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For The Newly Diagnosed
.
For anyone who has been diagnosed with a serious disease what follows is often fear of the unknown. As the weeks turn into months the realization sinks in that you have a heath crisis on your hands. Quickly you find yourself seeking out information, you ask yourself ; What can I do to improve my condition? Can this disease be treated, if so, when should I start treatment, or should you wait ?
For the millions of people who have been diagnosed with hepatitis C, the same questions need to be answered. First off, liver health is on the top of list and should always remain at the forefront.
Next, treatment is not for everyone, only you and your physician will determine what path you should investigate. However, if you are considering treatment, then arm yourself with accurate information.
The thought of treatment can be overwhelming, you may even see the side effects of treatment as much more detrimental then the disease itself. Or because the symptoms of Hepatitis C manifest very slowly, it's easy to dismiss treatment because it appears that there is nothing to be treated. What ensues for some people living with hepatitis C is a lack of urgency to seek treatment.
If you have only contracted HCV recently, then time is on your side. However, if you have been living with hepatitis C for years, I say to you -"There is a reason this virus is called the silent killer."
For 20% of people infected with hepatitis C - this virus is an agent of sabotage. Slowly sowing dissent in your liver, chipping away year after year, and leading a quiet coup against your health and well being. Like a good spy hepatitis C retains its cover as a non-threatening entity in your “political body”. We all require the knowledge to fight this cloak and dagger conflict. There are numerous sources with that valuable information to do so. But it’s up to you and your physician to recognize the potential threat. I urge you not to slip into contentment with this disease. If you have liver damage consider seeking treatment earlier then later before this despicable infiltrator is allowed to carry out its mission, a possible slow or rapid attack on your liver.
Need To Talk To Someone ?
Help is available, recently "Project Inform" announced the launch of a new national helpline, 877-HELP-4-HEP (877-435-7443), run by and for people affected by hepatitis C. The helpline operates Monday through Friday 9am to 7pm EST. To learn more, visit www.help4hep.org or email info@help4hep.org.
I also highly recommend the new book authored by Lucinda K. Porter, RN called Free from Hepatitis C:Your Complete Guide to Healing Hepatitis C
As a side note, we the baby boomers have been making the news -If you were born between 1945-1965 get tested for HCV
For the hands on reader check out the Multimedia section of the web site.This page contains udpated HCV educational podcasts, videos, and links.
Finding Accurate Information
Clinical Care Options - CCO
CCO has an extensive CME on the Management of Hepatitis C Infection, just released in Dec-2011.
Registering is always a nuisance but CCO is worth your time, click here to register. Once this is accomplished log on to the site, and return back here, to click on this link.
Why do you care ?
Because the information is invaluable, check out a few topics.
Told ya, please click here to register
A Few Facts
From 2010 @ Clinical Gastroenterology and Hepatology
Prevalence and Challenges of Liver Diseases in Patients with Chronic Hepatitis C Virus
Various estimates of HCV prevalence in the US population place the number of infected individuals (as defined by anti-HCV antibody positivity) at between 4.1 and 5 million. Of these, 3.2–3.4 million are chronically infected.
During the first 10–20 years of infection HCV-infected individuals generally experience asymptomatic or mild illness, which explains why an estimated 75% of infections remain undiagnosed in the United States.
Despite a decline in the number of new US cases of HCV infection from a peak of an estimated 262,000/year in 1986 to 17,000/year in 2007, the prevalence of individuals infected with HCV for more than 20 years is expected to continue to increase until 2015.
In the National Health and Nutrition Examination Survey (NHANES; 1999–2002), patients aged 40–49 years accounted for 66% of American HCVinfected patients, and the prevalence of HCV infection in the United States was 2.7 times higher among 40- to 49-year-olds than the general population. This "baby boomer" generation is particularly susceptible to blood-borne HCV transmission as a result of an increased lifetime risk of injection drug use (IDU), blood transfusion before 1992, or sexual activity with ≥20 partners, compared with older or younger patients.
The prevalence of HCV infection varies by age, sex, and race/ethnicity, and early identification of at-risk individuals through routine questioning by clinicians is critical, because management options are limited in late-stage disease.
Given the high prevalence of HCV infection among 40- to 49-year-olds and that Americans are now expected to live into their mid-70s or beyond, the incidence of complications of HCV infections can be expected to further increase in coming years. In fact, from 1995–2004, US HCV-related mortality already increased 123% from 1.09/100,000 to 2.44/100,000 persons, although this study has some limitations.
Furthermore, the proportion of CHC patients in the United States with cirrhosis is projected to rise from 25% in 2010 to 45% in 2030. Projections also estimate that without effective treatment, the annual number of US patients with cirrhosis, hepatic decompensation, or HCC will roughly double by 2020, and liver-related deaths will almost triple.
Although not all data agree with these estimates, several studies have suggested that HCV infection could have a deleterious effect on population mortality rates and life expectancy. HCV increased the risk of death in several analyses, irrespective of comorbidities such as coinfection with human immunodeficiency virus (HIV) or hepatitis B virus (HBV) and even after adjustment for alcohol consumption.
Furthermore, numerous studies and a Cochrane review indicated that achievement of an SVR through effective antiviral therapy can significantly reduce mortality in patients with chronic HCV.
If all HCV-infected patients were treated with currently available treatment in 2010, (Update 2011-2012 FDA approved Telaprevir,Boceprevir) liver-related HCV-associated deaths could be reduced by 36% by 2020, whereas antiviral treatment rates are currently declining. Improvements in diagnosis and treatment are therefore necessary to reduce the associated public health burden
After 30 years of infection, an estimated 15%–35% of patients will develop cirrhosis (5-year survival, 75%–80%);after 40 years, up to 60% could have cirrhosis.
Continue Reading...
Where Can You Find An Easy To Understand HCV Web Site With Accurate Information ?
HCV Advocate is the go to site for all your questions, filled with information, news, HeathWise articles, fact sheets, new drugs currently in the pipeline, clinical trials, and a monthly newsletter.
The Links
HeathWise articles found in the in the HCV Advocate Newsletter
Fact Sheets HCV Drug Pipeline News Updates Clinical Trials Hepatitis C
]
Next up, what about the disease progression of hepatitis C ?
By Alan Franciscus, Editor-in-Chief Of HCV Advocate
Disease progression
(HCV) is highly variable, which means that it is difficult to tell
who will and who will not have severe HCV disease progression.In general about 80% of people
with chronic hepatitis C will have a slow rate of disease progression
that may not lead to serious complication.
The other 20% of people with chronic hepatitis C will have
severe disease progression that could lead to complications such
as severe fibrosis, cirrhosis, liver failure, liver cancer and death.
