Hepatitis

HEPATITIS C

Hepatitis C is a liver disease caused by the hepatitis C virus. In most cases no symptoms are present. However in severe cases the patient may experience scarring of the liver (cirrhosis) leading to liver failure and liver transplant. There are various ways Hepatitis C is transmitted.  The most common occurs from blood contact with an infected person, intravenous drug use, and unprotected sexual contact with someone who is already infected. In rare cases a mother who has Hepatitis C can pass it to her unborn fetus. Diagnosis is done through an antibody test and viral load which determines the amount of virus in the blood.

There are two phases that can occur with hepatitis, acute or chronic. Acute Hepatitis is short-term with little or no symptoms. Some patients with acute hepatitis may experience yellowing of the skin (jaundice) that goes away.  In some cases, people may be able to clear the virus on their own. Chronic Hepatitis often causes no symptoms, but the virus is reproducing in the blood.

Hepatitis C does not always require treatment. However, regular monitoring is recommended. Careful screening is performed before starting treatment to determine the type of virus strain, medications prescribed, length of treatment and cure rate expected. Strict compliance and adherence is required when a patient is receiving therapy as adherence best determines the need for future therapies.

New London Specialty Pharmacy provides an adherence program that effectively promotes a team effort between the pharmacists and healthcare providers to promote health through education, refill assessments, counseling, specialized packaging, side effect management and referral to peer support groups to improve and manage patient’s treatment goals.  New London Specialty Pharmacy effectively promotes a team environment between the pharmacists and the patient’s provider.  Our pharmacists continuously strive to establish an integrated approach to the Hepatitis C patient that balances symptom management with adequate medication use.

Hepatitis C Q&A

1.      What is HCV?

a.      HCV, or the Hepatitis C virus, is a blood-borne virus that mainly affects the liver.  HCV causes inflammation of the liver, or hepatitis.

2.      How common is Hepatitis C?

a.      There are 130-150 million people chronically infected with Hepatitis C worldwide; 2.7 million in the US. The most recent survey of active injection drug users (IDUs) show that approximately 1/3 of IDUs aged 18-30 years are HCV-infected, which is lower than older and former IDUs due to improved education on clean needle use.

3.      How is Hepatitis C transmitted?

a.      Hepatitis is transmitted via blood to blood transfer or by blood-derived body fluids.  HCV can be spread by sharing used toothbrushes, razors, or needles.  Risk factors for HCV transmission include injection drug use, having multiple sexual partners, tattoos, and birth from an HCV-infected mother.  HCV cannot be spread by sweat, tears, urine, or breastmilk.

4.      Can Hepatits C be sexually transmitted?

a.      Yes, activities that increase the risk of sexual transmission include:  having multiple sexual partners, having another sexually transmitted infection, having HIV, engaging in rough sexual intercourse, and failure to use or improper use of a condom.  Persons with Hepatitis C should be honest with all sexual partners, use latex or polyurethane condoms, avoid sexual contact if an open cut or wound is present around the genitalia, and have their partners regularly tested.

5.      What is the progression of Hepatitis C in an infected individual?

a.      Once infected with Hepatitis C, the virus will go into an incubation state for a couple of weeks to months.  After the incubation period, the patient will get acute infection which can be with or without symptoms.  About 20% of patients infected with Hepatitis C will fight off the virus on their own; the other 80% will develop chronic infection.  This chronic infection can lead to liver cirrhosis, or scarring of the liver, in 20% of cases.  Cirrhosis can lead to a carcinoma of the liver; cancer occurs in 1-4% of individuals.  In cases of cirrhosis or carcinoma, liver transplant may be indicated.  This entire process takes around 20 years.

6.      How can Hepatitis C affect my body?

a.      Although the Hepatitis C virus only attacks the liver, without a functioning liver, many other organ systems cannot function properly.  Fat cannot be properly digested causing inflammation of the gallbladder and pain, glucose cannot be stored causing diabetes, bile cannot be broken down causing jaundice, toxins cannot be filtered leading to damage to the central nervous system, and blood cannot flow properly leading to internal bleeding.

7.      What should I change about my daily activities if diagnosed with Hepatitis C?

a.      Alcohol and tobacco intake should be minimized if not eliminated due to their harmful effects on the liver.  Patients with Hepatitis C should avoid IV drug use, donating blood, and sharing personal care items to reduce risk of transmitting to another patient.  People with Hepatitis C should also cover all cuts and sores and avoid starting over-the-counter medications without consulting their pharmacist or physician.  Patients should be vaccinated against Hepatitis A and B as well.

