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 by pan-genotypic activity and 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 .
Diagnosis Of Acute And Chronic Hepatitis C
Best Pract Res Clin Gastroenterol.Clin Infect Dis.
J Viral Hepat.
J Clin Microbiol.
Antivir Ther.J Clin Virol.J Viral Hepat.
Ann Intern Med.
de novoJ Hepatol.
- All patients with suspected HCV infection should be tested for anti-HCV antibodies in serum or plasma as first-line diagnostic test .
- In the case of suspected acute hepatitis C, in immunocompromised patients and in patients on haemodialysis, HCV RNA testing in serum or plasma should be part of the initial evaluation .
- If anti-HCV antibodies are detected, HCV RNA should be determined by a sensitive molecular method with a lower limit of detection 15IU/ml .
- In low- and middle-income countries, and in specific settings in high-income countries, a qualitative HCV RNA assay with a lower limit of detection 1,000IU/ml can be used to provide broad affordable access to HCV diagnosis and care .
- Anti-HCV antibody-positive, HCV RNA-negative individuals should be retested for HCV RNA 12 and 24weeks later to confirm definitive clearance .
- HCV core antigen in serum or plasma is a marker of HCV replication that can be used instead of HCV RNA to diagnose acute or chronic HCV infection when HCV RNA assays are not available and/or not affordable .
Hepatitis C Treatment And Herbs
Unlike conventional medical treatments, most herbal therapies have not undergone rigorous scientific study. Fortunately, a greater effort is being made to evaluate the safety and effectiveness of various types of dietary supplements, including herbs, through the National Center for Complementary and Integrative Health formerly called the National Center for Complementary and Alternative Medicine a center of the National Institutes of Health .
So while some products may be safe others may actually pose significant risks for example, by producing serious side effects or interacting badly with your Hepatitis C medication. Because herbs can interfere with the action of Hepatitis C medications, its important to tell your doctor about everything youre taking before starting treatment for Hepatitis C. And while getting treated, its important not to take any new herbs or supplements before consulting with your healthcare provider. For example, you should NOT take St. Johns wort , or a product that contains St. Johns wort, with several of the medications used to treat Hepatitis C, including Olysio, Sovaldi, Harvoni, and Daklinza.
CERTAIN HERBS ASSOCIATED WITH LIVER DAMAGE
Its also important to be aware that several common herbs can cause liver damage, especially in people with an existing liver disease such as Hepatitis C. These include:
Additionally, the following groups of people should avoid the use of herbs in general unless ordered by their medical provider:
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There Is No Vaccine For Hepatitis C
But, did you know?
- Hepatitis C can be treated with medication that has cure rates > 90%.
- Earlier diagnosis and treatment lead to better health outcomes.
- Early treatment may even prevent liver disease, liver cancer, or cirrhosis.
Testing is quick and simple with a blood test.
Ask your health care provider for a test if you think you could have hepatitis C.
The best way to know is to get tested.
To learn about how to protect yourself and where you can get tested, visit Canada.ca and search ‘hepatitis C.’
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- 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 are now available on the Pharmaceuticals Benefits Scheme.
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What Is The Impact Of Hepatitis C
- 58 million people have hepatitis C
- 75% of people with hepatitis C live in low- and middle-income countries
- About 50% of all people with hepatitis C live in 4 countries: China, Pakistan, India, and Egypt
- 79% are unaware they are infected
- only 13% have had access to treatment
- 2.3 million people have both HIV and hepatitis C
- 1530% of those chronically infected develop cirrhosis of the liver within 20 years
- 800 people die every day
Hepatitis C is found throughout the world. There are six different major strains of hepatitis C, known as genotypes, distributed across different regions, with genotype 1 being most prevalent in high-income countries and genotype 3 most prevalent in low- and middle-income countries. Genotype 3 accounts for 30% of global hepatitis C infection.
What Are The Symptoms Of Hepatitis C
Most people infected with hepatitis C have no symptoms. Some people with an acute hepatitis C infection may have symptoms within 1 to 3 months after they are exposed to the virus. These symptoms may include
- yellowish eyes and skin, called jaundice
If you have chronic hepatitis C, you most likely will have no symptoms until complications develop, which could be decades after you were infected. For this reason, hepatitis C screening is important, even if you have no symptoms.
