Hepatitis C

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Hepatitis C

About Hepatitis C

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Overview

Hepatitis C is a disease caused by a virus that infects your liver. Your liver is an important organ in your body. It removes harmful chemicals from your body, aids digestion, and processes vitamins and nutrients from food. The liver also makes chemicals that help your blood clot when you have a cut. You cannot live without a liver.

For some people with hepatitis C, the infection lasts only a short time and their body is able to get rid of the virus. However, most people infected with hepatitis C develop chronic hepatitis C. This is a long-term illness that happens when the hepatitis C virus stays in your body.

If you do not receive treatment, over time (20 to 30 years) the infection can damage your liver and make it not work properly. It can cause scarring on your liver, liver cancer, liver failure, and death.

There are six “genotypes” of hepatitis C—genotypes 1, 2, 3, 4, 5, and 6. Which genotype you have can affect the treatment your doctor suggests and how well the treatment works.

Genotype 1 is the most common; 75 percent of people with hepatitis C have genotype 1. People with this genotype, however, do not respond as well to treatment as those with one of the other genotypes. Your doctor can do a blood test to find out which genotype you have.

Treatment options

Depending on the amount of damage to your liver, your medical history, and your preferences, you and your doctor may decide on one of the following treatment plans:

Treatment right away: If your liver has a lot of damage, your doctor may suggest you have treatment right away.

Waiting and follow-up: If your liver does not have a lot of damage and you do not need treatment right away, your doctor may suggest you wait. Some people wait years before starting treatment. If you decide to wait, your doctor will probably want to check your liver on a regular basis to see if and possibly when you might need treatment.

Liver Transplants

If your chronic hepatitis C causes liver failure, you may need a liver transplant. In this surgery, the surgeon replaces your failed liver with a healthy liver from an organ donor. You may still have to take medicine for chronic hepatitis C after a liver transplant because the hepatitis C in your body usually infects the new liver.

People who need a new liver often have to wait a long time on a transplant list. Not everyone on the list will get a liver. If a liver does become available, liver transplant surgery can have serious risks, including death.

Common Symptoms

Symptoms of hepatitis C can include:

  • Feeling tired
  • Fever
  • Loss of appetite
  • Upset stomach
  • Nausea and vomiting
  • Joint pain

Symptoms of advanced hepatitis C can include:

  • Yellowed eyes and skin, called “jaundice”
  • Dark-colored urine
  • Light-colored stools
  • Easy bruising
  • Taking longer for bleeding to stop

What Causes it?

Hepatitis C is spread through blood. Anyone who comes into contact with infected blood can catch the virus.

You cannot catch the hepatitis C virus from simply being around an infected person, shaking hands, or hugging.

How can I prevent infecting others?

Hepatitis C is spread through blood. You can prevent infecting others by not sharing items that come into contact with your blood, such as a toothbrush, a razor, or needles.

Am I at Risk?

How common is hepatitis C?

  • Around 180 million people worldwide have chronic hepatitis C.
  • About 4 million people in the United States have chronic hepatitis C.
  • Two-thirds of Americans infected with the hepatitis C virus were born between 1945 and 1964 (Baby Boomers).
  • About 70 to 85 percent of people infected with the hepatitis C virus develop chronic hepatitis C.*
  • Hepatitis C is responsible for about 15,000 deaths in the United States each year.
  • Hepatitis C is the most common reason for liver transplants in the United States.

* This information came from the Centers for Disease Control and Prevention Web site: http://www.cdc.gov/hepatitis/hcv/index.htm.

People at risk for getting hepatitis C include people who:

  • Received a blood transfusion or an organ transplant before 1992
  • Received a blood product for blood clotting problems before 1987
  • Have gotten a tattoo or piercing with nonsterile tools
  • Shared drug needles with an infected person, even if it was only one time
  • Have been exposed to the hepatitis C virus at work (such as a health care worker coming into contact with infected blood)
  • Spent many years on dialysis for kidney failure
  • Are infected with HIV Used the toothbrush or razor of an infected person, although the risk is low
  • Had sex with an infected person, although the risk is low

What Medicines are Available?

Interferons:

 

Pegasys (peginterferon alfa-2a)

Cost: $2960/mo

PegIntron(peginterferon alfa-2b)

Cost: $2896-$3194/mo

Nucleoside Analogue Antiviral Medicine:

 

Copegus, Rebetol, Ribasphere (ribavirin)

Cost: $705-$3249/mo, depending on brand

Protease Inhibitor Antiviral Medicines:

 

Victrelis (boceprevir)

Cost: $6052/mo

Incivek (telaprevir)

Cost: $7520/mo

Chronic hepatitis C is treated with a combination of medicines. Some medicines work by helping your immune system fight the virus, and some medicines target the virus itself.

There are currently two therapies to treat people with chronic hepatitis C:

  • Dual therapy: an interferon + ribavirin
  • Triple therapy: an interferon + ribavirin + boceprevir or telaprevir

People with any of the six hepatitis C genotypes can take dual therapy. Triple therapy is approved by the U.S. Food and Drug Administration (FDA) only for people with genotype 1.