The question that has vexed us all is why some people with HCV
have serious disease progression while others only have mild progression.
Although we are far from completely understanding and
answering this important question there is information available about
some of the factors that will likely increase the risk for serious HCV
disease progression. This article will discuss the various factors that
increase the likelihood of disease progression and steps we can all
take to minimize these effects – at least for those factors over which
we have some control.
,
ALT Levels
Alanine aminotransferase or ALT (previously called SGPT) is
a chemical produced in the liver.
ALT levels are elevated when liver cells are inflamed, damaged, or
destroyed by HCV, HBV, alcohol and certain drugs.Persistently elevated ALT levels
are more of a sign that there is ongoing damage to the liver,and, if elevated over a
long period of time, indicate ongoing fibrosis progression. But it is important to know
that people with persistently normal ALT levels can also have fibrosis progression, although
the risk is much lower.
2012 - Clinical Features of Hepatitis C Virus Carriers With Persistently Normal Alanine Aminotransferase Levels
,
Inflammation
The amount or degree of inflammation in the liver roughly
correlates with the development of fibrosis and cirrhosis. The amount
of inflammation can be reduced by taking HCV medical treatment
and avoiding any substance that causes harm to the liver, such as
alcohol, etc.
,
Fibrosis/Cirrhosis
Light, moderate, or severe scarring of the liver (fibrosis) can eventually
lead to even more severe scarring of the liver called cirrhosis.
The damage caused by hepatitis C is not linear – this means that once
fibrosis and cirrhosis start to develop, the progression of liver disease
speeds up. In other words, it may take 10 years to progress
from one degree or stage of liver damage to another, but the next
increase in the amount of damage may take less time – say 7 years.
Progression to the next stage may only take 5 years and so forth.
HCV treatment can help to reduce, slow down or stop the disease
progression progress especially if HCV treatment is successful.
Lifestyle changes can also help the liver to stay healthy by maintaining
a healthy weight, eating a healthy diet, avoiding alcohol and drugs,
moderate exercise, stress reduction, etc.
,AGE
Age plays a critical role in HCV disease progression. The age at
the time that someone acquired HCV plays an important role in
disease progression – so the older you are when you acquire HCV
the faster the disease progression.
This is because the body’s immune system doesn’t work
as well to minimize the damage HCV causes. On the other hand,
if someone acquires HCV at an early age, as they get older the
greater the chances of more severe disease progression due to the accumulation
of damage over time.
For instance, some studies have found that people over 60 years old
have a quicker disease progression and other studies have found that
having HCV for 25 years or longer increases the chances of disease
progression.
,
Steatosis
Fatty liver or steatosis can contribute to lower HCV treatment
response and a faster rate of HCV disease progression. The cause
of steatosis in most people with HCV is a synergistic effect of thevirus,
poor diet and lack of exercise. If you are HCV genotype 3,
however, steatosis is most likely caused by the hepatitis C virus.
For example, in people with genotype 3 who are successfully treated
with HCV medications steatosis has been found to be decreased
or eliminated. This is not true of steatosis in people with HCV non-3
genotype.
For most people, steatosis can be prevented and even reversed by
the simple, but not so easy, methods that we all struggle with – a
healthy diet and exercise program.
We recommend that anyone who undertakes a diet and exercise
program consult with a medical provider and experts in the field of
diet and exercise.
Unfortunately,these tools are not available to
everyone; but there are still many avenues and resources open to
become even healthier. On the internet there is a wealth of diet
and exercise sites to help.
,Marijuana
There have been some studies that have found that regular daily
use of marijuana can significantly increase the risk of fibrosis progression.
There is a caveat, however, about the data that has surfaced.
The studies have been self-disclosure studies that are typically extremely
difficult to gauge as to how truthful people may answer questions
about how much they smoke.
But the most important factor is that it is impossible to measure the
concentrations of THC (the active ingredient in marijuana) that the
participants were smoking. Interestingly,
the studies that report that daily marijuana causes significant
fibrosis progression also report that non-daily use of marijuana did not
accelerate fibrosis progression. The bottom line – more is not better
when it comes to many issues including using marijuana.
.
Cigarettes
I don’t think anyone these days would be surprised to learn that
smoking cigarettes causes many health-related problems including
increasing the chances of fibrosis progression and liver cancer.
.
ALCOHOL
Another no-brainer is that alcohol consumption can increase
fibrosis and cirrhosis progression.
Excessive alcohol consumption – in and of itself – can lead to cirrhosis,
liver failure and liver cancer. If both of the negative effects, alcohol and
HCV, were combined I think it’s easy to see why people with HCV
should avoid alcohol. If someone has trouble stopping, they should
cut back on the amount of alcohol they drink and get help to stop.
There are many effective programs to help people stop drinking.
Metabolic Syndrome
In the last decade the relationship between metabolic disorders
and fibrosis progression has been well-documented. Metabolic disorders
are a group of conditions that increase the likelihood for
cardiovascular disease and other health problems.Components of
metabolic syndrome include:
• Abdominal obesity
• High blood cholesterol and
high triglycerides
• High blood pressure
• Insulin resistance
• State of inflammation caused
by obesity, insulin resistance,
etc.
• Prothrombotic state – increased
platelets
Although there are different components that define metabolic
syndrome they are also interconnected interconnected
especially with obesity.
Obesity and insulin resistance are the two factors that stand out as
factors that increase fibrosis progression.
A simple tool to measure insulin resistance is the HOMA-IR
– the higher the score, the higher the degree of insulin resistance.
The higher the HOMA-IR score, the more rapid fibrosis progression
is.
.
Many of the factors of metabolic syndrome can be treated with
lifestyle changes (diet, exercise, stress reduction) and medications
to control diabetes, high blood pressure, cholesterol, etc.
For More on HCV
http://www.hcvadvocate.org/
Transmission Of Hepatitis C
How is hepatitis C spread? Who's at risk?
Hepatitis C virus (HCV) is transmitted through contact with an infected person's blood.
The following list outlines sources of hepatitis C transmission
.
-Sharing needles and syringes (IV drug abuse);
-Other possible risk behaviors: tattoos, body piercing, living and medical care in a developing country, folk medicine, intranasal cocaine;
2012 - Amateur tattoos carry hepatitis C risk
IV User-Worried About HCV ? Check This Out
-Extensive surgical procedures
-Unknown--up to 5% of patients have no identifiable risk factors;
-Sexual transmission is rare; the risk of sexual transmission to an individual is probably less than 3% when a person is in a stable monogamous relationship;
-Vertical transmission from mother to baby;
-Reused needles in a medical or health care setting.
