A CURE FOR HEPATITIS C
Can hep c be cured?
The good news is yes, Hepatitis C (hep C) can be cured for most people. The new medicines, known as direct-acting antivirals (DAAs) are taken orally, are more effective and have less side-effects. The number of weeks that you need to be on treatment has also reduced and this is likely to improve even further as more new drugs become available. The new medicines are effective in treating and curing hep C in more than 90% of people[i].
Who can access the new cures?
Anyone in Australia who is living with chronic hepatitis C and who is eligible for Medicare can access the new medicines to cure their hep C. This is regardless of whether or not you are currently injecting drugs or you are accessing treatment for drug dependency, such as opioid substitution therapy (OST)
How do I get treatment to be cured?
Getting treatment for hep C is now much simpler. All you need to do is talk to your general practitioner (GP). Your GP will need to do some tests to help decide which medicines will work best for you. If you have cirrhosis (liver scarring), or there are other conditions affecting your liver, you may be referred to a liver specialist before starting treatment. If you go to a liver clinic at the hospital, you will be treated as an outpatient and won’t need to stay overnight. For most people, medicines for treating hep C are available through your local pharmacy/chemist. However, if you are seeing a liver specialist, you should check if your prescription needs to be filled at the hospital pharmacy or can be filled at your local chemist.
For more information on how to get onto treatment you can contact the National Hepatitis Info Line on 1800 437 222.
Being treatment ready
The treatment experience is different for everyone. The new medicines now used to treat most people have very few side-effects, and most people will be able to stick to a normal daily routine. The exact combinations of medicines to be taken will depend on a number of things, such as whether you have cirrhosis and the genotype (strain) of hep C you have.
While it is now unlikely, it may be necessary for some people to take the new medicines in combination with the older ones, including ribavirin but rarely interferon. Taking a combination of medicines which includes interferon may increase your chance of experiencing significant side-effects, and you may need to be on treatment longer. This may mean taking time off work or making other changes to your normal routine. In this case, you may want to discuss with your doctor, nurse, family or friends about when to start treatment and how you might need to manage possible side-effects. New treatments for the less common genotypes of hep C are expected to become available in the future and will remove the need to use the older medicines, but please talk to your doctor before deciding to wait for new treatment options.
Contacting the National Hepatitis Information Line on 1800 437 222 or your state hepatitis organisation is another good way to find support and answers to your questions.
What is the treatment medication?
From March 2016, new medicines known as direct-acting antivirals (DAAs) became available on the Pharmaceutical Benefits Scheme (PBS) in Australia. These new medicines are highly effective for most people, have less side-effects and are taken for a shorter time. The new medicines have proven to be > 90% effective in curing hep C. Treatment will usually be for a period of 8 to 12 weeks, but may be for up to 24 weeks for some people. The medicines your doctor prescribes for you will depend on a number of things. These include: the genotype of hep C you have, whether you have developed cirrhosis (liver scarring) or whether you have other existing health conditions. If you have a less common genotype, you may need to use a combination of the new and older medicines such as interferon. In this case, you will usually be referred to a liver specialist to find out the best treatment option. As newer medicines become available, it is likely the need to check genotype and use the older medicines will decrease, making treatment for all people with hep C much simpler.
The following DAA medicines are currently available in Australia on the PBS:
- Daklinza® (daclatasvir)
- Epclusa® (sofosbuvir + velpatasvir)
- Harvoni® (sofosbuvir + ledipasvir)
- Sovaldi® (sofosbuvir)
- Viekira Pak® (paritaprevir + ritonavir + ombitasvir + dasabuvir)
- Viekira Pak RBV® (paritaprevir + ritonavir + ombitasvir + dasabuvir + ribavirin)
- Zepatier® (grazoprevir + elbasvir)
Will I have to pay for treatment?
Public treatment for hep C is funded through Medicare and the Pharmaceutical Benefits Scheme. The only cost to you will be any fees for seeing your GP (if they do not bulk bill) and the dispensing fee for collecting your medicines at the pharmacy/chemist. Currently the dispensing fee is less than $40.00 per prescription. These fees will vary depending on whether you have a Health Care Card or Seniors Card. If you are prescribed more than one medicine, you will need to pay the pharmacy dispensing fee for each medicine. It is important to remember that if you are not eligible for a Medicare Card, you may need to pay the full price.
Most medicines can have side-effects and each person’s experience will be different. The new medicines now being used to treat hep C have a lot fewer side-effects and are better tolerated. Side-effects may include fatigue, headache, insomnia and nausea, but they are uncommon and typically mild in severity. In the small number of people who may still require ribavirin or interferon therapy, side-effects are more common and may be more severe. Please discuss possible side-effects with your doctor. It is important to understand what the possible side-effects are for any medicines you will be taking and tell your doctor if you are experiencing these symptoms. Health professionals can help reduce your side-effects and also help you to manage them.
What is meant by the term ‘cure’?
A ‘cure’ is indicated by a sustained viral response (SVR) at week 12 after treatment(i). Your doctor will order a PCR viral load test 12 weeks after treatment finishes, and if the results show ‘virus undetectable’ (no virus) it means that you have successfully cleared the virus and there is no hep C in your body. Some doctors will order a further PCR viral load test 24 weeks after treatment.
Once you have been cured of hep C, your body will continue to make antibodies for ten years or more. Antibodies are produced as a part of your body’s natural defence system to infections. Having hep C antibodies does not mean you still have hep C. If your PCR test is still negative 3 months after completing treatment, the virus is no longer in your body.
It is important to remember that while the antibodies remain in your blood, this does not protect you against getting hep C again. You should avoid blood-to- blood contact with others (including sharing injecting equipment) so you do not catch hep C again.
Most people will start to feel better during treatment for hep C. However, depending on the medicines used in your treatment, it may take some time after treatment for any side-effects to lessen and for you to feel the full benefits of being cured.
What if I don’t clear the virus
If you don’t respond to treatment, or relapse in the six-month period after treatment, it means that you have not cleared the virus, and treatment has not worked for you this time. It’s important not to feel that you have ‘failed’. The treatment has not been a waste of time and effort – even reducing the amount of virus in your liver for a short while provides a big benefit to your health and liver. Try to keep up with healthy eating and lifestyle, and stay in regular contact with your doctor, so that your health is regularly monitored. Your doctor may also recommend re-treatment, which is subsidised by the government in certain circumstances. By staying in touch with your doctor you will also learn of any new developments in hep C treatments.
Liver transplant and surgery
Less than one in five people with hep C will develop advanced cirrhosis. Usually it takes 20 to 40 years for this stage of liver damage to develop. People who have advanced cirrhosis are at increased risk for liver cancer or liver failure. If liver cancer does occur, radiotherapy, or cutting out a part of the liver may be necessary or in the event of liver failure, a liver transplant may be required. With increasing access to better and earlier treatment, even fewer people with hep C will develop serious cirrhosis and find themselves needing liver surgery or transplant. For more information about serious liver damage, speak to your specialist or doctor, or phone the National Hepatitis Information Line 1800 437 222.
[i] Hepatitis C Virus Infection Consensus Statement Working Group. Australian recommendations for the management of hepatitis C virus infection: a consensus statement (January 2017). Melbourne: Gastroenterological Society of Australia, 2017
Page updated: 30 June 2017