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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
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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How Do You Get Hepatitis C
Hepatitis C is a blood-borne virus. The most common ways to get infected are:
- unsafe injection practices
- inadequate sterilization of medical equipment
- blood transfusions of un-screened blood or blood products
Hepatitis C can also be transmitted sexually and be passed from mother to child, but these types of transmission are less common.
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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Recommendations For Testing Managing And Treating Hepatitis C Virus Infection
The advent of safe, well-tolerated, and highly efficacious direct-acting antiviral therapy for hepatitis C virus infection has ushered in an era in which elimination of hepatitis C is conceivable. In 2016, the World Health Organization proposed a global health sector strategy to eliminate hepatitis C as a public health threat by 2030 and developed an action plan to facilitate this goal. In response to the WHO action plan, the National Academies of Science, Engineering, and Medicine developed a US strategy for the elimination of hepatitis C. Key elements of the elimination plan include improved detection of undiagnosed cases, increased linkage and access to care for newly diagnosed persons, and expanded treatment access. Many of the recommendations included in the latest update to the HCV guidance and highlighted herein align with and support the goals of the NASEM and WHO strategies to move from control to eventual elimination of hepatitis C. Topics addressed include universal and risk-based hepatitis C screening, simplified treatment algorithms for treatment-naive adults without cirrhosis or with compensated cirrhosis, hepatitis C management in the pediatric population, acute hepatitis C testing and management, and transplantation of organs from HCV-viremic donors into HCV negative recipients.
Hepatitis C Treatment: Prevention
In the past, blood transfusions were a major cause of hepatitis C transmission. Now, blood donors are routinely screened for hepatitis C, and the incidence of post-transfusion hepatitis is significantly lower. Helping injection drug users modify their behavior has also reduced the prevalence of the disease.
To prevent hepatitis C:
- Choose a licensed facility if youd like to get a tattoo.
- Practice safe sex.
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Goals And Endpoints Of Hcv Therapy
Antivir Ther.J Clin Virol.
Ann Intern Med.
Clin Gastroenterol Hepatol.
- The goal of therapy is to cure HCV infection, in order to: prevent the complications of HCV-related liver and extra-hepatic diseases, including hepatic necro-inflammation, fibrosis, cirrhosis, decompensation of cirrhosis, HCC, severe extra-hepatic manifestations and death improve quality of life and remove stigma and prevent onward transmission of HCV .
- The endpoint of therapy is undetectable HCV RNA in serum or plasma by a sensitive assay 12weeks or 24weeks after the end of treatment .
- Undetectable HCV core antigen in serum or plasma 24weeks after the end of treatment can be used as an alternative endpoint of therapy in patients with detectable HCV core antigen prior to therapy, if HCV RNA assays are not available and/or not affordable .
- Undetectable HCV RNA in serum or plasma 24weeks after the end of treatment, using a qualitative HCV RNA assay with a lower limit of detection 1,000IU/ml , can be used as an alternative endpoint of therapy in areas where sensitive HCV RNA assays are not available and/or not affordable .
- In patients with advanced fibrosis and cirrhosis, surveillance for HCC must be continued because an SVR will reduce, but not abolish, the risk of HCC .
Who Treats Hepatitis C
If you think you are at risk of having Hepatitis C, talk to your current healthcare provider about getting tested. Once youve been diagnosed with Hepatitis C infection, you may want to see a specialist. Specialists who work with people with Hepatitis C include the following healthcare providers:
- Doctors who specialize in liver diseases
- Doctors who specialize in stomach and intestinal diseases
- Doctors who specialize in infectious disease
- Nurse practitioners whose practice concentrates on people with liver diseases
Nurse practitioners are registered nurses who are prepared through advanced education and clinical training to assume some of the duties formerly assumed only by physicians. They work in a medical care team, and can provide a wide range of health care services, including the diagnosis and management of common, as well as complex medial conditions.
