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.
Treatment Of Relapse Or Non
Sometimes you may need to take a different combination of medicines if your first round of treatment didn’t work very well. If it was not done before, your doctor may do a test to find out which genotype caused the infection. This may help the doctor choose a medicine that is more likely to cure the infection.
Needle Use Or Accidental Stick
You can get hepatitis C from:
- Sharing needles and other equipment used to inject drugs.
- Having your ears or another body part pierced, getting a tattoo, or having acupuncture with needles that have not been sterilized properly. The risk of getting hepatitis C in these ways is very low.
- Working in a health care environment where you are exposed to fresh blood or where you may be pricked with a used needle. Following standard precautions for health care workers makes this risk very low.
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Surveillance To Detect Liver Cancer Early
The most common causes of primary liver cancer are chronic infection with the hepatitis B and C viruses, excessive alcohol consumption, and fatty liver disease. NewYork-Presbyterian has a strong surveillance program for people at risk of liver cancer, particularly those with chronic hepatitis B or hepatitis C, with the hope of detecting the disease in its early, more curable stages.
Tests For The Hepatitis C Virus
If your doctor thinks that you may have hepatitis C, he or she may order:
- A hepatitis C virus test. This is a blood test that looks for antibodies against the hepatitis C virus. It shows whether you have been exposed to the virus.
- A blood test that looks for the genetic material of the hepatitis C virus. This test shows whether you are infected with the virus now.
- A blood test to find out the kind of hepatitis C virus you have. Knowing your genotype will help you and your doctor decide if and how you should be treated.
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What Should You Do In The Meantime
There are general guidelines to prevent transmission of infection, which you should keep in mind if you have a hepatitis Infection:
- Do not donate blood, tissue or semen
- Do not share appliances that come into contact with blood, such as toothbrushes, dental appliances, razors, nail clippers, glucometer and blood sugar testing lancets or needles
- Do not engage in unprotected sexual activity with multiple partners
- Reduce or discontinue alcohol consumption, as alcohol use may contribute to early development of liver disease
- Consider losing weight , follow a healthy diet and stay physically active
Primary Care Physicians And Nurse Practitioners Can Achieve Cure Rates Matching Those Of Liver Disease Specialists
This Reading Room is a collaboration between MedPage Today® and:
Primary care providers can successfully manage direct-acting antiviral treatment for hepatitis C, though some complicated cases should still be referred to specialists, experts say.
Recent studies have shows that hepatitis C treatment by primary care physicians and nurse practitioners can result in cure rates similar to those achieved by hepatologists and infectious disease specialists. Increasing the number of providers is key to expanding access to effective new therapies.
“There is no reason that a primary care provider cannot successfully treat the uncomplicated patient with chronic hepatitis C,” Raymond Chung, MD, chief of hepatology at Massachusetts General Hospital in Boston, told MedPage Today. “However, it is important that prospective treaters receive proper education and training first.”
The advent of DAAs has made treatment of chronic hepatitis C shorter, easier, and much more effective compared with the old interferon-based therapy.
Today, using interferon-free DAA regimens, treatment duration has fallen from a year to 8 or 12 weeks, and sustained virological response rates exceed 95% even for hard-to-treat patients. A growing number of experts maintain that all hepatitis C patients should be treated, and that biopsies are no longer necessary.
Studies show that many, or even most, hepatitis C patients do not need to be treated by specialists in the DAA era.
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What Should You Expect When You See A Specialist
When you see a specialist, you should expect to get laboratory and radiology testing. At the time of a hepatitis C infection clinic visit you should expect:
- Medical evaluation of the presence or development of liver disease
- Specific information regarding the type of hepatitis C virus
- Testing for HIV infection
- Discussion regarding possible treatment options and strategies
- Advice on how to monitor liver health, even if treatment is not recommended
- Consideration of hepatitis A and B vaccination
How To Find A Liver Specialist Who Really Knows Hepatitis B
If you have chronic hepatitis B or are newly-diagnosed, its important to see a liver specialist who has experience with hepatitis B.
