Ifn Monotherapy In Acute Hepatitis C
Although the short courses of standard IFN monotherapy introduced in the 1980s by Hoofnagle et al, Davis et al, and Di Bisceglie et al led to sustained improvement in liver disease and loss of virus in less than 10% of patients, these therapies were the first to cure chronic viral hepatitis.
Jaeckel et al reported that treatment with IFN alfa-2b prevented chronic infection in 98% of a group of 44 German patients with acute hepatitis C. In this study, patients received 5 million U/day of IFN alfa-2b subcutaneously for 4 weeks and then three times per week for another 20 weeks the IFN alfa-2b was well tolerated in all patients but one.
Because it has the poorest safety profile of all the HCV antiviral agents, with few exceptions PEG-IFN is no longer recommended in combination regimens. Spontaneous resolution of acute HCV infection may occur in 15% to 50% of patients. Monitoring for spontaneous clearance for a minimum of 6 months before initiating any treatment is therefore recommended.
World Health Organization. Hepatitis C: fact sheet. Available at . Updated: October 2017 Accessed: January 23, 2018.
Frank C, Mohamed MK, Strickland GT, et al. The role of parenteral antischistosomal therapy in the spread of hepatitis C virus in Egypt. Lancet. 2000 Mar 11. 355:887-91. .
Kim A. Hepatitis C virus. Ann Intern Med. 2016 Sep 6. 165 :ITC33-ITC48. .
Spread Of Hepatitis C
Hepatitis C is spread through blood-to-blood contact when blood from a person with hepatitis C enters another persons bloodstream.
The most common way people become infected with hepatitis C in Australia is by sharing injecting equipment such as needles, syringes, spoons and tourniquets. It is possible to be infected with hepatitis C after only one risk event.
Hepatitis C may also be spread through:
- tattooing and body piercing with equipment that has not been properly cleaned, disinfected or sterilised such as backyard tattoos’. Registered parlours with appropriate infection control procedures are not a risk
- needlestick injuries in a healthcare setting
- receiving blood transfusions in Australia prior to 1990 before hepatitis C virus testing of blood donations was introduced
- medical procedures, blood transfusions or blood products and mass immunisation programs provided in a country other than Australia
- pregnancy or childbirth there is a 5% chance of a mother with chronic hepatitis C infection passing on the virus to her baby during pregnancy or childbirth.
Breastfeeding is safe, however if nipples are cracked or bleeding cease breastfeeding until they have healed.
Less likely possible routes of transmission of hepatitis C include:
Hepatitis C cannot be transmitted by:
- sharing food, cups or cutlery
- shaking hands or day-to-day physical contact.
What Is Hepatitis C
Hepatitis C is a viral infection that causes liver inflammation and damage. Inflammation is swelling that occurs when tissues of the body become injured or infected. Inflammation can damage organs.
Viruses invade normal cells in your body. Many viruses cause infections that can be spread from person to person. The hepatitis C virus spreads through contact with an infected persons blood.
Hepatitis C can cause an acute or chronic infection.
Although no vaccine for hepatitis C is available, you can take steps to protect yourself from hepatitis C. If you have hepatitis C, talk with your doctor about treatment. Medicines can cure most cases of hepatitis C.
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Treatment Of Hepatitis C Virus Genotypes 5 And 6
HCV infection with GT5 and GT6 is quite rare in the Saudi population. Limited data is available in treating these groups of patients and the recommendations are primarily based on extrapolation of experience from other HCV genotypes .3]. In the NEUTRINO phase 3 trial on 320 patients with GT1 and GT4, and 7 patients of GT5 and GT6, who received SOF plus PegIFN and weight-based RBV, all achieved an SVR12.
In the ATOMIC study, Kowdley et al. treated 5 patients infected with GT6 with SOF, PegIFN, and weight-based RBV. All of the patients with GT6 were assigned to 24 weeks of therapy and 5 of 5 achieved an SVR12.
