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March 2017
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ASHM - Curing Hepatitis C, Nowra
Date: 29 Mar - 29 Mar

An update for primary care providers Primary care practitioners in the Illawarra Shoalhaven region can help to improve

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April 2017
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Sydney Korean Festival
Date: 01 Apr - 02 Apr

Celebrating and sharing the wonderful Korean culture Hepatitis NSW is excited to attend this years Sydney Korean Festiv

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ASHM - Hepatitis C in Drug and Alcohol Settings Education Program
Date: 01 Apr - 01 Apr

People who inject drugs represent approximately 90% of newly acquired hepatitis C infections. Clinicians in drug and alc

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Sydney Korean Festival
Date: 01 Apr - 02 Apr

Celebrating and sharing the wonderful Korean culture Hepatitis NSW is excited to attend this years Sydney Korean Festiv

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ASHM - Curing Hepatitis C, Bega Valley region
Date: 05 Apr - 05 Apr

An update for primary care providers Primary care practitioners in the Bega Valley region can help to improve the healt

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The Liver and Your Health Expo
Date: 07 Apr - 07 Apr

A health expo specifically-designed for the Chinese community To conclude The Liver and Your Health Program, the North

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May 2017
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National Apology Day
Date: 26 May - 26 May

This event marks the anniversary of the Apology to Australia’s Indigenous peoples in the House of Representatives on 1

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National Sorry Day
Date: 26 May - 26 May

National Sorry Day is a significant day for Aboriginal and Torres Strait Islander peoples, and particularly for Stolen G

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National Reconciliation Week
Date: 27 May - 03 Jun

National Reconciliation Week is an ideal time for everyone to join the reconciliation conversation and reflect on shared

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National Reconciliation Week
Date: 27 May - 03 Jun

National Reconciliation Week is an ideal time for everyone to join the reconciliation conversation and reflect on shared

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National Reconciliation Week
Date: 27 May - 03 Jun

National Reconciliation Week is an ideal time for everyone to join the reconciliation conversation and reflect on shared

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National Reconciliation Week
Date: 27 May - 03 Jun

National Reconciliation Week is an ideal time for everyone to join the reconciliation conversation and reflect on shared

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National Reconciliation Week
Date: 27 May - 03 Jun

National Reconciliation Week is an ideal time for everyone to join the reconciliation conversation and reflect on shared

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June 2017
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National Reconciliation Week
Date: 27 May - 03 Jun

National Reconciliation Week is an ideal time for everyone to join the reconciliation conversation and reflect on shared

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National Reconciliation Week
Date: 27 May - 03 Jun

National Reconciliation Week is an ideal time for everyone to join the reconciliation conversation and reflect on shared

Read more
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National Reconciliation Week
Date: 27 May - 03 Jun

National Reconciliation Week is an ideal time for everyone to join the reconciliation conversation and reflect on shared

Read more
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July 2017
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NSW Hepatitis Awareness Week
Date: 24 Jul - 30 Jul

NSW Hepatitis Awareness Week 2017 will start on Monday 24 July and run until Sunday 30 July, including World Hepatitis D

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NSW Hepatitis Awareness Week
Date: 24 Jul - 30 Jul

NSW Hepatitis Awareness Week 2017 will start on Monday 24 July and run until Sunday 30 July, including World Hepatitis D

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NSW Hepatitis Awareness Week
Date: 24 Jul - 30 Jul

NSW Hepatitis Awareness Week 2017 will start on Monday 24 July and run until Sunday 30 July, including World Hepatitis D

Read more
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NSW Hepatitis Awareness Week
Date: 24 Jul - 30 Jul

NSW Hepatitis Awareness Week 2017 will start on Monday 24 July and run until Sunday 30 July, including World Hepatitis D

Read more
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NSW Hepatitis Awareness Week
Date: 24 Jul - 30 Jul

NSW Hepatitis Awareness Week 2017 will start on Monday 24 July and run until Sunday 30 July, including World Hepatitis D

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World Hepatitis Day
Date: 28 Jul - 28 Jul

World Hepatitis Day, observed on July 28 every year, aims to raise global awareness of hepatitis and encourage preventio

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NSW Hepatitis Awareness Week
Date: 24 Jul - 30 Jul

NSW Hepatitis Awareness Week 2017 will start on Monday 24 July and run until Sunday 30 July, including World Hepatitis D

Read more
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NSW Hepatitis Awareness Week
Date: 24 Jul - 30 Jul

NSW Hepatitis Awareness Week 2017 will start on Monday 24 July and run until Sunday 30 July, including World Hepatitis D