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Treatments For Hepatitis C
The goal of treatment is a virological cure . This is defined as undetectable viral RNA in plasma 24 weeks after treatment has finished. A sustained virological response prevents the development of cirrhosis. In patients who already have cirrhosis, a sustained virological response reduces the risks of liver failure and hepatocellular carcinoma.
TABLE 3 TGA-approved interferon-free regimens for hepatitis C
F0-3 METAVIR fibrosis stage 0-3
F4 METAVIR fibrosis stage 4
* Not listed on the Pharmaceutical Benefits Scheme at the time of writing.
Response rate was defined as proportion of patients with a sustained virological response measured at 3 or 6 months after the end of treatment.
8 weeks may be considered in treatment-naïve patients with no cirrhosis and a baseline viral RNA concentration < 6 x 106 IU/mL.
§ 24 weeks is recommended for patients who have failed treatment with peginterferon + ribavirin with or without a protease inhibitor.
# 24 weeks is recommended for patients who have had a previous null response to peginterferon + ribavirin, defined by a decrease in the viral RNA level of < 2 log10 IU/mL at week 12 or < 1 log10 IU/mL at week 4 during previous peginterferon + ribavirin treatment.
What Are The Treatments For Hepatitis C
Treatment for hepatitis C is with antiviral medicines. They can cure the disease in most cases.
If you have acute hepatitis C, your health care provider may wait to see if your infection becomes chronic before starting treatment.
If your hepatitis C causes cirrhosis, you should see a doctor who specializes in liver diseases. Treatments for health problems related to cirrhosis include medicines, surgery, and other medical procedures. If your hepatitis C leads to liver failure or liver cancer, you may need a liver transplant.
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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
Who Is At Risk For Hepatitis C
You are more likely to get hepatitis C if you:
- Have injected drugs
If you have chronic hepatitis C, you probably will not have symptoms until it causes complications. This can happen decades after you were infected. For this reason, hepatitis C screening is important, even if you have no symptoms.
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Managing Side Effects Of Treatment
In the past when interferon was used, management of side effects was critical to have success with Hepatitis C treatment. Side effects are much less common now with the new Hepatitis C medications, but they can still happen. Fortunately, there are many steps you can take to manage them. Its important to talk to your Hepatitis C provider to help you manage side effects and have a good experience on treatment.
Keep in mind that not everyone will experience the same side effects, nor are they necessarily severe. Developing a good support system before beginning therapy with family, friends, and peer support group members can help you cope with treatment-related side effects.
The following tips will help you manage some of the more common side effects of Hepatitis C treatment:
- Modify your work schedule if possible.
- Get regular low-impact exercise such as walking.
- Eat well-balanced meals and drink enough fluids.
- Develop a regular routine go to bed and get up the same time every day.
- Use relaxation techniques such as meditation, warm baths or massage read or listen to music.
- Avoid exercise, caffeinated products, or heavy meals close to bedtime.
- Limit fluid intake about 2 hours before bedtime so you dont have to get up to go to the bathroom.
- Take over-the-counter or prescription medications as recommended by your provider.
- Eat smaller, more frequent meals.
- Eat whatever appeals to you most.
- Eat snacks high in protein have protein drinks .
On The Front Lines Of Curing Hepatitis C In New England
Testing for and treating hepatitis C in rural areas is a different challenge. In New Hampshire and Vermont, researchers are taking a mobile approach as part of the second-phase of the Rural New England Health Study focusing on injection drug users.
A joint effort between Better Life Partners, Baystate Health and Tufts University School of Medicine, a van offering hepatitis C testing, treatment and syringe services connects with people in rural communities in the Connecticut River Valley setting up in parking lots of community-based agencies people are already frequenting.
People who test positive for hepatitis C on the van are either referred to Dartmouth Medical Center or the University of Vermont Medical Center, or, participate in a trial to receive treatment directly on the van a way to measure effectiveness of mobile treatment.
Dr. Peter Freidmann, chief research officer at Baystate Health, said the availability of services in rural areas is “very limited,” and researchers wanted to focus on risk factors for injection drug users in communities as such. Whether people would respond positively to an unmarked van offering hepatitis C services was a big question.
Stopka said the van allows researchers and medical staff to “get into nooks and crannies of the community that otherwise won’t be reached or will have to go to great lengths to access services.”
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