The LDV/SOF combination is another option with limited data in treating HCV GT5 and GT6. In a small, open-label study conducted in France, a 12-week course of LDV/SOF, 39 of 41 subjects achieved an SVR12. SVR12 was achieved in 20/21 of the patients who were treatment- naïve and 19/20 patients who were treatment-experienced. Eight of 9 patients with cirrhosis achieved SVR12, whereas 31 of the 32 patients without cirrhosis achieved SVR12.
Hepatitis C And Injecting Drugs
If you inject drugs, avoid sharing needles, syringes or other equipment such as tourniquets, spoons, swabs or water.
Where possible, always use sterile needles and syringes. These are available free of charge from needle and syringe programs and some pharmacists. To find out where you can obtain free needles, syringes and other injecting equipment, contact DirectLine
Try to wash your hands before and after injecting. If you cant do this, use hand sanitiser or alcohol swabs from a needle and syringe program service.
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How Effective Is Treatment
Direct-acting antivirals cure 9 out of 10 patients with hepatitis C.
Successful treatment does not give you any protection against another hepatitis C infection. You can still catch it again.
There’s no vaccine for hepatitis C.
If treatment does not work, it may be repeated, extended, or a different combination of medicines may be tried.
Your doctor or nurse will be able to advise you.
Treatment Of Acute Hepatitis C
Diagnosis of acute HCV infection is a rare event since acutely infected individuals are mostly asymptomatic. Also, social problems within high risk groups keep these individuals from seeing physicians.
An optimal treatment for acute HCV infections has not been established. There are several studies showing excellent responses using IFN. The best results, with a SVR in over 95% of the patients, were achieved by using 5 million international units of IFN daily for 4 wk, followed by 5 MIU three times weekly for another 20 wk. This treatment was well tolerated in most cases. Another recent study achieved a SVR in 87% of patients, using 6 MIU of IFN injected intramuscularly daily for 4 wk. In acute HCV, genotype and RNA serum levels seem to have no influence on treatment outcomes. While undergoing treatment, patients need to be monitored at least every four weeks for transaminases, HCV antibodies and serum RNA levels.
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Hepatitis C And Blood Spills
When cleaning and removing blood spills, use standard infection control precautions at all times:
- Cover any cuts or wounds with a waterproof dressing.
- Wear single-use gloves and use paper towel to mop up blood spills.
- Clean the area with warm water and detergent, then rinse and dry.
- Place used gloves and paper towels into a plastic bag, then seal and dispose of them in a rubbish bin.
- Wash your hands in warm, soapy water then dry them thoroughly.
- Put bloodstained tissues, sanitary towels or dressings in a plastic bag before throwing them away.
Treatment Of Hepatitis C Infection In Children
Children suffering from chronic HCV infection generally show no symptoms. While biochemistry and histology are comparable to adults with HCV, the progression of hepatitis C seems to be slower compared to adults. It has been shown that, in general, children tolerate IFN therapy relatively well. Side effects are usually mild or moderate. One study of 41 children receiving standard combination therapy showed an overall SVR of 61% one year after treatment. Altogether response rates in children to INF monotherapy and combination therapy with INF and ribavirin seem to be equivalent to adults, PEG-IFN is not yet approved for use in children. Therefore, the present regime is 15 mg ribavirin per kg body weight per day plus 3 MIU/m2 body surface interferon alpha-2b three times per week. This treatment appears to be reasonably safe and effective in children with hepatitis C. Prospective controlled trials evaluating combination therapy with PEG-INF are being developed.
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Symptoms Of Hepatitis C
It is very important to know that not everyone with hepatitis C has symptoms. The only way to know if you have hepatitis is by talking to your doctor and getting a blood test.
Many people living with hepatitis C feel well and only have symptoms once the disease has progressed and there is serious liver damage.
If you do not have symptoms this does not mean that the virus isnt causing damage.
When first infected, some people may find:
- their urine becomes dark
- their eyes and skin turn yellow
- they experience a minor flu-like illness.
These symptoms may disappear within a few weeks, but this does not necessarily mean that the infection has been cleared.
Over time, symptoms that may develop include:
- tiredness and fatigue
- flu-like symptoms
- pain in the abdomen where the liver is located
- not feeling hungry and indigestion.
