Chronic hepatitis C has devastating health implications for sufferers, and society at large. An estimated 3.2 million Americans are infected with the hepatitis C virus (HCV), the vast majority of whom are baby boomers (born between 1945 and 1965).
The older treatments for hepatitis C virus (HCV) had about a 40 percent cure rate and a list of side effects (flu-like symptoms, extreme fatigue, depression and low white blood cell counts) that sufferers deemed worse than the disease. As a result, treatment was often not completed and therefore the disease went untreated, putting others at risk.
Today there are several prescription anti-viral drugs available with cure rates of 94 to 99 percent and minimal side effects. The downside is that these drugs are extremely costly (more than $83,000 for a 12 week dose).
Hepatitis C Explained
Hepatitis C is a contagious liver disease that is spread through contact with blood from an infected person. It can be acute, a short-term illness occurring within six months of exposure, or chronic, a long-term infection that can lead to serious liver disease such as cirrhosis, liver cancer and liver failure. Acute infection leads to chronic disease in 75-85 percent of cases. Most commonly, people become infected by sharing needles or other equipment used to inject drugs, but others can be at risk too (see box). Though less common, it is possible to become infected through sexual contact with a person with HCV and by sharing razors or toothbrushes that have come in contact with an infected person’s blood.
HCV is a sly disease since about 75 percent of people do not have any symptoms. That means the majority of people with HCV do not know it because they do not look or feel sick, and can unknowingly spread it to others. If symptoms do occur, they appear anywhere from two weeks to six months after exposure. Symptoms can be mild or severe and may include fever, fatigue, loss of appetite, nausea, vomiting, dark urine, clay-colored bowel movements, joint pain and/or jaundice (yellow color in the skin or eyes).
Who is at Risk for Hepatitis C Infections?
- Current or past injection drug users, even if done only once and long ago.
- Recipients of blood products or organs prior to 1992 when screening the blood supply became routine.
- People with tattoos or body piercings performed with non-sterile instruments.
- Healthcare workers injured by needle sticks.
- Those with HIV.
- Babies born to infected mothers.
Blood tests are used to screen for hepatitis C and screening is recommended for those with symptoms and/or risk factors for the disease (listed above).
How is It Treated?
For about 15 to 25 percent of people with acute HCV, the infection will clear on its own without treatment. However, if acute disease is diagnosed, treatment does reduce the risk that it will become a chronic infection.
There are different types of HCV called genotypes with the most common being genotype 1. The newest medications with high cure rates are marketed as Sovaldi, Harvoni and Viekira Pak. Viekira Pak and Harvoni have been approved for treatment of genotype 1. Sovaldi is used in combination with other medications for the treatment of genotypes 1, 2, 3 and 4. Treatment length can range from 8 to 24 weeks and depends upon genotype and whether other disease (such as cirrhosis) is present.
A person with HCV needs to take special care of their liver. It is important to seek care from a healthcare provider experienced with the disease and to be monitored regularly. Alcohol can cause additional liver damage, as can some prescription and over-the-counter medications and supplements. Currently, there is no hepatitis C vaccine, and those with the infection should inquire about the safety of being vaccinated against hepatitis A and B.
With costs for these new medications ranging on average from $83,319 to $94,500, it’s easy to have sticker shock. Some insurers require prior authorization for these prescriptions and/or that less expensive options be tried first, particularly for patients with less severe disease. Pharmaceutical companies offer financial assistance programs and other support services for those seeking treatment. Harvoni, for example, has a Co-Pay Coupon Program and provides specialists who will help patients navigate the insurance coverage process.
While these medicines hold promise as a cure for HCV, they are not recommended for use by people with end-stage kidney disease or advanced cirrhosis. They have significant negative interactions with some common medications, including anticonvulsants, acid reducers, heart drugs, and even the supplement, St. John’s Wort. It is also important to know that the medications have not yet been tested for use among pregnant women, nursing mothers and children.
As with all health conditions, patients are encouraged to discuss the pros and cons of all their treatment options with their provider. If you or someone in your family is facing the challenges of hepatitis C infection, know that KnovaSolutions is a source for additional information and support. Let us know how we can help! Call 800/355-0885.
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