Having a specialist with hepatitis B expertise on your team not only safeguards your health, it also lessens the stress of having a chronic liver disease. My specialist gave me all the possible scenarios, but most importantly, he gave me my life back, one hepatitis B patient recalled.
When first diagnosed, its often a primary health provider or for children a pediatrician who gets the test results and calls to break the news. Doctors may run additional blood tests and/or immediately refer you to a liver specialist. They may recommend a specialist who accepts your insurance or practices in the same healthcare system, but you may have to do some research to find the best specialist to treat your hepatitis B.
There are two types of specialists who treat liver diseases:
- A gastroenterologist is an internist who has trained in digestive disorders including the liver, but how much liver expertise a gastroenterologist has varies based on their training. Its important to find out if they specialize in liver diseases.
- A hepatologist is a physician who specializes in the liver. This doctor has the most expertise and should be up-to-date about new treatments and clinical trials. But not all hepatologists have treated hepatitis B. Many will have treated hepatitis C, but not hepatitis B, so you need to ask.
Tips for finding a specialist:
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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.
Healthy Tips For Living With Hepatitis C
The Mayo Clinic has identified some lifestyle changes you can make to help improve your health during your treatment for hepatitis C. They suggest that you:
- Be careful with your medications. Some drugs, even those prescribed by your doctor, may have the side effect of causing liver damage. This is a bigger risk for people with hepatitis C. Talk to your doctor about whether you should avoid certain prescription or over-the-counter drugs.
- Avoid alcohol. Drinking alcoholic beverages can make liver disease progress more quickly. Therefore, its best to avoid alcohol if you have hepatitis C.
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Hepatitis C And Health
How can health-care personnel avoid exposure to HCV?
Avoiding occupational exposure to blood is the primary way to prevent transmission of bloodborne illnesses among health-care personnel. To promote blood safety in the workplace, health-care personnel should consult infectious-disease control guidance from the National Institute for Occupational Safety and Health and from CDC. Depending on the medical procedure involved, Standard Precautions may include the appropriate use of personal protective equipment .
What is the risk of acquiring hepatitis C after being accidentally exposed to HCV-contaminated blood or body fluids in the workplace?
Although sharps injuries have decreased in recent decades due to improved prevention measures, they continue to occur, placing health-care personnel at risk for several bloodborne pathogens like hepatitis C. A recent analysis of several studies revealed an overall 0.2% risk for infection among those exposed to HCV-antibody-positive blood through needlestick or sharps injuries . Updated guidelines for management and treatment of hepatitis Cexternal icon are available to provide guidance for health-care personnel who become infected via exposure to contaminated blood at the workplace.
Other than needlesticks, do other exposures place health-care personnel at risk for hepatitis C?
Should HCV-infected health-care personnel be restricted in their work?
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.
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Preparing In Advance Can Help You Maximize Your Telehealth Appointment
If your hep C doctor recommends you try a telehealth appointment, take some time before your call to get ready. Write down any questions you have about your hepatitis C management, along with any symptoms youve been experiencing. Gather your existing medications to refer to if your doctor asks about them, and make sure you download any videoconferencing apps you need before your appointment time. Find a quiet, private space in your home where you wont be distracted, and ensure your computer, smartphone, or tablet is charged so your call can go off without a hitch. Your doctor wont be able to give you a physical exam, of course, but in many ways, your telehealth appointment for hep C will be similar to an in-person appointment.
How Is Hepatitis C Treated
Hepatitis C virus is treated with all-oral medications. These pills, calledantiviral medications, are usually taken once per day. These antiviral medications are extremely good at attacking the virus and preventing it from multiplying.
Antiviral medications were not the original treatment for hepatitis C. Before 2014, the only treatment for hepatitis C was called interferon and ribavirin, taken as weekly injections under the skin, plus pills. Interferon treatment caused many unpleasant side effects and was not usually successful. Then a new generation of medications became available. These antiviral treatments are extremely successful at curing the virus and have very minimal side effects.
Ribavirin is still sometimes prescribed to be taken along with the new antiviral medicines, but it has become more and more uncommon that ribavirin is needed at all. Ribavirin has some mild-moderate side effects. Ribavirin is a pill taken twice per day, as 2 or 3 pills in the morning plus 2 or 3 pills at night, depending on the patient’s body weight. Most patients do not need ribavirin.