Around 30% of people who have been infected may clear the virus from their blood naturally, with no treatment, within 6 months. These people no longer have the hepatitis C virus and are not infectious, but will always have hepatitis C antibodies in their blood. The presence of hepatitis C antibodies shows that someone has been exposed to the virus, but does not offer any immunity against hepatitis C. People can become reinfected after clearing the virus naturally, or after treatment.
Diagnosis Of Viral Infection C
The story of HCV is very singular since it is a virus that was discovered late , but in 30 years we have managed to isolate the virus, ant the collaboration between basic and clinical research has allowed the development of reliable diagnostic tests , , the discovery of effective treatment , , this allowed the healing of infected subjects and to evoke the elimination . This program, supported by the World Health Organization is expected to reduce new infections by 30%
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What Hepatitis C Medicines Are We Working On
We developed a safe, effective, and easy-to-use direct-acting antiviral regimen, to be used as an affordable combination paving the way for a public health approach to hepatitis C. Our goal is now to increase access to affordable treatments by supporting policy change and encouraging political will to treat hepatitis C. To do so, we are working on innovative programmes to improve access to hepatitis C diagnosis and treatment in a variety of countries.
Find out about our work on hepatitis C
Treatment Of Hepatitis C Virus Genotype 1
Treatment of HCV GT1 used to be a challenge, with the least acceptable chance of SVR among other genotypes. However, with the recent advances in direct acting antivirals, the SVR rate for these patients has increased dramatically.
The choice of therapy here depends on factors such as efficacy, duration, adverse side effects, previous exposure to therapy, type of previous response, and degree of fibrosis. DAA-based regimens result in higher SVR rates for GT1 infected patients.
GT1a infected patients are more likely to develop resistant variants, including those who previously had high-level resistance leading to virological failure. They tend to have lower response rates and higher relapse rates than patients with HCV GT1b with certain regimens.
Approximately 15% of GT1a patients have NS5A resistance associated variants without exposure to NS5A inhibitors. Such patients tend to have a lower treatment response to DAA.
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Treatment Of Chronic Hepatitis C
The primary treatment goal for chronic HCV infection is, as mentioned previously, sustained virologic response . With the recommended treatment, SVR can be achieved in about 55% of patients who are chronically infected with genotype 1 of HCV, while with genotype 2 and 3 the efficacy is 80% or greater. The standard therapy is PEG-IFN alpha-2a or PEG-IFN alpha-2b subcutaneously in combination with twice daily oral doses of ribavirin. The combination has proven to be more efficient than monotherapy alone, even though the antiviral mechanism of ribavirin is not fully understood. Ribavirin monotherapy has no therapeutic effect in HCV infected patients.
In summary, for patients who are chronically infected with HCV, the recommendation is to use PEG-IFN alpha-2b 1.5 g/kg per week or PEG-IFN alpha-2a 180 g/wk plus ribavirin 1000-1200 mg/d for 48 wk for patients with genotype 1 or 24 wk for patients with genotype 2 or 3. For genotypes 4, 5 and 6, the data are not sufficient for the development of a guideline, but it has been suggested to treat patients with these genotypes in a similar way as for patients with genotype 1. Recently, Hadziyannis et al presented a study on 36 genotype 4 carriers. While patients in the short-term group had a SVR of 63%-67%, treatment for 48 wk resulted in a SVR of 82.
Induction therapy does not result in higher SVR rates, therefore a recommendation regarding induction therapy cannot be given, but there are ongoing individual trials.
What Are The Treatments For Hepatitis C
Treatment for hepatitis C is with antiviral medicines. They can cure the disease in most cases.
If you have acute hepatitis C, your health care provider may wait to see if your infection becomes chronic before starting treatment.
If your hepatitis C causes cirrhosis, you should see a doctor who specializes in liver diseases. Treatments for health problems related to cirrhosis include medicines, surgery, and other medical procedures. If your hepatitis C leads to liver failure or liver cancer, you may need a liver transplant.
