How Is Monitoring Done After Treatment For Hepatitis C
Once patients successfully complete treatment, the viral load after treatment determines if there is an SVR or cure. If cure is achieved , no further additional testing is recommended unless the patient has cirrhosis. Those who are not cured will need continued monitoring for progression of liver disease and its complications.
While cure eliminates worsening of fibrosis by hepatitis C, complications may still affect those with cirrhosis. These individuals still need regular screening for liver cancer as well as monitoring for esophageal varices that may bleed.
Because hepatitis B co-infection may reactivate or worsen even after treatment for HCV, monitoring for hepatitis symptoms may be needed after the end of therapy.
Questions To Ask Your Doctor
- Do I need treatment?
- What treatment is best for me?
- What medicines should I take?
- Are there any medicines I should avoid?
- How can I cope with the side effects of treatment?
- Is there a therapist I can talk to?
- How long will my treatment last?
- Can hepatitis C be cured?
- Are organ transplants and blood transfusions safe?
- Is it safe for me to get pregnant?
How Do You Test For Hepatitis C
A simple blood test carried out by a healthcare professional will show whether you have the virus. You may also be given an extra test to see if your liver is damaged.
If youve got hepatitis C you should be tested for other STIs. It’s important that you tell your recent sexual partner/s so they can also get tested and treated. Many people who have hepatitis C do not notice anything wrong, and by telling them you can help to stop the virus being passed on. It can also stop you from getting the infection again.
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Getting Tested For Hepatitis C
Seek medical advice if you have persistent symptoms of hepatitis C or there’s a risk you’re infected, even if you do not have any symptoms.
A blood test can be carried out to see if you have the infection.
GPs, sexual health clinics, genitourinary medicine clinics or drug treatment services all offer testing for hepatitis C.
Early diagnosis and treatment can help prevent or limit any damage to your liver, as well as help ensure the infection is not passed on to other people.
Diagnosis Of Hepatitis C
If you are at risk of hepatitis C infection, or think you may have been exposed to hepatitis C in the past, see your doctor for an assessment of your liver health. This will include blood tests and possibly a non-invasive test for liver damage .
There are 2 blood tests used to diagnose hepatitis C. Usually these can be done at the same time but sometimes they will be done separately.
The first test known as a hepatitis C antibody test can tell you whether you have ever been exposed to hepatitis C.
It may take 2 to 3 months from the time of infection until a blood test can detect antibodies to hepatitis C, so there is a window period during which you cannot tell if you are or have been infected. In this time, take precautions to prevent the potential spread of the virus.
The second test is called hepatitis C PCR, which will be done if the antibody test is positive. This determines if the virus is still present in your blood or liver or if you have already cleared the infection.
If you have cleared the virus or had successful treatment to cure it, the PCR test will be negative.
A liver ultrasound or Fibroscan can also be performed to assess if you have any liver damage.
If your doctor is inexperienced in diagnosing hepatitis C you can call the LiverLine on for information, and to find a GP who can help you.
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How Will I Know If My Treatment Works
The goal of treatment is to reduce the amount of the hepatitis C virus in your blood to levels that cant be detected after 24 weeks of therapy. The amount of the virus in your blood is called your viral load. At the end of your treatment, your doctor will need to measure your viral load and find out how healthy your liver is. He or she may repeat many of the same tests that were done when you were first diagnosed with hepatitis C.
If your blood has so few copies of the virus that tests cant measure them, the virus is said to be undetectable. If it stays undetectable for at least 6 months after your treatment is finished, you have what is called a sustained virologic response . People who have an SVR have a good chance of avoiding serious liver problems in the future.
Treatment may not reduce your viral load. You may not have an SVR after treatment. If thats true, your doctor will discuss other treatment options with you. For example, if 1 round of treatment did not decrease your viral load enough, your doctor may recommend a second round. Even if treatment doesnt keep you from having active liver disease, lowering your viral load and controlling chronic liver inflammation may help you feel better for a longer time.
Do I Have To Have Drug Treatment
The choice is up to you and your doctor. The decision to use drug therapy can be hard to make because of the potential side effects. Your doctor will closely monitor your symptoms and the amount of the virus in your body. He or she will also consider your overall health. This includes looking at blood test results. All are important factors to consider before you and your doctor start drug treatment for your hepatitis C.
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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
Spread Of Hepatitis C
Hepatitis C is spread through blood-to-blood contact when blood from a person with hepatitis C enters another persons bloodstream.