Read more
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August 2017
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National Aboriginal & Torres Strait Islander Children’s Day
Date: 04 Aug - 04 Aug

National Aboriginal and Islander Children’s Day (NAICD) is a celebration of Indigenous children and is held on 4 Augus

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International Day of the World’s Indigenous People
Date: 09 Aug - 09 Aug

The International Day of the World’s Indigenous People was first proclaimed by the General Assembly in December 1994,

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International Overdose Awareness Day
Date: 31 Aug - 31 Aug

International Overdose Awareness Day (IOAD) is a global event held on August 31st each year and aims to raise awareness

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September 2017
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December 2017
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International Volunteer Day
Date: 05 Dec - 05 Dec

International Volunteer Day (IVD) is celebrated each year on 5 December and was established by the United Nations Genera

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Hep C direct acting antiviral treatment

Hep C direct acting antiviral treatment

 Treatment options  Genotypes 1-4   Genotypes 5-6

 

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Introduction

Direct acting antiviral treatment drugs are now available in Australia (listed in no particular order):

  • Harvoni (sofosbuvir/ledipasvir) two drugs combined in one pill, taken once per day
  • Sovaldi and Daklinza (sofosbuvir and daclatasvir) in 1 pill of each, taken once per day
  • Sovaldi and Ibavyr (sofosbuvir and ribavirin) in 3 or more separate pills, taken daily
  • VIEKIRA PAK (paritaprevir/ritonavir/ombitasvir and dasabuvir) in 4 separate pills, taken daily.
  • VIEKIRA PAK plus Ibavyr (paritaprevir/ritonavir/ombitasvir and dasabuvir and ribavirin) in 6 or more pills taken per day.
  • Zepatier (elbasvir and grazoprevir) two drugs combined in one pill, taken once per day
  • Zepatier (elbasvir and grazoprevir) and Ibavyr (ribavirin), in two or more pills taken per day.

Other new drugs for treating hepatitis C are currently in different stages of development and/or approval. Over time, these new drugs will also likely be PBS listed and funded, and this page will be amended.

 

Success rates of the new treatments

Genotype 1:   Harvoni; or Sovaldi and Daklinza; or VIEKIRA PAK (with or without Ibavyr); or Zepatier (with or without Ibavyr), all achieve cure rates in excess of 95-97%, depending on pre-treatment variables such as the presence of cirrhosis, prior therapy, etc.

Genotype 2:   Sovaldi and Ibavyr achieves cure rates of around 95% depending on pre-treatment variables such as the presence of cirrhosis, prior therapy, etc.

Genotype 3:   Sovaldi and Daklinza (with or without Ibavyr) achieves cure rates of around 95% depending on pre-treatment variables such as the presence of cirrhosis, prior therapy, etc.

Genotype 4:   Zepatier (with or without Ibavyr), achieve cure rates in excess of 95-97%, depending on pre-treatment variables such as the presence of cirrhosis, prior therapy, etc.

Genotype 6:    People with genotype 6 remain limited to Sovaldi taken with pegylated interferon and Ibavyr treatment. They enjoy a greater than 90% chance of cure.

The above cure rates relate to people’s hepatitis C genotype and treatment history. Treating doctors will advise which treatment options are suitable for individual people.

 

Treatments and genotypes

If you have hep C genotype 1a or 1b, you might be offered Harvoni (on its own), or Sovaldi plus Daklinza (taken together), or Zepatier (own its own or with Ibavyr).

If you have hep C genotype 1a, you might be offered VIEKIRA PAK plus Ibavyr (taken together).

If you have hep C genotype 1b, you might be offered VIEKIRA PAK.

If you have hep C genotype 2, you are offered Sovaldi plus Ibavyr (taken together).

If you have hep C genotype 3, you are offered Sovaldi plus Daklinza (taken together, with or without Ibavyr).

If you have hep C genotype 4, you are offered Zepatier (on its own or with Ibavyr).

If you have hep C genotype 6, you remain limited to Sovaldi taken with pegylated interferon injections plus Ibavyr pills.

Other drug combinations are approved and available but those mentioned above are the ones with best response and tolerability.