Related:Hepatitis transmission risk needs to be studied in nail salons, barbershops
Is hepatitis C transmitted sexually?
According to studies in the Journal of the American Medical Association, a low sexual transmission rate of hepatitis C was suggested. Of the 62 patients studied, none of the monogamous heterosexual partners had developed the hepatitis C antibody. In general, the probable risk of heterosexual transmission of hepatitis C is less than 3%.
It is recommend that all patients in a non-monogamous relationship use a condom or spermicide and patients in a monogamous relationship use a barrier method only if they are anxious or concerned about transmission.
All non-monogamous individuals should use safe sex practices.
For patients with hepatitis C, testing of spouses, babies and significant others is recommended by Centers for Disease Control(CDC). Please discuss these issues with your physician.
The Sexual Transmission of Hepatits C In The HIV Population
2011 - Hepatitis C Transmitted by Unprotected Sex Between HIV-Infected Men
Is hepatitis C transmitted by breast milk to infants?
There is no substantial evidence that hepatitis C is transmitted through breast milk, however, a few studies have been performed that tested breast milk and very rarely is hepatitis C found in the breast milk--even using the most sensitive tests such as PCR. The CDC has issued a statement explaining that mothers who have HCV can breast feed, but should avoid it if there are sores around the nipple.
Can hepatitis C be transmitted to other members of my family (household contacts)?
There is a slight risk of hepatitis C transmission among household contacts, so family members should not share items such as razors or toothbrushes that may transmit blood or secretions. Women who have hepatitis C and are menstruating as well as men or women with hepatitis C and sores in the genital area should avoid sexual contact. The CDC recommends that spouses or partners of a hepatitis C patient be tested for hepatitis C.
Can a pregnant woman give hepatitis C to her baby?
A report in New England Journal of Medicine suggested a 7% transmission rate of hepatitis C from mother to child at birth. Though this is a high estimate, the possibility of transmission must be considered when a woman with hepatitis C is deciding whether to have children.
For infants who have received the hepatitis C virus from their mother, brief elevations of liver enzymes may occur, but no chronic liver disease has been reported. There have been no reports of cirrhosis in newborns, infants or child due to mother-to-child hepatitis C infection. It is recommended that all babies born to mothers with HCV be tested annually until age three with antibody tests.
HCV In Pregnancy
Women with AIDS and hepatitis C are at high risk for transmitting the virus to their babies, and research has shown that these women consistently transmit the virus to their babies at birth.
Is hepatitis C transmitted by insects?
There is no documented transmission of hepatitis C through insects. The virus, however, is related to a group of viruses including yellow fever and Dengue, and those are known to have been spread by insects.
Related - Hey Can I Get Hepatitis C From...............
Exams and Tests
The following tests are done to help diagnose hepatitis C:
Learn more here
Related - Hey , I Have A Question About HCV Tests
Diagnosis of HCV infection is based on the detection of anti-HCV antibodies by enzyme immunoassay.
Anti-HCV test detects the presence of antibodies to the virus, indicating exposure to HCV. This test cannot distinguish between someone with an active or a previous HCV infection. Usually, the test is reported as "positive" or "negative." There is some evidence that if the test is "weakly positive," it may be a false positive. The Centers for Disease Control and Prevention (CDC) suggests that weakly positive tests be confirmed with the HCV RIBA test before being reported.
HCV recombinant immunoblot assay (RIBA) test is an additional test ordered to confirm the presence of HCV antibodies. In most cases, it can tell if the positive anti-HCV test was due to exposure to HCV (positive RIBA) or represents a false signal (negative RIBA). In a few cases, the results cannot answer this question (indeterminate RIBA). Like the anti-HCV test, the RIBA test cannot distinguish between a current or past infection.
Can you have a "false positive" anti-HCV test result?
Yes. A false positive test means the test looks as if it is positive, but it is really negative. This happens more often in persons who have a low risk for the disease for which they are being tested. For example, false positive anti-HCV tests happen more often in persons such as blood donors who are at low risk for hepatitis C. Therefore, it is important to confirm a positive anti-HCV test with a supplemental test as most false positive anti-HCV tests are reported as negative on supplemental testing.
Can you have a "false negative" anti-HCV test result?
Yes. Persons with early infection may not as yet have developed antibody levels high enough that the test can measure. In addition, some persons may lack the (immune) response necessary for the test to work well. In these persons, research-based tests such as PCR may be considered. . How long after exposure to HCV does it take to test positive for anti-HCV? . Anti-HCV can be found in 7 out of 10 persons when symptoms begin and in about 9 out of 10 persons within 3 months after symptoms begin. However, it is important to note that many persons who have hepatitis C have no symptoms..
Hepatitis C RNA assays to determine virus levels (called viral load)
Viral Load Test
How long after exposure to HCV does it take to test positive with Qualitative HCV RNA test =PCR?
It is possible to find HCV within 1 to 2 weeks after being infected with the virus
Unlike antibody tests, HCV RNA tests directly measure for the presence of the hepatitis C virus. HCV RNA tests may be qualitative or quantitative.
Qualitative HCV RNA tests are used to diagnose hepatitis C. Your doctor might choose to perform an HCV RNA test instead of the ELISA, especially if you are at high-risk for hepatitis C. The HCV RNA test will be positive in as little as 1 to 2 weeks after exposure.
A positive HCV RNA test means a person has hepatitis C infection.
Quantitative HCV RNA tests allow your doctor to determine exactly how much virus is in the blood. This is referred to as the viral load.
The viral load is usually expressed as units per milliliter or copies per milliliter. In patients with chronic hepatitis C infection, viral loads vary widely from 50,000 to 5 million copies per milliliter. A higher viral load may not necessarily be a sign of more severe or more advanced disease but it does correlate with likelihood to respond to treatment. HCV RNA tests can also be used to monitor response to hepatitis C treatment. For example, if the viral load decreases during treatment, this suggests that treatment is working and should be continued, referred to as response guided treatment . Conversely, if the viral load remains the same, it suggests that the patient is not responding to treatment.
On-Treatment Predictors of Response
Once hepatitis C virus (HCV) treatment is started, initial viral kinetics are helpful in predicting treatment outcome. Patients who have cleared the virus by Week 4 of therapy, whether with protease inhibitor (PI)–based triple therapy or with peginterferon/ribavirin alone, are very likely to achieve sustained virologic response (SVR). By contrast, those who still have detectable HCV RNA (virus) levels by Week 12 of therapy have very low likelihood of obtaining SVR
Viral Load - Familiar Treatment Terms
Response guided treatment-
Or viral load monitoring during treatment is intended to enable the physician to determine the duration of combination therapy based on a patients viral response.
