Tuesday, 30 October 2012

Hepatitis C diagnosis and treatment (More Information)

1 Deciding on treatment
2 What tests do I need?
3 What are the benefits of going on hepatitis C treatment?
4 What treatments are available to me?
5 How much does it cost?
6 Who is eligible for government subsidised treatment?
7 Side effects of Treatments
8 Hepatitis C treatment and pregnancy
9 Complementary therapies
10 Support
11 If you are using drugs or are being treated for drug use
12 Preparing for medical appointments
13 Going on treatment - time and commitment
14 What happens when you go on treatment?
15 Managing side effects
16 Looking after yourself while you are on treatment
17 Can I travel overseas when I am on treatment?

1 Deciding on treatment

Before you decide on treatment for hepatitis C you need to be clear about:
  • Why you should go on treatment
  • What the treatment is
  • What tests do you need
  • How the treatment works
  • What are the side effects of treatment
  • What it means for you and your family 
When you are first diagnosed with hepatitis C, you may have felt confused, angry, depressed or nothing at all.
 You are not alone. These are normal responses. It’s important to find out as much information as you can
before you make a decision about treatment.
Treatment for hepatitis C can be either for 24 or 48 weeks (depending on your genotype and response
of the virus to medication), so it is important to be well informed about hepatitis C and the available
treatments before you begin.
Deciding to start treatment is a personal decision. The decision can depend on your individual
 situation and include issues like family and work commitments, relationships and the level of
support you have. It is important to discuss with your doctor or liver specialist what treatment
options are best for you.Below are some things to consider before deciding about treatment:

2 What tests do I need?

There are a number of tests used to diagnose and monitor chronic hepatitis C. You need to have
 a number of tests before you begin hepatitis C treatment. These are some of the tests you may
 be asked to have.

Antibody Test

This is a blood test that is usually done before other tests. The Antibody Test shows if you have been
in contact with to the hepatitis C virus. It does not always mean that the hepatitis C virus is active
in the body. A positive test means you need to have further testing to confirm the diagnosis.

Liver Function Test

This is a blood test that measures if there is inflammation or damage to the liver. The Liver Function
 Test is often used with other tests to monitor chronic hepatitis C.

The Polymerase Chain Reaction Test (PCR)

The PCR Test measures current hepatitis C infection. A positive result means the hepatitis C
 virus is active in your body. A negative result means the virus in currently not active.
This test looks at what strain of the hepatitis C virus you have which is very important for determining
 the length of treatment.

What are Genotypes?
There are different strains (genotypes) of the hepatitis C virus. The different types of genotypes
 do not show the severity of liver disease people have. Understanding which genotype of the
 hepatitis C virus you have is useful because each genotype responds differently to treatment.
People with genotype 2 & 3 are more likely to have a quicker response to treatment,
 whereas people with other genotypes (mainly 1 & 4) may need a longer time on treatment.
When you are thinking about treatment it is important to find out your genotype as this may
help you make a decision.

Viral Load
The viral load test measures the level of the hepatitis C virus in the blood. This test is performed
 before treatment and at 12 weeks of treatment to show if the treatment is being effective against
the virus.
Liver Biopsy
A Liver Biopsy involves removing a small part of your liver that is then looked at under a microscope.
The test looks at how much scar tissue (fibrosis) has formed in your liver and how much inflammation.
 This is the best way of seeing how much the liver is damaged. As of April 2006, this test is not
 compulsory before going on hepatitis C treatment but your doctor or specialist will discuss whether
 you need it.

This is a new test that is being introduced into many liver clinics. It is a test that helps the doctor
 decide how much scar tissue is present in the liver. This test may provide extra information to help
guide a decision about treatment for hepatitis C.

3 What are the benefits of going on hepatitis C treatment?

Some of the positive reasons for going on hepatitis C treatment are:
  • To improve your health
  • To live longer
  • To get rid of the virus
  • To reduce the symptoms and increase your quality of life
  • To prevent liver cirrhosis and liver cancer

4 What treatments are available to me?

The main treatment for hepatitis C is called Combination Therapy which means that injections and capsules
 or tablets are used together. The injections are Pegylated Interferon and the capsules or tablets are Ribavirin.
They both fight viruses and they work well together to fight hepatitis C. Currently in Australia combination
therapy can only be prescribed under the supervision of specialist doctors.

Pegylated interferon
Given as an injection once a week
Taken as capsules or tablets each day for the treatment period
Stops the hepatitis C virus from reproducing
Increases the effect of the pegylated interferon
Slows down or stops the progression of liver disease

Improves the body’s immune system to destroy the hepatitis C virus

Current hepatitis C treatments get rid of the hepatitis C virus in 50% to 80% of people.
 The success of hepatitis C treatment depends on the genotype of the hepatitis C virus and
 how much liver damage there is.
A small number of people cannot take Ribavirin. Pegylated Interferon alone (mono-therapy) is available
but is not as effective in treating the hepatitis C virus. There are also other therapies that can help
 with your general health. You should ask your doctor or nurse about the best treatment for your needs.