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Liver Transplantation For Hepatitis C
NewYork-Presbyterian’s Center for Liver Disease and Transplantation excels in providing liver transplantation to people with HCV and has more clinical experience caring for these patients than most hospitals. These individuals require careful monitoring and care, since the immunosuppressive drugs they take after the transplant increase the risk of recurrent HCV disease in the new liver. We have a distinguished track record for liver transplantation and a multidisciplinary team of world-renowned leaders in the field.
New Treatments Available For Hepatitis C
Standard of care therapy for most patients with hepatitis C until 2011 included combination therapy with weekly pegylated interferon injections and ribavirin pills for 48 weeks. For many patients, this treatment was only successful less than 50 percent of the time.
Now, several new medications, called direct-acting antiviral agents, have been approved by the FDA for the treatment of hepatitis C. These interferon-free medications, which include protease, polymerase and NS5A inhibitors, act to directly block enzymes crucial to the replication of the virus. By taking at least one of these new medications by mouth, the likelihood of treatment success increases dramatically, and treatment may even be shortened to as few as eight to 12 weeks for many patients, a real advancement in the treatment of this disease.
Many more medications are expected to hit the market in the next few years. There has never been a better time to be treated for hepatitis C.
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How Common Is Hepatitis C In The United States
In the United States, hepatitis C is the most common chronic viral infection found in blood and spread through contact with blood.14
Researchers estimate that about 2.7 million to 3.9 million people in the United States have chronic hepatitis C.13 Many people who have hepatitis C dont have symptoms and dont know they have this infection.
New screening efforts and more effective hepatitis C treatments are helping doctors identify and cure more people with the disease. With more screening and treatment, hepatitis C may become less common in the future. Researchers estimate that hepatitis C could be a rare disease in the United States by 2036.17
Telehealth Can Improve Hepatitis C Management Between Appointments
Since the bulk of your time will be spent between doctors appointments, the responsibility falls on you to stick with your treatment planand telehealth can help. Possible uses include:
- Getting text reminders to take your medication on time
- Using your phone to track your daily activity and provide incentives for meeting your goals
- Utilizing phone support from a nurse or another health care provider to encourage healthy lifestyle changes, like avoiding alcohol or improving your nutrition
- Accessing educational materials online to increase your knowledge of the disease
Telehealth is still a growing area of medicine. As technology continues to advance, there will likely be more application of telehealth to hepatitis C disease management. If youre interested in learning more about incorporating telehealth into your care, talk to your doctor.
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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:
Eat Regular Nutritious Meals
Sometimes people with hepatitis C have a hard time eating. You may have no appetite, feel nauseated, or have different tastes than you are used to. Even if you don’t feel like eating, it’s very important to eat small meals throughout the day. Some people have nausea in the afternoon. If this happens to you, try to eat a big, nutritious meal in the morning.
If you have cirrhosis, it may not be a good idea to eat salty foods or foods that are high in protein. If you want to know more about which foods to avoid and which foods are good to eat, ask your doctor about meeting with a registered dietitian to discuss a healthy eating plan.
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Doctors And Specialists Who Can Treat Hepatitis
Robert Burakoff, MD, MPH, is board-certified in gastroentrology. He is the vice chair for ambulatory services for the department of medicine at Weill Cornell Medical College in New York, where he is also a professor. He was the founding editor and co-editor in chief of Inflammatory Bowel Diseases.
If you have hepatitis, you may be wondering who can treat your hepatitis. Well, a hepatitis specialist can help. But do you know the difference between the different kinds of clinicians who can treat your hepatitis? To help you understand who does what, here’s a short description of the different professionals who might work in your healthcare setting.
What Can People Do To Help The Medications Work Best
- Take the medications every day
- Stay in touch with pharmacy to be sure that all refills are ready on time
- Take the medications exactly as prescribed
- Do not skip doses
- Get all blood tests done on time
- Go to all visits with providers as recommended
- Tell the provider about all other medications that are being taken – including over-the-counter medicines, vitamins, herbs, and supplements
- Complete the entire course of medication
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