Terms Used In Response guided treatment
(RVR)-Rapid Viral Response; Is an undetectable viral load four weeks into treatment. In SOC-standard therapy if you have an RVR your chance of cure is better than 78% and 92% and your doctor may recommend that you shorten your treatment.
(cEVR) Complete early viral response- Is an undetectable viral load 12 weeks into treatment. If you have a complete EVR you have a good chance of being cured .
(pEVR) Partial early viral response - A drop in viral load of at least 2-log (e.g. from 600,000 IU/mL down to 6,000 IU/mL) at 12 weeks of treatment, but still detectable virus in your blood. In people with genotype 1 the chance of viral clearance is low and treatment is generally stopped.
(non-EVR) Non-response- No significant drop in viral load in the first 12 weeks of treatment.
What Is A 100-fold reduction in viral load ?
Changes in viral load are sometimes expressed in terms of logs: a 1-log change means a 10-fold increase or decrease; a 2-log change is a 100-fold increase or decrease.
What Is A 2 Log Drop?
Example: 2 log drop = 15,000,000 IU/Ml to 150,000 IU/mL; a viral load that starts at 15,000,000 IU/mL and does not decrease to 150,000 IU/mL or lower.
Terms Used To Define Patienst
Naïve- No prior treatment/first time treating HCV.
Relapsers- People whose viral load drops to an undetectable level with treatment but rises again after treatment ends.
Partial responders- People who have at least a 2 log10 (100-times) drop in viral load, but do not reach undetectable levels in the blood by week 24.
Null responders- People who failed to reduce their viral load by at least 2 log10 (100 times) after 12 weeks of prior treatment, which is the currently recommended Food and Drug Administration (FDA) definition for clinical trials of investigational hepatitis C treatments.
Protocol for both Telaprevir and Boceprevir can be found by clicking on the link below:
A Practical Guide for the Use of Boceprevir and Telaprevir for the Treatment of Hepatitis C
Quick Facts Victrelis-boceprevir, Incivek-telaprevir
Genotype-Test
A better understanding of Genotypes
The following tests are done to identify and monitor liver damage from hepatitis C:
Liver function tests
Albumin level
Prothrombin time
A better understanding of Liver Function Tests
. Will I need a Liver Biopsy ?
According to your genotype some doctors may want you to have a liver biopsy, although at this time most often noninvasive tests are used to measure liver damage.
Based on the abundant literature in chronic hepatitis C, alternative, non-invasive methods can now be used instead of liver biopsy in patients with chronic hepatitis C to assess liver disease severity prior to therapy at a safe level of predictability.
Great Article : Liver Biopsy and Noninvasive Tests For Fibrosis
HEPATITIS C SYMPTOMS
.
When you are first exposed to the hepatitis C virus and become infected, you are said to have "acute hepatitis C". Most people have no symptoms of infection during this time.
In 70 to 80 percent of people, the infection becomes chronic. The word "chronic" implies that the infection will be prolonged, or even lifelong, unless you get treatment that cures the infection.
Many people with chronic hepatitis C have no symptoms, even if there is serious liver damage. Of those who do develop symptoms, the most common symptom is fatigue; other less common symptoms include nausea, lack of appetite, muscle or joint aches, weakness, and weight loss.
Also See :Symptoms .
Treating Hepatitis C - Whats New?
HCV Drugs In Development
Hepatitis C New Drug Pipeline New drugs in development for the treatment of hepatitis C
Interferon Free ?
For anyone who has been diagnosed with a serious disease what follows is often fear of the unknown. As the weeks turn into months the realization sinks in that you have a heath crisis on your hands. Quickly you find yourself seeking out information, you ask yourself ; What can I do to improve my condition? Can this disease be treated, if so, when should I start treatment, or should you wait ?
For the millions of people who have been diagnosed with hepatitis C, the same questions need to be answered. First off, liver health is on the top of list and should always remain at the forefront.
Next, treatment is not for everyone, only you and your physician will determine what path you should investigate. However, if you are considering treatment, then arm yourself with accurate information.
The thought of treatment can be overwhelming, you may even see the side effects of treatment as much more detrimental then the disease itself. Or because the symptoms of Hepatitis C manifest very slowly, it's easy to dismiss treatment because it appears that there is nothing to be treated. What ensues for some people living with hepatitis C is a lack of urgency to seek treatment.
If you have only contracted HCV recently, then time is on your side. However, if you have been living with hepatitis C for years, I say to you -"There is a reason this virus is called the silent killer."
For 20% of people infected with hepatitis C - this virus is an agent of sabotage. Slowly sowing dissent in your liver, chipping away year after year, and leading a quiet coup against your health and well being. Like a good spy hepatitis C retains its cover as a non-threatening entity in your “political body”. We all require the knowledge to fight this cloak and dagger conflict. There are numerous sources with that valuable information to do so. But it’s up to you and your physician to recognize the potential threat. I urge you not to slip into contentment with this disease. If you have liver damage consider seeking treatment earlier then later before this despicable infiltrator is allowed to carry out its mission, a possible slow or rapid attack on your liver.
Need To Talk To Someone ?
Help is available, recently "Project Inform" announced the launch of a new national helpline, 877-HELP-4-HEP (877-435-7443), run by and for people affected by hepatitis C. The helpline operates Monday through Friday 9am to 7pm EST. To learn more, visit www.help4hep.org or email info@help4hep.org.
I also highly recommend the new book authored by Lucinda K. Porter, RN called Free from Hepatitis C:Your Complete Guide to Healing Hepatitis C
As a side note, we the baby boomers have been making the news -If you were born between 1945-1965 get tested for HCV
For the hands on reader check out the Multimedia section of the web site.This page contains udpated HCV educational podcasts, videos, and links.
Finding Accurate Information
Clinical Care Options - CCO
CCO has an extensive CME on the Management of Hepatitis C Infection, just released in Dec-2011.
Registering is always a nuisance but CCO is worth your time, click here to register. Once this is accomplished log on to the site, and return back here, to click on this link.
Why do you care ?
Because the information is invaluable, check out a few topics.
- Pretreatment Evaluation
- History
- Physical Examination
- Laboratory Testing
- Role of Liver Biopsy and Noninvasive Tests in Determining Fibrosis
- Pretreatment Optimization of the Cirrhotic Patient
- Therapeutic Regimens: Which Therapy for Which Patient?
- Goals of Therapy
- Types of Therapy
- Peginterferon Alfa
- Ribavirin
- Protease In hibitors
Told ya, please click here to register
A Few Facts
From 2010 @ Clinical Gastroenterology and Hepatology
Prevalence and Challenges of Liver Diseases in Patients with Chronic Hepatitis C Virus
Various estimates of HCV prevalence in the US population place the number of infected individuals (as defined by anti-HCV antibody positivity) at between 4.1 and 5 million. Of these, 3.2–3.4 million are chronically infected.
