Tuesday, October 25, 2016

Hepatitis C: Treatment

Points to Remember

  • Hepatitis C is a virus, or infection, that causes inflammation of the liver.
  • Anyone can get hepatitis C, but some people are more likely to than others.
  • You could get hepatitis C through contact with an infected person’s blood.
  • Most people do not have any symptoms until the hepatitis C virus causes liver damage, which can take 10 or more years to happen.
  • See a doctor right away if you or a child in your care has symptoms of hepatitis C.
  • Acute hepatitis C is a short-term infection with the hepatitis C virus.
  • Chronic hepatitis C is a long-lasting infection with the hepatitis C virus. Chronic hepatitis C occurs when the body can’t get rid of the hepatitis C virus.
  • A blood test will show if you have hepatitis C.
  • If you are at higher risk of getting hepatitis C, get tested. Many people with hepatitis C do not know they are infected.
  • Hepatitis C usually is not treated unless it becomes chronic. Chronic hepatitis C is treated with medicines that slow or stop the virus from damaging the liver.
  • Tell your doctor and your dentist if you have hepatitis C.
  • See your doctor right away if you think you have been in contact with the hepatitis C virus. Early diagnosis and treatment of chronic hepatitis C can help prevent liver damage.



Source: CDC


Treatment

Hepatitis C does not always require treatment as the immune response in some people will clear the infection, and some people with chronic infection do not develop liver damage. When treatment is necessary, the goal of hepatitis C treatment is cure. The cure rate depends on several factors including the strain of the virus and the type of treatment given.

The standard of care for hepatitis C is changing rapidly. Until recently, hepatitis C treatment was based on therapy with interferon and ribavirin, which required weekly injections for 48 weeks, cured approximately half of treated patients, but caused frequent and sometimes life-threatening adverse reactions.

Recently, new antiviral drugs have been developed. These medicines, called direct antiviral agents (DAA) are much more effective, safer and better-tolerated than the older therapies. Therapy with DAAs can cure most persons with HCV infection and treatment is shorter (usually 12 weeks) and safer. 

Although the production cost of DAAs is low, these medicines remain very expensive in many high- and middle-income countries. Prices have dropped dramatically in some countries (primarily low-income) due to the introduction of generic versions of these medicines.

Much needs to be done to ensure that these advances lead to greater access to treatment globally.


Recommendations on hepatitis C treatment

Assessing for HCV treatment
All adults and children with chronic HCV infection should be assessed for antiviral treatment.

Treatment with direct-acting antivirals (DAAs)
WHO recommends that all patients with hepatitis C be treated with DAA-based regimens, except for a few specific groups of people in whom interferon-based regimens can still be used (as an alternative regimen for patients with genotype 5 or 6 infection and those with genotype 3 HCV infection who also have cirrhosis).

Telaprevir and boceprevir should no longer be used
These 2 first-generation DAAs, which are administered with pegylated interferon and ribavirin, were recommended in the 2014 guidelines. Evidence now shows that they result in more frequent adverse effects and less frequent cures compared with newer DAA-based regimens. Thus, these 2 medicines are no longer recommended by WHO.

WHO recommends preferred and alternative DAA regimens based on genotype and cirrhosis status
The Guideline Development Group reviewed all the available data (over 200 studies) to determine which regimens were most effective and safest to treat each of the 6 different genotypes.


Hepatitis C FAQs for the Public: Treatment

Can acute Hepatitis C be treated?
Yes, acute hepatitis C can be treated. Acute infection can clear on its own without treatment in about 25% of people. If acute hepatitis C is diagnosed, treatment does reduce the risk that acute hepatitis C will become a chronic infection. Acute hepatitis C is treated with the same medications used to treat chronic Hepatitis C. However, the optimal treatment and when it should be started remains uncertain.

Can chronic Hepatitis C be treated?
Yes. There are several medications available to treat chronic Hepatitis C, including new treatments that appear to be more effective and have fewer side effects than previous options. The Food and Drug Administration (FDA) maintains a complete list of approved treatments for Hepatitis C.

Is it possible to get over Hepatitis C?
Yes, approximately 15%–25% of people who get Hepatitis C will clear the virus from their bodies without treatment and will not develop chronic infection. Experts do not fully understand why this happens for some people.

What can a person with chronic Hepatitis C do to take care of his or her liver?
People with chronic Hepatitis C should be monitored regularly by an experienced doctor. They should avoid alcohol because it can cause additional liver damage. They also should check with a health professional before taking any prescription pills, supplements, or over-the-counter medications, as these can potentially damage the liver. If liver damage is present, a person should check with his or her doctor about getting vaccinated against Hepatitis A and Hepatitis B.



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