8.      Do I need to adjust my diet now that I have been diagnosed with Hepatitis C?

a.      A good diet can improve liver health in patients with Hepatitis C, as well as help prevent other disease states caused by cirrhosis.  People diagnosed with Hepatitis C should eat at least 3 balanced meals a day.  Each meal should include whole-grains, fruits, vegetables, low-fat dairy products, and healthy protein sources. Healthy protein sources include low-fat dairy products, lean meats, fish, nuts, beans, and eggs.  It is also important for Hepatitis C patients to avoid a few things in their diets.  Saturated fat, or animal fat, salty foods, sugary foods, and alcohol should be avoided.  As for vitamin and mineral supplements, Hepatitis C patients should always consult their physicians before starting supplements.  This is due to the accumulation of some vitamins and minerals in the body that occurs as a result of having a diseased liver.  Excess vitamins and minerals can cause toxicities that can be dangerous.

9.      What are the symptoms of Hepatitis C?

a.      Many patients will not have symptoms until they develop a chronic infection and liver failure.  However, if patients do develop symptoms during a Hepatitis C infection, they can expect fever, fatigue, dark urine, clay-colored stool, loss of appetite, nausea, vomiting, abdominal pain, joint pain, and jaundice.

10.   How is Hepatitis C screened and diagnosed?

a.      HCV can be screened for by looking for anti-HCV antibodies in your blood using an enzyme immunoassay (EIA). Anti-HCV antibodies are immune cells made by your body to fight off the infection, it takes 4-6 weeks after being infected with Hepatitis C to develop these antibodies.  If anti-HCV antibodies are present, then a nucleic acid test for HCV RNA is done.  This test checks to see whether or not the Hepatitis C virus is present; if it comes back negative, then your body fought off the infections and you do not have Hepatitis C.  If a person is diagnosed with Hepatitis C, further laboratory tests will be done to identify the genotype of the Hepatitis C strain present which helps to guide therapy.

11.   Who should be screened for Hepatitis C?

a.      Current or past injection drug users, HIV infected persons, hemodialysis patients, persons with multiple sex partners, individuals who received a blood transfusion or a transplant before 1992 (HCV screening became available in 1992), people accidently stuck by a used needle, or people with unexplained liver disease.

12.   Who should receive treatment for Hepatitis C?

a.      Treatment is recommended for patients with chronic HCV infection.  People who have the highest priority for treatment include those with liver cirrhosis, organ transplant recipients, or those with nephrotic syndrome.

13.   What are some treatment options for Hepatitis C?

a.  Some medication options include but not limited to Harvoni  http://www.harvoni.com and Viekira https://www.viekira.com . The medication(s) you receive for your Hepatitis C infection depends on the genotype you are infected with.  These antiviral medications treat 50-90% of patients which prevent cirrhosis and liver cancer.  If a Hepatitis C infection goes untreated or medication therapy fails, the liver damage done can warrant a liver transplant.  Speak with your provider today for questions regarding proper therapy.

14.   What are some of the side effects of the Hepatitis C medications?

a.  Side effects may vary depending on therapy, comorbidities and individual. Although, some medication(s) can cause flu-like symptoms, depression, suicidal thoughts, fatigue, headache, muscle aches, insomnia, nausea, and diarrhea.

15.   What are the benefits of the Hepatitis C medications?

a.      With the development of the new Hepatitis C medications patients can be cured of the virus 90-99% of the times.

16.   Will a liver transplant cure me of the HCV infection?

a.  Cirrhosis due to chronic hepatitis C infections has become one of the leading causes of liver transplantation. Although, a liver transplantation will restore the function of the liver, it will not completely cure you of the HCV infection.  Recurrent HCV infection commonly occurs in new liver transplants.  Liver transplantation is an effective means of restoring normal liver function to a Hepatitis C patient with end stage liver disease, but not every patient with end stage liver disease will qualify for this procedure.  It is important to regularly see your physician while infected the Hepatitis C virus so that your liver function can be monitored and assessed for transplantation.

17.   Is there a vaccine available for Hepatitis C?

a.   Currently there is no vaccine for Hepatitis C, but research into the development of a vaccine is under way.

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