During the first 10–20 years of infection HCV-infected individuals generally experience asymptomatic or mild illness, which explains why an estimated 75% of infections remain undiagnosed in the United States.
Despite a decline in the number of new US cases of HCV infection from a peak of an estimated 262,000/year in 1986 to 17,000/year in 2007, the prevalence of individuals infected with HCV for more than 20 years is expected to continue to increase until 2015.
In the National Health and Nutrition Examination Survey (NHANES; 1999–2002), patients aged 40–49 years accounted for 66% of American HCVinfected patients, and the prevalence of HCV infection in the United States was 2.7 times higher among 40- to 49-year-olds than the general population. This "baby boomer" generation is particularly susceptible to blood-borne HCV transmission as a result of an increased lifetime risk of injection drug use (IDU), blood transfusion before 1992, or sexual activity with ≥20 partners, compared with older or younger patients.
The prevalence of HCV infection varies by age, sex, and race/ethnicity, and early identification of at-risk individuals through routine questioning by clinicians is critical, because management options are limited in late-stage disease.
Given the high prevalence of HCV infection among 40- to 49-year-olds and that Americans are now expected to live into their mid-70s or beyond, the incidence of complications of HCV infections can be expected to further increase in coming years. In fact, from 1995–2004, US HCV-related mortality already increased 123% from 1.09/100,000 to 2.44/100,000 persons, although this study has some limitations.
Furthermore, the proportion of CHC patients in the United States with cirrhosis is projected to rise from 25% in 2010 to 45% in 2030. Projections also estimate that without effective treatment, the annual number of US patients with cirrhosis, hepatic decompensation, or HCC will roughly double by 2020, and liver-related deaths will almost triple.
Although not all data agree with these estimates, several studies have suggested that HCV infection could have a deleterious effect on population mortality rates and life expectancy. HCV increased the risk of death in several analyses, irrespective of comorbidities such as coinfection with human immunodeficiency virus (HIV) or hepatitis B virus (HBV) and even after adjustment for alcohol consumption.
Furthermore, numerous studies and a Cochrane review indicated that achievement of an SVR through effective antiviral therapy can significantly reduce mortality in patients with chronic HCV.
If all HCV-infected patients were treated with currently available treatment in 2010, (Update 2011-2012 FDA approved Telaprevir,Boceprevir) liver-related HCV-associated deaths could be reduced by 36% by 2020, whereas antiviral treatment rates are currently declining. Improvements in diagnosis and treatment are therefore necessary to reduce the associated public health burden
After 30 years of infection, an estimated 15%–35% of patients will develop cirrhosis (5-year survival, 75%–80%);after 40 years, up to 60% could have cirrhosis.
Continue Reading...
Where Can You Find An Easy To Understand HCV Web Site With Accurate Information ?
HCV Advocate is the go to site for all your questions, filled with information, news, HeathWise articles, fact sheets, new drugs currently in the pipeline, clinical trials, and a monthly newsletter.
The Links
HeathWise articles found in the in the HCV Advocate Newsletter
Fact Sheets HCV Drug Pipeline News Updates Clinical Trials Hepatitis C
]
Next up, what about the disease progression of hepatitis C ?
By Alan Franciscus, Editor-in-Chief Of HCV Advocate
Disease progression
(HCV) is highly variable, which means that it is difficult to tell
who will and who will not have severe HCV disease progression.In general about 80% of people
with chronic hepatitis C will have a slow rate of disease progression
that may not lead to serious complication.
The other 20% of people with chronic hepatitis C will have
severe disease progression that could lead to complications such
as severe fibrosis, cirrhosis, liver failure, liver cancer and death.
The question that has vexed us all is why some people with HCV
have serious disease progression while others only have mild progression.
Although we are far from completely understanding and
answering this important question there is information available about
some of the factors that will likely increase the risk for serious HCV
disease progression. This article will discuss the various factors that
increase the likelihood of disease progression and steps we can all
take to minimize these effects – at least for those factors over which
we have some control.
,
ALT Levels
Alanine aminotransferase or ALT (previously called SGPT) is
a chemical produced in the liver.
ALT levels are elevated when liver cells are inflamed, damaged, or
destroyed by HCV, HBV, alcohol and certain drugs.Persistently elevated ALT levels
are more of a sign that there is ongoing damage to the liver,and, if elevated over a
long period of time, indicate ongoing fibrosis progression. But it is important to know
that people with persistently normal ALT levels can also have fibrosis progression, although
the risk is much lower.
2012 - Clinical Features of Hepatitis C Virus Carriers With Persistently Normal Alanine Aminotransferase Levels
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Inflammation
The amount or degree of inflammation in the liver roughly
correlates with the development of fibrosis and cirrhosis. The amount
of inflammation can be reduced by taking HCV medical treatment
and avoiding any substance that causes harm to the liver, such as
alcohol, etc.
,
Fibrosis/Cirrhosis
Light, moderate, or severe scarring of the liver (fibrosis) can eventually
lead to even more severe scarring of the liver called cirrhosis.
The damage caused by hepatitis C is not linear – this means that once
fibrosis and cirrhosis start to develop, the progression of liver disease
speeds up. In other words, it may take 10 years to progress
from one degree or stage of liver damage to another, but the next
increase in the amount of damage may take less time – say 7 years.
Progression to the next stage may only take 5 years and so forth.
HCV treatment can help to reduce, slow down or stop the disease
progression progress especially if HCV treatment is successful.
Lifestyle changes can also help the liver to stay healthy by maintaining
a healthy weight, eating a healthy diet, avoiding alcohol and drugs,
moderate exercise, stress reduction, etc.
,AGE
Age plays a critical role in HCV disease progression. The age at
the time that someone acquired HCV plays an important role in
disease progression – so the older you are when you acquire HCV
the faster the disease progression.
This is because the body’s immune system doesn’t work
as well to minimize the damage HCV causes. On the other hand,
if someone acquires HCV at an early age, as they get older the
greater the chances of more severe disease progression due to the accumulation
of damage over time.
For instance, some studies have found that people over 60 years old
have a quicker disease progression and other studies have found that
having HCV for 25 years or longer increases the chances of disease
progression.
,
Steatosis
Fatty liver or steatosis can contribute to lower HCV treatment
response and a faster rate of HCV disease progression. The cause
of steatosis in most people with HCV is a synergistic effect of thevirus,
poor diet and lack of exercise. If you are HCV genotype 3,
however, steatosis is most likely caused by the hepatitis C virus.