The most common way people become infected with hepatitis C in Australia is by sharing injecting equipment such as needles, syringes, spoons and tourniquets. It is possible to be infected with hepatitis C after only one risk event.
Hepatitis C may also be spread through:
- tattooing and body piercing with equipment that has not been properly cleaned, disinfected or sterilised such as backyard tattoos’. Registered parlours with appropriate infection control procedures are not a risk
- needlestick injuries in a healthcare setting
- receiving blood transfusions in Australia prior to 1990 before hepatitis C virus testing of blood donations was introduced
- medical procedures, blood transfusions or blood products and mass immunisation programs provided in a country other than Australia
- pregnancy or childbirth there is a 5% chance of a mother with chronic hepatitis C infection passing on the virus to her baby during pregnancy or childbirth.
Breastfeeding is safe, however if nipples are cracked or bleeding cease breastfeeding until they have healed.
Less likely possible routes of transmission of hepatitis C include:
Hepatitis C cannot be transmitted by:
- sharing food, cups or cutlery
- shaking hands or day-to-day physical contact.
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Can Hepatitis C Be Prevented Or Avoided
The only way to prevent hepatitis C is to avoid coming in contact with an infected persons blood. Always have protected sex . Dont do intravenous drugs. Dont share personal care items with a person who has hepatitis C. If youre a health care worker, follow your workplaces standard safety practices.
What Are The Treatment Guidelines For Hepatitis C
Hepatitis C treatment is best discussed with a doctor or specialist familiar with current and developing options as this field is changing, and even major guidelines may become outdated quickly.
The latest treatment guidelines by the American Association for the Study of Liver Disease and Infectious Disease Society of America recommends use of DAAs as first-line treatment for hepatitis C infection. The choice of DAA varies by specific virus genotype, and the presence or absence of cirrhosis. In the U.S., specific insurance providers also might influence the choice due to the high cost of DAAs. Although the individual, public health, and cost benefits of treating all patients with hepatitis C is clear, the most difficult barrier to treating all people with HCV is the very high cost of the drug regimens. Patients are encouraged to discuss options with their health care professional.
Treatment is recommended in all patients with chronic hepatitis C unless they have a short life expectancy that is not related to liver disease. Severe life-threatening liver disease may require liver transplantation. Newer therapies with DAAs have allowed more and more patients to be treated.
What are the goals of therapy for hepatitis C infection?
The ultimate goals of antiviral therapy are to
- prevent transmission of hepatitis C,
- prevent progression to cirrhosis and liver cancer, and
- improve survival and quality of life.
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Hepatitis C Symptoms In Men
Hepatitis C symptoms in men are the same as in women. However, a 2014 study indicated that men may be less likely to clear the virus than women.
Hepatitis C in men may stay in their systems longer. It may also be more likely to cause symptoms in men compared to younger women.
Currently, there isnt a hepatitis C vaccine, though research is underway. However, avoiding contact with the blood of someone who has an HCV infection can help prevent you from acquiring the hepatitis C virus.
You can do this by:
- avoiding using someone elses razor, nail clippers, or toothbrush
- not sharing needles or syringes
- getting tattoos or piercings only at licensed facilities
- practicing safer sex with your partner by using condoms or other barrier methods
If you think you may have been exposed to HCV, its important to get tested as soon as possible.
Some people with hepatitis C may need a liver transplant.
If you believe you contracted HCV, the sooner you receive a hepatitis C diagnosis, the sooner your doctor can start a treatment plan to help you avoid complications.
Hepatitis C Testing And Diagnosis
Doctors will start by checking your blood for:
Anti-HCV antibodies: These are proteins your body makes when it finds the hep C virus in your blood. They usually show up about 12 weeks after infection.
It usually takes a few days to a week to get results, though a rapid test is available in some places.
The results can be:
- Nonreactive, or negative:
- That may mean you donât have hep C.
- If youâve been exposed in the last 6 months, youâll need to be retested.
If your antibody test is positive, youâll get this test:
HCV RNA: It measures the number of viral RNA particles in your blood. They usually show up 1-2 weeks after youâre infected.
- The results can be:
- Negative: You donât have hep C.
- Positive: You currently have hep C.
You might also get:
Liver function tests: They measure proteins and enzyme levels, which usually rise 7 to 8 weeks after youâre infected. As your liver gets damaged, enzymes leak into your bloodstream. But you can have normal enzyme levels and still have hepatitis C. Learn the reasons why you should get tested for hepatitis C.