5 How much does it cost?

The cost of medication to treat hepatitis C depends on the length of time of the treatment and the dosage.
 Combination therapy is subsidised under the Pharmaceutical Benefits Scheme (PBS) by the Australian
 Government. This means that you only have to pay around $25.00 per month if you have Medicare card
and around $5.00 per month if you have a Health Care or Pension card.

6 Who is eligible for government subsidised treatment?

In Australia, subsidised treatment is available to people who hold a Medicare card. People are eligible
for a Medicare card if they live in Australia and are either an Australian citizen, a permanent resident
or a New Zealand citizen.
To access subsidised treatment, you also need:
  • to be 18 years of age and over
  • to have active hepatitis C (tested with the antibody and PCR tests)
  • (for women) you must not be pregnant or breastfeeding
  • (for men) your partner must not be pregnant
Males and females MUST be willing to use contraception when taking treatment.
In general, you can only have subsidised treatment once. In some cases, you may be eligible for
 a second course of subsidised treatment.
If you do not have a Medicare or Health Care card, you are NOT eligible for the government
subsidised combination therapy. You need to speak to your doctor or nurse about other options for treatment.

7 Side effects of treatments

Knowing the side effects is really important for making the decision to start or not start treatment.
 Although there are many potential side effects, some people experience very few side effects,
while others experience many side effects.
There are many ways to manage side effects that will make your life easier and healthier while on treatment.
 Health professionals are trained to see early signals of side effects and prevent major problems.
 Despite the side effects approximately 90% of people on hepatitis C treatment, complete the treatment.
The possible side effects and how to manage them are explained in detail on page 12.

8 Hepatitis C treatment and pregnancy

The medication used to treat hepatitis C may be very dangerous for unborn children or breastfeeding
children and cannot be used during pregnancy because it causes birth defects.
  • If you are a woman, you must not be pregnant or be breastfeeding during treatment or for 24 weeks after treatment – you may be asked to have a pregnancy test during treatment
  • If you are a man, your wife or partner should not be pregnant during the treatment or for 24 weeks after 
  • treatment.
Because of this it is very important that you use two methods of contraception. This is important during
the treatment and for 6 months after the treatment is finished. Your doctor or nurse can help you choose
 which methods of contraception best suit you and your treatment plan.

9 Complimentary Therapies

Some people choose to use other treatments such as traditional Chinese medicine, acupuncture,
 homeopathy, herbal therapies, vitamin and dietary supplements to manage the symptoms of hepatitis
 C infection and/or help with the side effects of combination therapy. Some of these other treatments
 can interfere with combination therapy for hepatitis C, therefore it is important that you see a qualified
 therapist and inform them and your doctor about the treatments you are on and any that you are considering

10 Support

It is very important to have a good support system before going on treatment. People including family,
 friends, work colleagues and health care providers can assist you and understand what you are going through.
 Many people, for various reasons, prefer not to discuss their hepatitis C, or any details about treatment,
 with their work colleagues.

11 If you are using drugs or are being treated for drug use

Many people who are on methadone or other drug replacement therapy have been successfully treated
 for hepatitis C. It is important that you tell your doctor or nurse if you are on methadone or other therapies
because your dose may need to be changed. People who are current injecting drug users are successfully
 treated at some clinics.

12 Preparing for your medical appointments

It is always a good idea to prepare a list of questions about things you want to know from your doctor
 or nurse before you go on treatment. Below are some questions you may want to ask.
  • What treatment is used for hepatitis C?
  • How does treatment work?
  • What tests will I need beforehand?
  • Is this the best available treatment for me?
  • Can I travel overseas while on treatment?
  • Can I still have sex?
  • How will it affect my employment?
  • How long will I have to take the treatment?
  • What are my options if treatment does not work?
  • How often will I have to take the treatment, and how is it taken?
  • What are the side effects of the treatment and how often do they occur?
  • How much does it cost?
  • Where do I get the treatment?
  • What are the effects on treatment on an unborn child?
  • If I miss a dose, or I accidently take too much, what should I do?
  • If I stop the treatment suddenly, what will happen?
  • Why do I have to keep having more tests?
  • Why do I have to continue seeing my doctor, specialist or nurse at the liver clinic?

13 Going on treatment – Time and Commitment

Being on hepatitis C treatment means regular visits to your doctor or the liver clinic and having other tests.
 It is worth thinking about some of the changes you may have to make in order to fit the treatment into your life.
 Your doctor or nurses at the liver clinic can help you do this.

14 What happens when you go on treatment?

  • Your GP will refer you to see a specialist, either at a liver clinic or in private practice
  • . If the specialist is at a liver clinic, you may need to go on a waiting list before you have your first 
  • The specialist will do more tests to check your liver and the progression of chronic hepatitis C.
  • If you are prescribed treatment, you will have appointments every few weeks depending on the specialist 
          or clinic.
  • If you do not go on treatment, you will still have to get your liver checked by having more tests and will have appointments with your specialist or the liver clinic every 3, 6 or 12 months (this varies depending on your situation).