For example, in people with genotype 3 who are successfully treated
with HCV medications steatosis has been found to be decreased
or eliminated. This is not true of steatosis in people with HCV non-3
genotype.
For most people, steatosis can be prevented and even reversed by
the simple, but not so easy, methods that we all struggle with – a
healthy diet and exercise program.
We recommend that anyone who undertakes a diet and exercise
program consult with a medical provider and experts in the field of
diet and exercise.
Unfortunately,these tools are not available to
everyone; but there are still many avenues and resources open to
become even healthier. On the internet there is a wealth of diet
and exercise sites to help.
,Marijuana
There have been some studies that have found that regular daily
use of marijuana can significantly increase the risk of fibrosis progression.
There is a caveat, however, about the data that has surfaced.
The studies have been self-disclosure studies that are typically extremely
difficult to gauge as to how truthful people may answer questions
about how much they smoke.
But the most important factor is that it is impossible to measure the
concentrations of THC (the active ingredient in marijuana) that the
participants were smoking. Interestingly,
the studies that report that daily marijuana causes significant
fibrosis progression also report that non-daily use of marijuana did not
accelerate fibrosis progression. The bottom line – more is not better
when it comes to many issues including using marijuana.
.
Cigarettes
I don’t think anyone these days would be surprised to learn that
smoking cigarettes causes many health-related problems including
increasing the chances of fibrosis progression and liver cancer.
.
ALCOHOL
Another no-brainer is that alcohol consumption can increase
fibrosis and cirrhosis progression.
Excessive alcohol consumption – in and of itself – can lead to cirrhosis,
liver failure and liver cancer. If both of the negative effects, alcohol and
HCV, were combined I think it’s easy to see why people with HCV
should avoid alcohol. If someone has trouble stopping, they should
cut back on the amount of alcohol they drink and get help to stop.
There are many effective programs to help people stop drinking.
Metabolic Syndrome
In the last decade the relationship between metabolic disorders
and fibrosis progression has been well-documented. Metabolic disorders
are a group of conditions that increase the likelihood for
cardiovascular disease and other health problems.Components of
metabolic syndrome include:
• Abdominal obesity
• High blood cholesterol and
high triglycerides
• High blood pressure
• Insulin resistance
• State of inflammation caused
by obesity, insulin resistance,
etc.
• Prothrombotic state – increased
platelets
Although there are different components that define metabolic
syndrome they are also interconnected interconnected
especially with obesity.
Obesity and insulin resistance are the two factors that stand out as
factors that increase fibrosis progression.
A simple tool to measure insulin resistance is the HOMA-IR
– the higher the score, the higher the degree of insulin resistance.
The higher the HOMA-IR score, the more rapid fibrosis progression
is.
.
Many of the factors of metabolic syndrome can be treated with
lifestyle changes (diet, exercise, stress reduction) and medications
to control diabetes, high blood pressure, cholesterol, etc.
For More on HCV
http://www.hcvadvocate.org/
Transmission Of Hepatitis C
How is hepatitis C spread? Who's at risk?
Hepatitis C virus (HCV) is transmitted through contact with an infected person's blood.
The following list outlines sources of hepatitis C transmission
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-Sharing needles and syringes (IV drug abuse);
-Other possible risk behaviors: tattoos, body piercing, living and medical care in a developing country, folk medicine, intranasal cocaine;
2012 - Amateur tattoos carry hepatitis C risk
IV User-Worried About HCV ? Check This Out
-Extensive surgical procedures
-Unknown--up to 5% of patients have no identifiable risk factors;
-Sexual transmission is rare; the risk of sexual transmission to an individual is probably less than 3% when a person is in a stable monogamous relationship;
-Vertical transmission from mother to baby;
-Reused needles in a medical or health care setting.
Related:Hepatitis transmission risk needs to be studied in nail salons, barbershops
Is hepatitis C transmitted sexually?
According to studies in the Journal of the American Medical Association, a low sexual transmission rate of hepatitis C was suggested. Of the 62 patients studied, none of the monogamous heterosexual partners had developed the hepatitis C antibody. In general, the probable risk of heterosexual transmission of hepatitis C is less than 3%.
It is recommend that all patients in a non-monogamous relationship use a condom or spermicide and patients in a monogamous relationship use a barrier method only if they are anxious or concerned about transmission.
All non-monogamous individuals should use safe sex practices.
For patients with hepatitis C, testing of spouses, babies and significant others is recommended by Centers for Disease Control(CDC). Please discuss these issues with your physician.
The Sexual Transmission of Hepatits C In The HIV Population
2011 - Hepatitis C Transmitted by Unprotected Sex Between HIV-Infected Men
Is hepatitis C transmitted by breast milk to infants?
There is no substantial evidence that hepatitis C is transmitted through breast milk, however, a few studies have been performed that tested breast milk and very rarely is hepatitis C found in the breast milk--even using the most sensitive tests such as PCR. The CDC has issued a statement explaining that mothers who have HCV can breast feed, but should avoid it if there are sores around the nipple.
Can hepatitis C be transmitted to other members of my family (household contacts)?
There is a slight risk of hepatitis C transmission among household contacts, so family members should not share items such as razors or toothbrushes that may transmit blood or secretions. Women who have hepatitis C and are menstruating as well as men or women with hepatitis C and sores in the genital area should avoid sexual contact. The CDC recommends that spouses or partners of a hepatitis C patient be tested for hepatitis C.
Can a pregnant woman give hepatitis C to her baby?
A report in New England Journal of Medicine suggested a 7% transmission rate of hepatitis C from mother to child at birth. Though this is a high estimate, the possibility of transmission must be considered when a woman with hepatitis C is deciding whether to have children.
For infants who have received the hepatitis C virus from their mother, brief elevations of liver enzymes may occur, but no chronic liver disease has been reported. There have been no reports of cirrhosis in newborns, infants or child due to mother-to-child hepatitis C infection. It is recommended that all babies born to mothers with HCV be tested annually until age three with antibody tests.
HCV In Pregnancy
Women with AIDS and hepatitis C are at high risk for transmitting the virus to their babies, and research has shown that these women consistently transmit the virus to their babies at birth.
Is hepatitis C transmitted by insects?
There is no documented transmission of hepatitis C through insects. The virus, however, is related to a group of viruses including yellow fever and Dengue, and those are known to have been spread by insects.
Related - Hey Can I Get Hepatitis C From...............
Exams and Tests
The following tests are done to help diagnose hepatitis C:
Learn more here
Related - Hey , I Have A Question About HCV Tests
Diagnosis of HCV infection is based on the detection of anti-HCV antibodies by enzyme immunoassay.