Dual therapy became the standard treatment for chronic hepatitis C in the early 2000s. The FDA approved boceprevir (Victrelis®) and telaprevir (Incivek®) for triple therapy in people with genotype 1 in 2011.

Treatment often lasts 6 to 12 months. It is important to take these medicines as prescribed by your doctor. Do not stop taking these medicines or change the dose (amount) you take without first talking with your doctor. Ask your doctor if these medicines might interact with other medicines you are taking.

Always talk with your doctor before taking any herbal remedies or vitamin supplements. These could make the damage to your liver worse and could interact with your hepatitis C medicines.

After you complete therapy, your doctor will check your blood to see if the hepatitis C virus has been cleared. Six months after the end of your treatment, if the hepatitis C virus is not found in your blood, the virus has been cleared. This means the virus will probably not come back. After successful treatment, you can still be reinfected with hepatitis C. It is important to take precautions to prevent becoming infected again.

Are they Effective?

Researchers found:

  • Dual therapy with peginterferon alfa-2a appears to work about as well as dual therapy with peginterferon alfa-2b.
  • For people with genotype 1, triple therapy appears to work better than dual therapy.
  • In people with genotype 1 who complete triple therapy, the hepatitis C virus is cleared from their blood around 60 to 75 percent of the time.
  • In people with genotype 1 who complete dual therapy, the hepatitis C virus is cleared from their blood around 40 to 50 percent of the time.
  • In people with genotype 2 or 3 who complete dual therapy, the hepatitis C virus is cleared from their blood around 60 to 80 percent of the time (depending on how long their treatment lasted).
  • There is not enough research to know how often the hepatitis C virus is cleared from the blood after dual therapy in people with genotype 4, 5, or 6.

Are they Safe?

The FDA lists the following side effects for the combination of an interferon and ribavirin.

The most common:

  • Feeling tired
  • Headache
  • Muscle aches
  • Fever
  • Chills
  • Nausea and vomiting
  • Loss of appetite
  • Skin reaction at the injection site
  • Hair loss

More severe, but less common:

  • Severe depression
  • Thoughts of suicide
  • A low number of white blood cells (cells that fight infection)
  • Thyroid problems
  • High blood sugar
  • Nerve problems
  • Serious eye problems
  • Anemia (a low number of red blood cells, which carry oxygen throughout the body)
  • Further damage to your liver
  • Inflammation of the pancreas or bowels
  • Lung problems
  • A rash or other serious skin reactions
  • Problems with your teeth or gums
  • Serious allergic reaction (swelling of the face, eyes, lips, tongue, or throat; trouble breathing; chest pain)

Warning

Ribavirin can cause birth defects or death in an unborn baby. Women should not take ribavirin if they may be or are planning to become pregnant. A woman should avoid becoming pregnant if her male partner is taking ribavirin. A woman should wait at least 6 months after she or her male partner has stopped taking ribavirin before becoming pregnant.

People with a history of heart disease should be followed closely by their doctors during treatment with ribavirin. Ribavirin can produce severe anemia in some people, which can increase the risk of heart attacks.

The FDA lists the following side effects for boceprevir (Victrelis®):

  • Feeling tired
  • Anemia
  • Nausea
  • Headache
  • A bitter taste

The FDA lists the following side effects for telaprevir (Incivek®):

  • Feeling tired
  • Itching
  • Anemia
  • Nausea and vomiting
  • Rash (can be severe and even life threatening in rare cases)
  • Hemorrhoids
  • Diarrhea
  • Itching and discomfort around the anus
  • A bitter taste

Risks associated with different therapies

Dual Therapy

  • People who take dual therapy with peginterferon alfa-2a have a higher risk of having a low number of white blood cells, a rash, and other serious side effects than those who take dual therapy with peginterferon alfa-2b.

Triple Therapy With Boceprevir (Victrelis®)

  • 50 percent develop anemia
  • Up to 5 percent develop severe anemia
  • 25 percent develop a low number of white blood cells
  • Up to 15 percent develop a very low number of white blood cells

Triple Therapy With Telaprevir (Incivek®)

  • 25 percent to more than 75 percent develop anemia
  • Up to 10 percent develop severe anemia
  • 33 to 66 percent develop a rash
  • Up to 10 percent develop a severe rash

Comparing Dual and Triple Therapy

  • People who take triple therapy have a higher risk of anemia than people who take dual therapy.
  • People who take triple therapy with telaprevir (Incivek®) have a higher risk of rash than people who take dual therapy.

Are there Non-Drug Options?

Protecting your Liver

Your doctor may suggest other ways to help protect your liver, such as:

  • Avoiding alcohol or limiting the amount you drink
  • Eating a healthy diet
  • Maintaining a healthy weight
  • Getting enough exercise

Source

Agency for Healthcare Research and QualityTreating Chronic Hepatitis C: A Review of the Research for Adults. Published November 2012.

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