 

Treatment durations

Harvoni
= 8 weeks for people with no prior treatment, no cirrhosis and viral load less than 6 million IU/mL
= 12 weeks for people with no prior treatment, no cirrhosis and viral load more than 6 million IU/mL
= 12 weeks for people with no prior treatment and cirrhosis
= 24 weeks for people with prior treatment and cirrhosis

Sovaldi and Daklinza
= 12 weeks (although likely longer for people with cirrhosis)
= 24 weeks for people with genotype 3 and cirrhosis

Sovaldi and Daklinza plus Ibavyr
= 12 weeks for people with genotype 1 and cirrhosis
= 12 weeks for people with genotype 3 and cirrhosis

Sovaldi and Ibavyr
= 12 weeks for people with genotype 2

VIEKIRA PAK
= 12 weeks for people with genotype 1b, no cirrhosis
= 12 weeks for people with genotype 1b, compensated cirrhosis

VIEKIRA PAK plus Ibavyr
= 12 weeks for people with genotype 1a, no cirrhosis
= 12 weeks for people with genotype 1a, with cirrhosis
= 24 weeks for people with genotype 1a, cirrhosis and prior null response to treatment

Zepatier
= 12 weeks for people with genotype 1 or 4, with no prior treatment, or with prior treatment relapse

Zepatier plus Ibavyr
= 16 weeks for people with genotype 1a or 4, who experienced prior treatment failure.

There are a range of different treatment regimens. People are offered treatment on the basis of their genotype, level of liver damage and treatment history.

 

Are new treatments taken with ribavirin (Ibavyr) or interferon injections?

Several of the new treatments, listed above, are sometimes taken with Ibavyr. Importantly, all the new treatments are taken as tablets (pills) and none involve interferon injections.

(Treatment for people with genotype 6, involves Sovaldi taken with pegylated interferon injections and Ibavyr tablets. A new interferon-free treatment will become available later in 2017).

 

Treatment side effects

Harvoni is well tolerated with only minor side effects.

Sovaldi and Daklinza are well tolerated with only minor side effects.

Sovaldi and Ibavyr are well tolerated (the most common adverse events of Ibavyr are anaemia, fatigue, headache, skin irritation and insomnia).

VIEKIRA PAK is well tolerated with only minor side effects. When taken with Ibavyr, it is well tolerated but may be associated with anaemia, fatigue, headache, skin irritation and insomnia.

Zepatier is well tolerated with only minor side effects. When taken with Ibavyr, it is well tolerated but may be associated with anaemia, fatigue, headache, skin irritation and insomnia.

Sovaldi/peginterferon/Ibavyr combination treatment involves side effects including fatigue, headache, throwing up, sleep problems, itching and crawling of the skin, and anaemia (low blood platelets). Pregnancy must be strictly avoided by both men and women (during treatment and for 24 weeks after). This is because Ibavyr has been shown to cause birth defects.

 

Treatment contraindications

There are some drug-to-drug interaction issues (for example, with the drug amiodarone which is used for heart problems) but most issues will be adequately handled with changing accompanying medications, or choice of hepatitis C medication, or through careful monitoring.

VIEKIRA PAK includes ritonovir which can lead to significant drug-drug interactions. All medications should be checked before prescribing with any hepatitis C medications.

Pregnancy must be strictly avoided by both men and women treated with Ibavyr in any of the previously mentioned treatment combinations (during treatment and for 24 weeks after). Pregnancy must also be avoided with Daklinza (during treatment and for 5 weeks after). Talk to your doctor about treatment with Harvoni in pregnancy. It is recommended that treatment is not taken while breastfeeding.

Your doctor or specialist will advise which treatments would be suitable (or not suitable) for you, depending on your past and present medical conditions and any other medications you are taking.

Does treatment interfere with other drugs?

Sometimes one medicine we take interferes with other medicines, or with recreational drugs (including alcohol). A useful website that lists all these interactions is based at University of Liverpool (UK). Of course, it is really important to talk about these issues with your treatment doctor or nurses.

HEP Drug Interactions website

 

No treatment restrictions

All Australian adults who have chronic hep C (genotypes 1, 2 and 3) and who have a Medicare Card can access the new DAA treatments, regardless of their stage of disease.

There are no restrictions if you inject drugs. If you feel that you are being denied access in any way, and believe it is because your health workers think you use drugs, please call either the Hepatitis Infoline on 1800 803 990 or the NSW Users and AIDS Association on 02 8354 7300 to chat about your options.

 

Treatment access

The new medicines are available through Medicare (PBS) to all adults who hold a Medicare Card.

Doctors and specialists working at hospital liver clinics can provide treatment.

Many doctors can provide treatment. This expands access to treatment, especially for people in rural areas.

See www.hep.org.au/services-directory/ for a listing of doctors across NSW. This list will also be updated on a regular basis.

 

Preparing for treatment

People with hepatitis C have an initial doctor or specialist assessment. This involves full blood testing and assessment of fibrosis stage, via Fibroscan or APRI test. People with cirrhosis are referred for specialist care and treatment. People with cirrhosis require long term monitoring for complications including liver cancer. See www.hep.org.au/services-directory/ for a listing of Fibroscan availability across NSW.