Anti-HCV test detects the presence of antibodies to the virus, indicating exposure to HCV. This test cannot distinguish between someone with an active or a previous HCV infection. Usually, the test is reported as "positive" or "negative." There is some evidence that if the test is "weakly positive," it may be a false positive. The Centers for Disease Control and Prevention (CDC) suggests that weakly positive tests be confirmed with the HCV RIBA test before being reported.
HCV recombinant immunoblot assay (RIBA) test is an additional test ordered to confirm the presence of HCV antibodies. In most cases, it can tell if the positive anti-HCV test was due to exposure to HCV (positive RIBA) or represents a false signal (negative RIBA). In a few cases, the results cannot answer this question (indeterminate RIBA). Like the anti-HCV test, the RIBA test cannot distinguish between a current or past infection.
Can you have a "false positive" anti-HCV test result?
Yes. A false positive test means the test looks as if it is positive, but it is really negative. This happens more often in persons who have a low risk for the disease for which they are being tested. For example, false positive anti-HCV tests happen more often in persons such as blood donors who are at low risk for hepatitis C. Therefore, it is important to confirm a positive anti-HCV test with a supplemental test as most false positive anti-HCV tests are reported as negative on supplemental testing.
Can you have a "false negative" anti-HCV test result?
Yes. Persons with early infection may not as yet have developed antibody levels high enough that the test can measure. In addition, some persons may lack the (immune) response necessary for the test to work well. In these persons, research-based tests such as PCR may be considered. . How long after exposure to HCV does it take to test positive for anti-HCV? . Anti-HCV can be found in 7 out of 10 persons when symptoms begin and in about 9 out of 10 persons within 3 months after symptoms begin. However, it is important to note that many persons who have hepatitis C have no symptoms..
Hepatitis C RNA assays to determine virus levels (called viral load)
Viral Load Test
How long after exposure to HCV does it take to test positive with Qualitative HCV RNA test =PCR?
It is possible to find HCV within 1 to 2 weeks after being infected with the virus
Unlike antibody tests, HCV RNA tests directly measure for the presence of the hepatitis C virus. HCV RNA tests may be qualitative or quantitative.
Qualitative HCV RNA tests are used to diagnose hepatitis C. Your doctor might choose to perform an HCV RNA test instead of the ELISA, especially if you are at high-risk for hepatitis C. The HCV RNA test will be positive in as little as 1 to 2 weeks after exposure.
A positive HCV RNA test means a person has hepatitis C infection.
Quantitative HCV RNA tests allow your doctor to determine exactly how much virus is in the blood. This is referred to as the viral load.
The viral load is usually expressed as units per milliliter or copies per milliliter. In patients with chronic hepatitis C infection, viral loads vary widely from 50,000 to 5 million copies per milliliter. A higher viral load may not necessarily be a sign of more severe or more advanced disease but it does correlate with likelihood to respond to treatment. HCV RNA tests can also be used to monitor response to hepatitis C treatment. For example, if the viral load decreases during treatment, this suggests that treatment is working and should be continued, referred to as response guided treatment . Conversely, if the viral load remains the same, it suggests that the patient is not responding to treatment.
On-Treatment Predictors of Response
Once hepatitis C virus (HCV) treatment is started, initial viral kinetics are helpful in predicting treatment outcome. Patients who have cleared the virus by Week 4 of therapy, whether with protease inhibitor (PI)–based triple therapy or with peginterferon/ribavirin alone, are very likely to achieve sustained virologic response (SVR). By contrast, those who still have detectable HCV RNA (virus) levels by Week 12 of therapy have very low likelihood of obtaining SVR
Viral Load - Familiar Treatment Terms
Response guided treatment-
Or viral load monitoring during treatment is intended to enable the physician to determine the duration of combination therapy based on a patients viral response.
Terms Used In Response guided treatment
(RVR)-Rapid Viral Response; Is an undetectable viral load four weeks into treatment. In SOC-standard therapy if you have an RVR your chance of cure is better than 78% and 92% and your doctor may recommend that you shorten your treatment.
(cEVR) Complete early viral response- Is an undetectable viral load 12 weeks into treatment. If you have a complete EVR you have a good chance of being cured .
(pEVR) Partial early viral response - A drop in viral load of at least 2-log (e.g. from 600,000 IU/mL down to 6,000 IU/mL) at 12 weeks of treatment, but still detectable virus in your blood. In people with genotype 1 the chance of viral clearance is low and treatment is generally stopped.
(non-EVR) Non-response- No significant drop in viral load in the first 12 weeks of treatment.
What Is A 100-fold reduction in viral load ?
Changes in viral load are sometimes expressed in terms of logs: a 1-log change means a 10-fold increase or decrease; a 2-log change is a 100-fold increase or decrease.
What Is A 2 Log Drop?
Example: 2 log drop = 15,000,000 IU/Ml to 150,000 IU/mL; a viral load that starts at 15,000,000 IU/mL and does not decrease to 150,000 IU/mL or lower.
Terms Used To Define Patienst
Naïve- No prior treatment/first time treating HCV.
Relapsers- People whose viral load drops to an undetectable level with treatment but rises again after treatment ends.
Partial responders- People who have at least a 2 log10 (100-times) drop in viral load, but do not reach undetectable levels in the blood by week 24.
Null responders- People who failed to reduce their viral load by at least 2 log10 (100 times) after 12 weeks of prior treatment, which is the currently recommended Food and Drug Administration (FDA) definition for clinical trials of investigational hepatitis C treatments.
Protocol for both Telaprevir and Boceprevir can be found by clicking on the link below:
A Practical Guide for the Use of Boceprevir and Telaprevir for the Treatment of Hepatitis C
Quick Facts Victrelis-boceprevir, Incivek-telaprevir
Genotype-Test
- Viral genotyping is used to determine the kind, or genotype, of the HCV virus present. There are 6 major types of HCV; the most common (genotype 1) is less likely to respond to treatment than genotypes 2 or 3. Genotyping is often ordered before treatment is started to give an idea of the likelihood of success and how long treatment may be needed.
A better understanding of Genotypes
The following tests are done to identify and monitor liver damage from hepatitis C:
Liver function tests
Albumin level
Prothrombin time
A better understanding of Liver Function Tests
. Will I need a Liver Biopsy ?
According to your genotype some doctors may want you to have a liver biopsy, although at this time most often noninvasive tests are used to measure liver damage.
Based on the abundant literature in chronic hepatitis C, alternative, non-invasive methods can now be used instead of liver biopsy in patients with chronic hepatitis C to assess liver disease severity prior to therapy at a safe level of predictability.