Managing side effects

The most important thing in managing the side effects of hepatitis C treatment is to keep a
 positive attitude and seek help. This is a time where you need to be gentle with yourself.
Here are some common side effects of pegylated interferon and ribavirin, and some ways
 you can manage them.
Side Effect
Ways to manage
Pain, itchiness or a red mark may come up with the injection
  • Wash your hands before injection to avoid infection
  • Make sure the area to be injected is clean and sterile
  • Use different injecting place each week to allow for healing time
Flu-like symptoms – fever, chills, tiredness, nausea, headache and poor appetite
  • Most people feel these after their injection
  • They generally last from a few hours to a day
  • Have your injection before going to sleep
  • Drink plenty of water
  • Keep warm with extra clothing to reduce the chills
  • Stay cool to reduce the fever
  • Get plenty of rest
Feeling sick in the stomach including loss of appetite
  • Avoid having an empty stomach, eat when you are most hungry
  • Eat smaller meals more often
  • Avoid fatty foods and alcohol and eat food that contains lots of vitamins
Dry skin, itching skin, rash
  • Avoid perfumed soaps and shampoos
  • Avoid very hot showers and baths
  • Protect your skin from the sun
  • Use creams for dry skin
  • Vary you activities – do not sit too long or stand too long
  • Balance rest with activity
  • Take short naps
  • Eat healthy food and drink water
Depression and anxiety
Mood swings and irritability
  • Get support, ask your family and friends
  • Avoid and reduce stress
  • Gentle exercise every day
  • Talk to a health professional about how you feel and what can be done
Difficulty with concentration and forgetfulness
  • Make lists and work through them
  • Give yourself more time to finish things
  • Discuss important decisions with someone you trust
Some less common side effects are: joint and muscle pain, insomnia, liver pains, hair loss (temporary),
 loss of appetite and weight loss, mouth ulcers, poor eyesight including blurred vision and changes in libido. For strategies to manage these side effects speak to your doctor or nurse.
Your treatment doctor or nurse will also need to monitor your blood for changes and might need to adjust
your hepatitis C combination therapy.
Always keep in mind that once treatment stops, generally, so do the side effects. Some of the effects
may continue for a little longer so it’s important to be aware of this and allow for time to get better.

16 Looking after yourself while you are on treatment

One of the most important things for good health is exercise. Exercise helps reduce tiredness from
treatment and is important in helping you feel better physically and mentally. It is important to do
regular exercise. Some low-impact exercise includes: walking, swimming, gardening, stretching, tai chi, yoga.
Being on treatment can be stressful. Some people will be affected by the experience of treatment, trying to
 remember to take their medication, managing side effects and maintaining their everyday life. Making time
for relaxation can help to reduce stress.
A nutritious balanced diet is important to keep up energy levels, general good health and feelings of well-being.
 A diet that is low in fat, sugar and salt is important, and drink plenty of water.
Alcohol and other drugs
If you drink alcohol, you should reduce the amount you drink, to less than 7 standard drinks per week.
 If you have cirrhosis, it is strongly recommended that you don’t drink alcohol at all. Some illegal drugs
can harm your liver or make it harder to monitor your treatment. It is important to think about the drugs
 you use and how they may affect the health of your liver.
Other medicines
Many prescription and over-the-counter medicines can be harmful to your liver if taken for a long time or
 in high doses. Discuss any other medicine you are taking, including vitamins, Chinese herbs and so on,
 with your doctor or nurse.
Avoiding hepatitis viruses
Many doctors advise people with hepatitis C to have hepatitis A and hepatitis B vaccinations. Even though
the viruses are different, they all affect the liver. Other ways to prevent getting either hepatitis A or hepatitis
 B is by using condoms for sexual intercourse, not sharing any injecting equipment, and drinking bottled
water and being careful about what you eat, when you are travelling overseas.

17 Can I travel overseas when I am on treatment?

It is important that once you have started hepatitis C treatment you continue to ensure that you get the
 best possible result. There are a number of things you should consider when you plan to go overseas
while on hepatitis C treatment.
  • Tell your doctor or nurse about your plans. That way you can plan together for any medical needs.
  • You need to make arrangements to travel with needles and syringes. Carrying needles and medication
  •  while travelling may require a letter from your doctor or nurse. The letter will explain what the medication is, 

  • how it is to be taken and that it must be kept cool.
  • Ensure you have enough hepatitis C treatment medication to last through your travels. In many countries these treatments are not available or are very expensive. Find out what you can do in the country you are visiting,
  •  if you lose or damage your medications.
  • Always carry your hepatitis C treatment medication and other prescription medication in your hand luggage 
  • in case your other luggage is lost or delayed. It is important for your medication to be kept cool, so a cooler
  •  bag with a frozen ice pack will be useful. The medication will then need to be refrigerated when you get to
           your destination.
  • It is important not to get infected with other forms of hepatitis so talk to your doctor about being vaccinated for hepatitis A and B.
  • Remember to pay attention to your diet and especially the water you drink to avoid diarrhoea 
          and other illnesses.

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