It is important that all people are tested for the presence of hepatitis B prior to starting hepatitis C medications. This is because some people with hepatitis B have had increased activity of hepatitis B during treatment which may require special attention.

 

Filling of prescriptions

Scripts are usually filled for a month at a time. S100 scripts are written as public hospital items and need to be dispensed in the public hospital pharmacy. Hospital pharmacies will usually be able to fill scripts on the day.

The new S85 (General Schedule streamlined approval) scripts are written by doctors or specialists and are dispensed at community pharmacies. Community pharmacies don’t normally have the capacity to carry stocks of the DAA medicines, but order them in – usually within 72 hours. It is important to remind the community pharmacy to order in the next month’s supply of medications about a week before the medications are due to be collected.

For more information, please call the Hepatitis Infoline on 1800 803 990.

 

Online pharmacies

The new hepatitis C treatment drugs can also be ordered from online pharmacies. While this might not be as secure as customers picking up their treatment drugs from a local pharmacy, it will be very helpful for people who live in parts of NSW with no pharmacies that fill these scripts.

Consumers are required to

  • fill in their details online
  • phone the pharmacy
  • post the prescription to the address provided on the website.

The pharmacy must first receive the prescription. Once they receive the script, they will place the order for the medicine, which may arrive within 1-2 days and then the medicine is delivered through Australia Post.

Try the following online pharmacies…

https://www.chemistwarehouse.com.au/

https://www.epharmacy.com.au

https://www.pharmacyonline.com.au

http://www.pharmacydirect.com.au/

http://www.yourchemistshop.com.au/

http://www.royyoungchemist.com.au/

If the treatment drugs don’t appear in their ‘search’ option, people should call the online pharmacy. They can take orders over the phone (generally, a medicine doesn’t go live on their site until it’s ordered previously). Further, online pharmacies prefer to receive a call about the script beforehand so they can explain to the consumer the process.

 

Treatment costs

People are charged only the usual monthly co-payment paid for a prescription. This is currently $38.80 per month for general patients and $6.30 per month for concessional patients.

 

Treatment monitoring and follow up

Viral load is not checked while people are on treatment as the result does not affect the treatment duration. Only liver enzymes, kidney function and full blood count are checked at week 4 of treatment.

If ribavirin is required in the treatment, then most people will have blood tests every month of treatment.

Some hospital clinics may use different monitoring protocols based on whether or not people have other illnesses and the complexity and severity of their hepatitis C disease.

All people will require a PCR viral detection test 12 weeks after treatment finishes to check if they are cured.

 

Defining cure

“Cure” or “SVR” (Sustained Virological Response) means that you have got rid of the hep C virus from your body. This is measured by a PCR viral detection test. If you have one of these tests at 12 weeks after treatment finishes and it shows “undetectable” (no virus), then you are considered to be cured. Some clinics will still do an additional PCR viral detection test at 24 weeks.

But if hep C has caused liver damage already, being cured (getting rid of the virus) might not mean that you are healthy again all of a sudden. If you have cirrhosis (serious liver damage), you will still need to see a doctor or specialist for ongoing care (including Fibroscan examinations every 6 months). If you have cirrhosis you still have a risk of liver cancer, even after being cured of hep C.

Talk to your doctor about what “cure” should mean for you.

 

Treatment inside NSW jails

The Federal Government has agreed to fund the new treatments for prisoners under the current S100 scheme. On this basis, NSW adult prisoners will have access to the new DAA treatments after 1 March 2016.

In NSW jails, if you have hep C, you will be assessed and treated under Justice Health and Forensic Mental Health Network’s (Justice Health’s) Nurse-Led Model of Care.

There are 31 Justice Health Centres across NSW and most will be able to initiate and manage the new hep C treatments. To talk about accessing treatment while you are in custody, prisoners should first talk to the Health Centre Nurse.

For more information about hep C including treatment, please call the Hepatitis Infoline by dialling 3 on the Common Calls list. This is a free service.

 

Children and treatment

The new DAA treatments are for Australian adults only. Children with hep C should be seen and assessed by a paediatrician (children’s doctor) who knows about hepatitis. To find out more about care and treatment for children, phone the gastro unit at The Children’s Hospital at Westmead (02 9845 3989).

 

For more news, subscribe to The Champion e-newsletter, and call the Hepatitis Infoline (1800 803 990).

 

This page was last updated 20 March 2017.

Content drawn from Australian Recommendations for the Management of Hepatitis C Virus Infection: a Consensus Statement 2016, and publications of ASHMThe Kirby Institute and The Centre for Social Research in Health, and vetted by our Medical and Research Advisory Panel.