What Medication Is Used For Hepatitis C

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.

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.

New Hep C Treatments Usually Cure People In One Cycle

In the past, some people needed to be treated as many as four times something that put them through hell, says Laryea.

Hepatitis C was complicated to treat, she says. Every patient required different combinations of medications for different lengths of time. Factors including age and the amount of scarring of the liver impacted treatment. Today, she continues, Weve taken hepatitis C from something very complicated to something that is treated like a typical infection.

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Antiviral Medication For Hepatitis B

Doctors may recommend antiviral medication for people with chronic hepatitis B, which occurs when the virus stays in your body for more than six months.

Antiviral medication prevents the virus from replicating, or creating copies of itself, and may prevent progressive liver damage. Currently available medications can treat hepatitis B with a low risk of serious side effects.

NYU Langone hepatologists and infectious disease specialists prescribe medication when they have determined that without treatment, the hepatitis B virus is very likely to damage the liver over time. People with chronic hepatitis B may need to take antiviral medication for the rest of their lives to prevent liver damage.

There are many different types of antiviral medications available, and your doctor recommends the right type for you based on your symptoms, your overall health, and the results of diagnostic tests. A doctor may take a wait-and-see approach with a person who has a healthy liver and whose blood tests indicate a low viral load, the number of copies of the hepatitis B virus in your bloodstream.

Someone with HIV infection or AIDS may have a weakened immune system and is therefore more likely to develop liver damage. The U.S. Centers for Disease Control and Prevention strongly recommends that people with HIV infection who are diagnosed with hepatitis B immediately begin treatment with antiviral medication.

What Are The Side Effects Of Daas

The most common side effects of DAAs include:

Less frequent side effects may include:

• 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

• 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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Proinflammatory Cytokines Induce Depression

Mercifully, for patients with hepatitis C, treatment with the cytokine interferon IFN-alpha has been supplanted by more effective and tolerable treatment options. But during the years of its clinical hegemony, IFN-alpha provided a unique model system for understanding behavioral and biological responses to chronic inflammation relevant to depression. Results from many studies have been quite consistent in demonstrating that IFN-alpha exposure produces a widespread increase in depressive and anxious symptoms, with a sizable minority of patients meeting full criteria for major depressive disorder within a month of commencing treatment. As reviewed in Miller and Raison , IFN-alpha treatment also produces all known biological changes associated with MDD more generally, including increased circulating pro-inflammatory cytokines, disruption of the diurnal cortisol rhythm and induction of glucocorticoid resistance, altered sleep physiology, and changes in monoamine metabolism, with many of these changes associating with increased depression during treatment . Supporting these findings are studies showing that even a single exposure to inflammatory stimuli induces depressive symptoms and depressive-style social cognitions in healthy volunteers, with these effects being strongest in women .

Anton Pozniak, in, 2010

Treatment For Acute And Chronic Hepatitis C Infection

Some people are diagnosed with hepatitis C when the infection is in the acute phase . About one in four people will clear the hepatitis C virus from their body on their own within six months. When a person is diagnosed with hepatitis C in the acute phase, a healthcare provider might recommend waiting to see if their body clears the virus on its own.

Current treatment guidelines in Canada focus on treatment for chronic hepatitis C infection . The treatment guidelines recommend that treatment of acute hepatitis C infection be assessed on an individualized basis. In many cases, a person has to progress to chronic hepatitis C infection before they can receive public or private drug coverage for hepatitis C treatments.

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How Much Will It Cost Patients To Access The New Drugs

The Pharmaceutical Benefits Scheme listing means that hepatitis C patients will only pay the normal co-payment for the new drugs. The co-payment is currently worth $6.20 for patients with concessional healthcare cards and $38.30 for general patients without concessional healthcare cards, per drug, per month. For some patients needing three drugs, for example, the co-payment will therefore be $114.90 per month, or $18.60 per month concession.

More information on co-payment charges can be found on the Commonwealth Department of Healths website

Understanding Hepatitis C Genotypes

There is a range of medications for hepatitis C because no single drug works for everyone.

Medications may vary depending on the amount of liver scarring a person has and the viruss genotype.

A genotype refers to the genes that make up the hepatitis C virus. All genotypes cause similar liver damage, but the long-term effects may differ.

Hepatitis C has seven genotypes. Doctors represent these types by using the numbers 1 to 7. The genotype is type 1 hepatitis C. There are also subgroups within these groups, such as hepatitis 1a and 1b.

Knowing which genotype a person has is crucial in getting the proper treatment.

suggests ribavirin effectively treats several genotypes, but it does not work on its own. So the doctor will prescribe another medication to take with ribavirin to treat hepatitis C.

Other facts about ribavirin include:

• Treatment duration depends on other drugs a person is taking.
• The dosage depends on the persons body weight.
• A person will need their blood levels frequently checked while taking the medication to monitor efficiency and toxicity.
• Ribavirin may also cause congenital anomalies. Avoid ribavirin while pregnant or if trying to conceive.

Combination drugs tend to be effective for most or all hepatitis C genotypes.

