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Hep C treatment
Alternative access to treatment
What is meant by the terms “response” and “cure”?
Hep C antiviral treatment involves pills each day and one injection a week. The pills are ribavirin and the injection is pegylated interferon. It is usually called combination treatment but is marketed under the names Pegatron and Pegasys RBV. Interferon is a drug that helps your body to defend itself against infections. Ribavirin is a drug which reduces hep C’s ability to replicate (multiply).
Improvements in treatment drugs have led to a better chance of your hep C being cured, but there is usually no need to make a rushed decision about starting treatment. You may want to take some time to chat with your doctor, specialist and treatment nurses, and family members or friends. If your choice is to proceed with treatment, it should start at a time that best suits your lifestyle and plans.
The cure rate for combination treatment depends on your hep C genotype:
- If you have genotype 1, you are given 12 months of treatment and have a 50% chance of cure
- If you have genotypes 2 or 3, you are generally given six months of treatment and have an 80% chance of cure
To be cured, you have to clear the hep C virus from your blood. Doctors refer to this as a sustained viral response. To see whether you have cleared the virus, PCR blood tests are done at the end of treatment and then repeated six months later. You have cleared your hep C if both tests are negative. In this case, your blood is very unlikely to be infectious (no risk of transmitting hep C) and you would probably see a reduction in symptoms of illness.
You are less likely to be cured with combination treatment if you have cirrhosis but even if treatment doesn’t work, it may still be of benefit as it can slow down liver damage. If you do have cirrhosis and successfully clear the virus, it is likely your liver will gradually repair itself, though probably not completely. You should continue seeing your doctor for follow-up, as cirrhosis is associated with a small ongoing risk of liver cancer.
The Australian government provides subsidised combination treatment (if you meet certain criteria) under the Medicare s100 specialised drugs scheme. The criteria change from time to time and are becoming more relaxed. Check for the current criteria and your nearest treatment centre by phoning the Hepatitis Helpline or click on this link to the Pharmaceutical Benefits Scheme website and follow our instructions, below.
- In the "Simple search term" field, enter either one of the two combination treatment names - "pegatron" or "pegasys-rbv" - and then click on "Search".
- This will bring up several links. Click on the "Condition for prescribing" links to find the most recent access criteria and other treatment information. Also note, the links to "Consumer factsheet" PDFs.
NB: although only one of the two brands of combination treatment is formally subsidised under the S100 scheme, the other brand is approved for retreatment and is subsidised although not currently under the S100 scheme.
Combination treatment nearly always involves side effects. The most common are flu-like symptoms such as chills, fever, muscle pain and loss of appetite. Other common side effects include anaemia, depression, mood swings, sleep disturbance, tingling or crawling of the skin and brain fog (impaired concentration, memory loss and a slowing down of mental processes).
Management of side effects has improved over the years and more than nine in ten people now complete their treatment. When side effects occur, it is important to speak to your treating doctor or nurse. They can help reduce your side effects, and help you to manage them. Usually this involves adjusting the combination treatment dosage or taking additional medications.
Evidence of current or past psychiatric problems no longer excludes people from treatment. Psychiatric problems may mean a person is at higher risk for side effects and antidepressants might be provided. The person would be carefully monitored and the dose adjusted if necessary.
Combination treatment and avoiding pregnancy – Because ribavirin has been shown to cause birth abnormalities, pregnancy must be avoided while on treatment. Women of child bearing age must not be pregnant or breastfeeding while on combination treatment. They, and any male sex partners, must use two effective forms of contraception during sex (e.g. she using the contraceptive pill and he using condoms). Additionally, the female sexual partners of men who are on combination treatment must avoid pregnancy.
Dealing with treatment side effects can be a serious issue. You should seek support from family and friends, and your treatment centre nurses. You can find additional support by phoning the Hepatitis Helpline to chat with a worker or be put in contact with a Hep Connect peer support volunteer.
Medicare s100 drugs are free but an administrative fee is payable when you pick up the medication from your hospital pharmacy. The level of payment (up to $25 per month, as at 2008) depends on whether you are a private or public patient, and whether you hold a Healthcare Card or Senior’s Card. You may also have to pay for other medicines if they are needed to help you manage with treatment side effects.
Alternative access to treatment
If you are not eligible for s100 subsidised treatment, you can seek access to treatment through industry-sponsored compassionate-use schemes. These schemes are limited and access is not guaranteed. Additionally, you can purchase the medications at full price on prescription. For more information, speak to your doctor or specialist.
Because hep C treatment can produce side effects, you will need to be closely monitored while you are taking it. This monitoring includes regular visits to your treatment centre or doctor for blood tests and general assessment. PCR viral detection tests and viral load tests are used at particular points during treatment to monitor your response to treatment. Test results early on in treatment can show whether you have a good chance of being cured. They can help you decide whether or not to stop treatment if your chances of a cure are small.
What is meant by the terms “response” and “cure”?
There are several different results with treatment but the main ones are:
Early / Rapid Viral Response: a significant drop in viral load at week four of treatment. This is seen as a good early predictor of sustained viral response (below)
Non-Response: no significant drop in viral load after twelve weeks of treatment. This means you probably won’t be cured
End-of-Treatment Response: whether or not the virus is detectable in your blood at the end of treatment (either six months or twelve months). This is good but it doesn’t mean you are cured
Sustained Viral Response: viral clearance as proved by a negative PCR result six months or more after treatment finishes. This is the result that people hope for and is what doctors refer to when someone is successfully cured
If your treatment is successful, you will not have any immunity to hep C. You need to avoid blood-to-blood contact with others in order not to catch hep C again. Your body will continue to manufacture antibodies for ten years or more after successful treatment but don’t let these confuse you; having hep C antibodies does not mean you still have hep C. It is the PCR test results that count (see Sustained Viral Response, above). If you do not respond to treatment, or relapse in the six-month period after treatment, you will not clear your hep C. In this case, you should maintain regular follow up visits with your doctor. He or she can provide ongoing monitoring and advice on giving combination treatment a second go and ways to help reduce possible ongoing liver damage.
Drug companies and researchers are working to develop new treatments for hep C and several experimental drugs show potential and are currently being trialed. It is hoped that some of these will become available over the next few years. For up-to-date information about new treatments, speak to your doctor or phone the Hepatitis Helpline.
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Stock photos used. People shown may have no actual connection with hepatitis C.
Top image taken with thanks from www.images.google.com.au
This page last updated 5 May 2010
