylated interferon and ribavirin together or separately may still be used in combination with newer antiviral drugs.

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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Symptoms May Not Develop For Many Years

An acute hepatitis C infection occurs within the first 6 months after exposure to the virus. Symptoms, which can sometimes appear weeks or months after infection, may include nausea, vomiting, loss of appetite, diarrhea, fever, headache, and abdominal pain.

Up to 25% of people with an acute infection clear the virus from their blood without treatment. In most people, however, the virus remains in the bloodstream, and the infection becomes chronic. A chronic hepatitis C infection causes liver damage and inflammation. Healthy liver tissue dies and is replaced by scar tissue. If left untreated, hepatitis C infection can lead to permanent liver failure, making liver transplantation necessary.

What Are The Side Effects Of Daas

The most common side effects of DAAs include:

Less frequent side effects may include:

• Dysgeusia

• Reduced number of white blood cells
• Shortness of breath
• Increased bilirubin

The addition of protease inhibitors to PegIFN/RBV is associated with an additional decrease in red blood cells and white blood cells compared with PegIFN/RBV alone.

Daklinza commonly causes

• diarrhea, and
• elevated liver enzymes.

Certain heart rhythm medications, especially amiodarone , can cause slow heartbeat or heart block and should be avoided with daclatasvir.

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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.

Sustained Viral Response: A Patient

The molecular demonstration of the absence of HCV-RNA twelve weeks after the end of a course of antiviral treatment confirms the sustained eradication of the virus. The likelihood of a late recurrence is well under 1% , and most such events are actually not recurrences but reinfections . The eradication of HCV does not generate protective immunity .

A meta-analysis of 129 studies involving a total of 34 563 patients who had undergone interferon-based treatment revealed that a sustained virological response was associated with a 62% to 84% reduction of mortality, a 68% to 79% reduction of the risk of hepatocellular carcinoma , and a 90% reduction of the risk of needing liver transplantation . As interferon-based treatment was contraindicated in patients with decompensated cirrhosis, these data are uninformative with respect to any potential clinical benefit, for these patients, of sustained viral eradication with direct antiviral agents . Initial studies have yielded clinical and laboratory evidence of improvement mainly for patients with a MELD score below 1618 points . In large-scale cohort studies, sustained viral eradication was associated both with lower liver-associated mortality and with substantially lower extrahepatic mortality . Sustained viral eradication eliminates the risk of individual transmission and is associated with a better quality of life .

HCV genotypes

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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.

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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What Causes Hepatitis C

The hepatitis C virus causes hepatitis C. The hepatitis C virus spreads through contact with an infected persons blood. Contact can occur by

• sharing drug needles or other drug materials with an infected person
• getting an accidental stick with a needle that was used on an infected person
• being tattooed or pierced with tools or inks that were not kept sterilefree from all viruses and other microorganismsand were used on an infected person before they were used on you
• having contact with the blood or open sores of an infected person
• using an infected persons razor, toothbrush, or nail clippers
• being born to a mother with hepatitis C
• having unprotected sex with an infected person

You cant get hepatitis C from

• being coughed or sneezed on by an infected person
• drinking water or eating food
• hugging an infected person
• shaking hands or holding hands with an infected person
• sharing spoons, forks, and other eating utensils
• sitting next to an infected person

A baby cant get hepatitis C from breast milk.18

What Is Hepatitis C

Hepatitis C is a viral infection that causes liver inflammation and damage. Inflammation is swelling that occurs when tissues of the body become injured or infected. Inflammation can damage organs.

Viruses invade normal cells in your body. Many viruses cause infections that can be spread from person to person. The hepatitis C virus spreads through contact with an infected persons blood.

Hepatitis C can cause an acute or chronic infection.

Although no vaccine for hepatitis C is available, you can take steps to protect yourself from hepatitis C. If you have hepatitis C, talk with your doctor about treatment. Medicines can cure most cases of hepatitis C.

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What Are Genotypes And Do They Matter

Six different genotypes of hepatitis C have been identified. Genotypes 1 and 3 are the most common causes of hepatitis C in Australia and make up 90 per cent of all cases. They are important because they help determine the treatment you need. Unlike in the past, however, your genotype is not important in terms of the chance of cure. With the treatment drugs, all six genotypes have a very high chance of cure.

Direct Acting Antiviral Agents

This is the class of drugs acting against viral and host proteins involved in HCV life cycle. The major inhibitors of NS3 viral protein are telaprevir and boceprevir. Telaprevir was approved and recommended for use with PegIFN- and ribavirin in genotype-1 patients. This was classified as triple therapy. Since telaprevir treatment is reported to be effective against the resistant mutants in the short term duration, it was decided to use it for long-term and subsequently approved for the treatment. It is important to note here that the long term use of these drugs often leads to drug resistance including T54A/S, R155K/T, V36A/M, V55A, and A156/S/T/V, etc. Simeprevir is another NS3 protease inhibitor classified as second generation drug. This drug is a reversible inhibitor of NS3/4A protease. Danoprevir and faldaprevir are also second-generation HCV NS3/4A protease inhibitors and used in patients infected HCV genotype-1. In addition to these drugs, there are various other NS3 protease inhibitors like Vaniprevir , Narlaprevir , Asunaprevir , VX 985, and MK-5172 which are used for treatment of HCV infection. There is every possibility that these drugs may be approved for therapeutic use against HCV infection.

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Treatment For People With Hiv And Hepatitis C Co

In the UK, standards for HIV treatment and care are set and monitored by the British HIV Association , the professional association for HIV doctors and other healthcare professionals. The most recent guidelines on HIV and hepatitis co-infection were produced in 2017 . Experts now agree that treatment recommendations for people with HIV and hepatitis C should be the same as for everyone else with hepatitis C, so your treatment will follow national guidelines for hepatitis C treatment.

Like everyone else living with HIV, people with HIV and hepatitis C co-infection are advised to start antiretroviral treatment soon after being diagnosed with HIV. People with co-infection may particularly benefit from early treatment because having well-controlled HIV and restored immune function reduces the risk of liver disease progression.

Current guidelines recommend that everyone with HIV and HCV co-infection should start hepatitis C treatment with DAAs. Treatment is especially urgent if you have moderate or worse liver fibrosis . But everyone with HIV and hepatitis C co-infection can benefit from early hepatitis C treatment because their liver disease may progress faster than it would in an HIV-negative person. Where there is a waiting list for treatment, people with HIV and hepatitis C co-infection are likely to be prioritised, especially if you have moderate or severe fibrosis.

• abacavir/lamivudine
• rilpivirine
• dolutegravir
• raltegravir .