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The Chain Of Addiction Care Project

The CAC pathway is a new approach to HCV care in the Dutch addiction care setting, in line with regular HCV care guidelines . All five addiction care organizations in the Nijmegen Institute for Scientist-Practitioners in Addiction collaboration will be invited to participate but we will also reach out to other major addiction care organizations to achieve nationwide coverage. All centers will be invited within a timeframe of two months. There will be no financial compensation for participation, however participation will include free education on hepatitis C. We anticipate that at least four out of five NISPA organizations and at least two non-NISPA organizations will participate. We will focus on centers that provide outpatient care, outreaching care or methadone posts, as these settings will contain most patients at risk for bloodborne infections and be suitable to provide hepatitis C care. Unfortunately, inpatient hepatitis C treatment is not currently reimbursed in the Netherlands. All phases of HCV care tasks are shifted to the addiction care physicians and nurses, from case finding in patients with a risk for bloodborne infections to counselling, testing, treatment and follow-up. Patients at risk who visit the participating centers will be educated on viral hepatitis and HIV and motivated to undergo venipuncture. In the majority of patients, pangenotypic DAA treatment will be provided by the ACP after evaluation of biomarker panels .

Fig. 1

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.

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Treatment After A Previous Course Of Direct

Brand name

NOTE

This chart is not a complete list of Health Canada-approved treatments for hepatitis C. This chart lists common daily dosing schedules. People should always follow the dosing schedule prescribed by their healthcare provider. Healthcare providers can check for drug interactions between hepatitis C treatment and other drugs a person is taking with a pharmacist or at www.hep-druginteractions.org.

Disclaimer

Information provided by CATIE is not medical advice. Decisions about medical treatments should always be made in consultation with a medical practitioner knowledgeable about HIV and hepatitis C. CATIE endeavours to provide the most up-to-date and accurate information at the time of publication. However, information changes and users are encouraged to ensure they have the most current information. Any opinions expressed herein may not reflect the opinions of CATIE, its partners or funders.

Acknowledgements

Production of this publication has been made possible in part through financial contributions from the Ontario Ministry of Health and the Public Health Agency of Canada . The views expressed herein do not necessarily represent the views of our funders.

Antiviral Treatment In Childhood

In an initial clinical trial, 12 weeks of treatment with sofosbuvir/ledipasvir yielded sustained virus eradication rates of 96% and 100% in patients aged 12 to 17 with chronic HCV infection of genotypes 1 and 4, respectively. The pharmacokinetic parameters of both substances were analogous to those seen in adults . Further cohorts of children aged 611 and 35 are now under evaluation, with drug doses of 33.7545 mg and 150200 mg . The findings are expected to become available in 2017.

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Other Side Effects Of Ribavirin

Other side effects of ribavirin may include:

• nausea and vomiting

All DAAs are oral drugs that you swallow. Follow your doctors or pharmacists instructions on how to take these medications. They can also tell you what side effects are possible and symptoms of any serious side effects to look out for.

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 Victorias website or their Hepatitis Infoline on 1800 703 003or refer to the Hepatitis Victoria, PBS factsheets

Barriers To Accessing Hepatitis C Treatment

In spite of recent improved treatment outcomes for hepatitis C patients, available data show treatment uptake continues to be very low among injecting drug users. The literature highlights a number of possible reasons for this. Service providers cite concerns around adherence, risk of exacerbation of psychiatric disorders and the potential for reinfection after treatment as reasons for not assessing or treating hepatitis C in injecting drug users . On the part of patients, the lack of access of people who inject drugs to testing still constitutes a key-barrier to entering a care pathway. In addition, poor knowledge about hepatitis C and treatment availability, the absence of noticeable symptoms and the perceived side-effects of treatment are named as barriers for accessing hepatitis C care. Finally, until recently, current drug injecting was an exclusion criterion for receiving government-funded hepatitis C antiviral treatment in a number of European countries. This obstacle, however, is now being removed, with most clinical guidelines revised to allow for the treatment of hepatitis C in injecting drug users.

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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

Am I Eligible For Treatment

In the past, when treatment for Hepatitis C basically consisted of interferon and ribavirin, side effects precluded many patients from being eligible. However, with the current availability of interferon-free treatment regimens, many of these people can now receive treatment for their Hepatitis C infection.

Some things your Hepatitis C provider will want to know when discussing your eligibility for treatment, as well as deciding which treatment regimen is best for you, include the following:

• What medications do you currently take? Some medicines interact with Hepatitis C medications, which can affect the level of either one meaning that the level of the Hepatitis C medicine or your other medicine may become too high or too low. There can be risks of toxicity if too high, or the medication may be less effective if too low. If available, your Hepatitis C provider will select a treatment option with no interactions. If not available, he or she can talk to your other healthcare providers about the possibility of changing your current medicines before Hepatitis C treatment begins. As an example, people taking amiodarone should not take Sovaldi or Harvoni due to serious risks of a slow heart rate deaths have been reported. People taking amiodarone would need to take some other Hepatitis C treatment.

• Are you pregnant? Antiviral medications may not be recommended if you are pregnant, because these medications can cause birth defects in babies.

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What Are The Symptoms Of Hepatitis C

Symptoms of Acute Hepatitis C Infection

The majority of newly-infected patients identified with HCV do not have symptoms. The minority of patients who have symptoms typically have complaints of

Symptoms of Chronic Hepatitis C Infection

Chronic hepatitis C usually causes no symptoms until very late in the disease. Over the years or decades, chronic inflammation may cause scarring . Extensive scarring in the liver is called cirrhosis.

Becoming infected with another viral hepatitis or other exposures that damage the liver in addition to hepatitis C can increase liver damage or even cause severe hepatitis. Having HIV infection along with HCV accelerates the progression of chronic hepatitis C to end-stage liver disease, sometimes shortening the course to a few years instead of decades.