Great Article : Liver Biopsy and Noninvasive Tests For Fibrosis
HEPATITIS C SYMPTOMS
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When you are first exposed to the hepatitis C virus and become infected, you are said to have "acute hepatitis C". Most people have no symptoms of infection during this time.
In 70 to 80 percent of people, the infection becomes chronic. The word "chronic" implies that the infection will be prolonged, or even lifelong, unless you get treatment that cures the infection.
Many people with chronic hepatitis C have no symptoms, even if there is serious liver damage. Of those who do develop symptoms, the most common symptom is fatigue; other less common symptoms include nausea, lack of appetite, muscle or joint aches, weakness, and weight loss.
Also See :Symptoms .
Treating Hepatitis C - Whats New?
HCV Drugs In Development
Hepatitis C New Drug Pipeline New drugs in development for the treatment of hepatitis C
Interferon Free ?
Curing Hepatitis C
With a combination of a nucleoside and a polymerase inhibitor, Gane and colleagues[6] have shown a high rate of success in suppressing hepatitis C virus (HCV) to undetectable levels in 14 days without the need for peginterferon and ribavirin. Although based on limited sample size and long-term follow-up, these findings represent enormous progress in the field of hepatitis C treatment.
The standard treatment for the most common and difficult to treat form of HCV infection, genotype 1, has been peginterferon plus ribavirin. Cure was achieved in only 30%-40%, and toxicity was often severe, but this combination represented the state of the art for many years until telaprevir and boceprevir were approved by the FDA in May 2011. These protease inhibitors substantially augmented the probability of achieving "sustained viral response" (indicating cure) when added to peginterferon plus ribavirin. The INFORM-1 trial suggests that we will be able to achieve this goal with greater success and far less toxicity within 1-2 years with the avalanche of these and other new drugs that are currently being tested.[7]
INFORM-1 study was the first several years go by Roche to examine interferon-free therapy, involved a combination of an NS5B polymerase inhibitor (RG7128) and an NS3/4A protease inhibitor (danoprevir).
Why Is This a Game Changer?
Drug development for HCV is exploding. At present, new drugs for HCV include 4 agents in phase 3 and 2 agents in phase 2 FDA testing. Although these new drugs are clearly "game changers" for patients with hepatitis C, their use is restricted to specialists as a result of the complexity of the regimens, toxicity, resistance issues, drug interactions, and cost.
In contrast to treatment of HIV or hepatitis B, the goal of hepatitis C treatment is a cure. With the 2 recently approved protease inhibitors (telaprevir/boceprevir), a cure is likely to be achieved in more than 70% of patients, and in almost all patients when the new drugs in the pipeline become available. Nevertheless, economics will be an issue because current costs of treatment are $50,000-$70,000/patient.
What Does This Mean to the Practitioner?
- About 1% of people in the United States (approximately 300,000 individuals) are infected with hepatitis C, and 70% of these people do not know they are infected. It will be important to screen patients with HCV antibody serology and evaluate those who are positive with liver function tests, genotyping, and HCV viral load, all tests that are readily available.
- The decision for treatment depends on results of baseline tests and confounding issues such as substance abuse, mental health, and other comorbidities. These issues can be resolved at the primary care or specialty level.
- Decisions about who to treat must take into account the stage of the patient's disease because it is likely that the newer drugs that are anticipated for 2012-2013 will more effective, less toxic, and possibly less expensive. The urgency of treatment typically depends on the liver fibrosis score, which predicts the consequences of a delay in treatment. It is probably wise to urge patients who can delay therapy for 1-2 years to wait.
Links
Direct acting antivirals for the treatment of chronic hepatitis C: one pill a day for tomorrow
The end of the beginning for hepatitis C treatment
Interferon Free Therapies
New FDA Approved Treatments For Hepatitis C
Feb 2012-Patients’ Expectations About New HCV Direct-Acting Antivirals Often Unrealistic
FDA Transcripts Telaprevir/Boceprevir April Advisory Committee Meeting
Telaprevir FDA Approved
FDA Approves Telaprevir/Incivek For Hepatitis C
Telaprevir/Incivek Prescribing Information
Medication Guide
Boceprevir FDA Approved
Vicrelis/Boceprevir IS NOW FDA Approved May 13 2011
VICTRELIS™- Boceprevir: Prescribing Information and Medication Guide
Patient Assistance Program
INCIVEK/Telaprevir and VICTRELIS (Boceprevir) Patient Assistance Programs
Medication Guides;
Peginterferon alfa
Ribavirin
Telaprevir-Incivek and Boceprevir-Victrelis - Side Effects
Standard therapy-Pegylated Interferon Alfa and Ribavirin is used along with both protease inhibitors, information on adverse effects of standard therapy are also included
Side Effects: Peginterferon and Ribavirin
How Do I Take Incivek-telaprevir ?
Included in the information will be the dosing regimen for Incivek in combination with pegIFN/RBV, and a list of drugs that could cause drug interactions if used while taking the combo.
Clinical Trials-
To learn more about Hepatitis C virus clinical trials or to find out if a study is enrolling patients in your area, please click here.
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Questions for a specialist
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It's important to keep an open dialogue with your doctor, especially when it comes to understanding your treatment options, and how your body is responding to the therapy.
.
The following list of questions may be helpful to print and take to your appointment:
What is my genotype and how does it impact my therapy?
What is my viral load and how does it impact my therapy?
What are my expected outcomes with treatment?
What are my expected outcomes without treatment?
Do I have any other conditions that will complicate treatment?
What changes should I make in my everyday life?
What is the most important information I need to know before starting treatment?
What should I do next?
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A specialist can help determine whether treatment is right for you.
Ask your doctor to recommend one today; your chances for recovery may be better than you think.
What Is A Hepatologist ? What Is A Gastroenterologist?
Hepatitis C-Related Conditions
Conditions associated with the hepatitis C virus
Links To More Information
These links will take you to the premier Hepatitis C sites and keep you informed with breaking news, clinical studies, new drugs, podcasts, newsletters, support, personal experiences and more.
A few updates
2012
What is Killing People With Hepatitis C Virus Infection?
2011
Chronic hepatitis C doubles the normal risk of dying early from any cause, a new study shows.
Prevalence and Challenges of Liver Diseases in Patients with Chronic Hepatitis C Virus Infection
What About Liver Health?
Advance Liver Disease What Every HCV Treater Should Know
Hepatitis C and Liver Health-Getting It Right In 2012
Hepatitis C - Five Ways You Can Take Care of Your Liver
AASLD-The Mediterranean Diet Improves Liver Health
Getting Ready For Treatment
Treating Hepatitis C; Improving Your Shot At A Cure