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Cost Of Hepatitis C Medicines
The newer direct-acting antiviral medicines for hepatitis C can be costly. Most government and private health insurance prescription drug plans provide some coverage for these medicines. Talk with your doctor about your health insurance coverage for hepatitis C medicines.
Drug companies, nonprofit organizations, and some states offer programs that can help pay for hepatitis C medicines. If you need help paying for medicines, talk with your doctor. Learn more about financial help for hepatitis C medicines.
How Is Hepatitis C Spread
Hepatitis C spreads through contact with the blood of someone who has HCV. This contact may be through:
- Sharing drug needles or other drug materials with someone who has HCV. In the United States, this is the most common way that people get hepatitis C.
- Getting an accidental stick with a needle that was used on someone who has HCV. This can happen in health care settings.
- Being tattooed or pierced with tools or inks that were not sterilized after being used on someone who has HCV
- Having contact with the blood or open sores of someone who has HCV
- Sharing personal care items that may have come in contact with another person’s blood, such as razors or toothbrushes
- Being born to a mother with HCV
- Having unprotected sex with someone who has HCV
Before 1992, hepatitis C was also commonly spread through blood transfusions and organ transplants. Since then, there has been routine testing of the U.S. blood supply for HCV. It is now very rare for someone to get HCV this way.
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Interferons And Pegylated Interferons
The two most frequently used recombinant interferon preparations in clinical trials have been IFN alfa-2b and IFN alfa-2a , which differ from each other by only a single amino acid residue. IFN alfacon-1 , or consensus IFN, is a genetically engineered compound synthesized by combining the most common amino acid sequences from all 12 naturally occurring IFNs. Roferon-A was discontinued from the market in 2007 and Infergen was discontinued from the market in 2013.
The addition of propylene glycol molecules to IFN has led to the development of long-lasting IFNs that have better sustained absorption, a slower rate of clearance, and a longer half-life than unmodified IFN, which permits more convenient once-weekly dosing. The FDA has approved PEG-IFNs for the treatment of chronic hepatitis C.
Two PEG-IFN preparations are available for the treatment of chronic hepatitis C. PEG-IFN alfa-2b consists of IFN alfa-2b attached to a single 12-kd PEG chain it is excreted by the kidneys. PEG-IFN alfa-2a consists of IFN alfa-2a attached to a 40-kd branched PEG molecule it is metabolized predominantly by the liver.
Key Findings And Strength Of Evidence
The evidence reviewed in this study is summarized in . The specific domain scores used to determine the overall strength of evidence for each body of evidence are shown in . We identified no studies that evaluated comparative effectiveness of current antiviral regimens on long-term clinical outcomes such as mortality, complications of chronic HCV infection, or quality of life. Such trials would be difficult to design and carry out due to the long time required for complications of chronic HCV infection to develop in most patients.
Summary of evidence on comparative effectiveness of treatment for hepatitis C.
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World Health Organization Elimination Policy
Virological healing induces a collective and individual benefit with stabilization or improvement of clinical and biological manifestations. On these evidences is based the elimination policy proposed, from 2017, by the World Health Organization.
With the efficacy of pangenotypic oral antivirals, elimination is possible . From the availability of effective drugs, only the 5% of the infected patients worldwide has been treated, due
What Causes Hepatitis C
The hepatitis C virus causes hepatitis C. The hepatitis C virus spreads through contact with an infected persons blood. Contact can occur by
- sharing drug needles or other drug materials with an infected person
- getting an accidental stick with a needle that was used on an infected person
- being tattooed or pierced with tools or inks that were not kept sterilefree from all viruses and other microorganismsand were used on an infected person before they were used on you
- having contact with the blood or open sores of an infected person
- using an infected persons razor, toothbrush, or nail clippers
- being born to a mother with hepatitis C
- having unprotected sex with an infected person
You cant get hepatitis C from
- being coughed or sneezed on by an infected person
- drinking water or eating food
- hugging an infected person
- shaking hands or holding hands with an infected person
- sharing spoons, forks, and other eating utensils
- sitting next to an infected person
A baby cant get hepatitis C from breast milk.18
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