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The 5 Types Of Viral Hepatitis
Viral infections of the liver that are classified as hepatitis include hepatitis A, B, C, D, and E. A different virus is responsible for each type of virally transmitted hepatitis.
Hepatitis A is always an acute, short-term disease, while hepatitis B, C, and D are most likely to become ongoing and chronic. Hepatitis E is usually acute but can be particularly dangerous in pregnant women.
Duration Of Hepatitis C
The other 75 to 85 percent of people go on to become hepatitis C carriers and develop a chronic infection, which can last a lifetime if left untreated. Chronic hepatitis C can lead to hepatitis Crelated complications, including chronic liver disease, cirrhosis, and liver cancer.
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Interpreting Hcv Rna Test Results
It is essential that the provider understands how to interpret HCV RNA test results, especially during the course of HCV treatment.
|Result of HCV RNA Test||Interpretation|
|A quantified viral load — any exact number||Ongoing HCV infection|
|“Detected”||The HCV RNA is detectable but the number of international units is so low that it cannot be quantified accurately. This indicates extremely low level of virus is present.|
|“< 12 IU/mL” or “< 15 IU/mL” or “< 25 IU/mL” All of these are “less than the LLOQ”||HCV RNA is undetectable. No virus is detected at all in the patient’s serum specimen.|
How Is Hepatitis C Treated
Forty percent of people do not need treatment for hepatitis C because their immune systems are able to clear the virus on their own. However, if that doesnt happen, then medications called direct acting antiviral therapy are needed to help the immune system clear the virus. In 2011, the FDA approved the first DAAT for treating hepatitis C. Since then, many DAATs have hit the market with more in development. Common DAATs include:
These medications are usually taken by mouth for 8 to 12 weeks. Some people may need more than one course of treatment in order to be cured.
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How Does It Affect The Body
The incubation period for hepatitis B can range from . However, not everyone who has acute hepatitis B will experience symptoms.
About 95 percent of adults completely recover from hepatitis B. However, hepatitis B can also become chronic.
The risk of chronic hepatitis B is greatest in those who were exposed to HBV as young children. Many people with chronic hepatitis B dont have symptoms until significant liver damage has occurred.
In some people whove had hepatitis B, the virus can reactivate later on. When this happens, symptoms and liver damage may occur. People with a weakened immune system and those being treated for hepatitis C are at a higher risk for HBV reactivation.
Specific Hcv Rna Assays And Range Of Detectable Virus
HCV RNA tests use target amplification techniques. Several assays exist for HCV RNA testing. Methods include polymerase chain reaction , transcription mediated amplification , and branched chain DNA tests. Results are expressed as international units/mL . The different methods and different commercial assays each have a lower limit of quantification and lower limit of detection , therefore a patient’s results could be reported differently depending on the assay used. HCV RNA tests must have an LLOQ of 25 IU/mL or lower when used to assess treatment response with DAAs.
LLOQ = the lowest HCV RNA level that is within the linear and analytically acceptable range of the assay.
LLOD = the lowest level of HCV RNA that is detected 95% of the time.
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How Is Hepatitis C Spread
The hepatitis C virus is spread through contact with infected blood and bodily fluids, such as semen and vaginal fluid. You will only be infected if the virus enters your bloodstream.
In Canada, most people are infected by:
- using or sharing drug paraphernalia contaminated with infected blood, including:
If you have hepatitis C, you can pass the virus to your baby during:
- breastfeeding if your nipples are cracked and bleeding, and your baby also has bleeding in or on the mouth
- it can be hard to tell if a baby has bleeding in or on the mouth
- cracked nipples may not be bleeding but may begin to during breastfeeding
You can also be infected if you receive contaminated:
- blood products
Although rare, hepatitis C can also be spread through unprotected sex especially if it involves blood contact, such as:
- contact with:
- open sores, cuts or wounds
- semen or vaginal fluid if blood is present
Unprotected sex means having sex without using a condom or other barrier safely.
Hepatitis C is not spread through:
- breast milk
Favorite Hep C Support Networks
This site gives a very detailed listing of live hep C support groups in cities across the country. Meetings are often for those undergoing treatment or people who have questions about treatment. A database that searches by ZIP code makes it simple to find a support group near you.
This online support network has about 34,000 members at latest count. People can anonymously post about all concerns related to the disease, including issues about stigma, depression, and care.
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