This piece was commissioned by Ellen Health, but may be of interest to the wider community. The original article can be found here.
From 1st March 2016, new and highly effective Hepatitis C treatments will become listed on the Pharmaceutical Benefits Scheme (PBS), making them accessible and affordable to the general public. This article will address what these new treatments will involve, and how Ellen Health is leading the way.
What is Hepatitis C?
Hepatitis C is an infectious liver disease caused by the Hepatitis C virus. Of those infected, about 75% are unable to clear the virus and go on to develop chronic hepatitis C. Being chronically infected puts a person at risk of liver scarring (‘fibrosis’ in the early stage and the severe ‘cirrhosis’ in later stages), liver failure and hepatocellular carcinoma, and is also the most common indication for liver transplantation.
In its early stages Hepatitis C usually causes no symptoms, although a small proportion of people may experience fatigue, nausea, stomach pain, dark coloured urine and jaundice. After years of chronic infection, patients can develop a collection of signs and symptoms that include easy bruising and bleeding, fluid accumulation and confusion.
Hepatitis C is curable and the disease complications can be prevented with treatment. The nature of this treatment is dependent on which of the six Hepatitis C ‘Genotypes’ a person is infected with.
How common is Hepatitis C and who is at risk of contracting it?
In 2012 it was estimated that 230 000 Australians were living with chronic hepatitis C, and that a further 40 000-50 000 Australians were unaware that they were chronically infected.
Hepatitis C is spread by blood-to-blood transmission, with the majority of Australian cases being caused by unsafe injecting drug use (such as sharing needles). Other people at risk include:
- People with tattoos or body piercings
- Sex workers
- People who received organ donations or blood transfusions overseas or before 1990 in Australia.
- Children born to mothers with hepatitis C.
- People who obtain needle-stick injuries.
- People with liver disease.
- People with HIV or Hepatitis B.
- Migrants from areas of high prevalence, including Africa, Southern Asia and Eastern Europe.
How is Hepatitis C treatment changing?
Until recently, the mainstay of Hepatitis C treatment was Peginterferon-based antiviral therapy. While curing over 70% of those with Genotype 3 infection, there were a significant proportion of people who either did not respond to the medication (such as those with Genotype 1 infection), were ineligible (including patients with severe mental health issues or advanced liver disease) or relapsed soon after treatment completion. For those who could take the medication, many experienced debilitating side effects, including severe flu-like illnesses, fatigue, bone marrow suppression, mood disturbances and alopecia.
From March 1st 2016, a number of new ‘interferon-free’ treatments for Hepatitis C will become available to the general public outside of the hospital system. Unlike Peginterferon, these drugs directly target the virus and, when used together, affect multiple steps in the viral life cycle.
The new medications that will be PBS listed are:
- Sofosbuvir and Ledipasvir (Harvoni®)
- Sofosbuvir (Sovaldi®)
- Daclatasvir (Daklinza®)
- Ribavirin (Ibavyr®)
The new medications will be used in combination and the choice will depend on both the Hepatitis C Genotype and the degree of liver scarring present. Once PBS listed, patients will only be charged the usual co-payment for these prescriptions: $30.30 for general patients and $6.20 for patients with a concession.
What are the advantages of the new treatments?
The advantages of the new medications are:
- Highly effective with a greater than 90% cure rate.
- Very few side effects.
- The most common side effects are mild fatigue, headache and nausea, but these can be controlled by over-the-counter medications.
- Are taken orally for as little as 8-12 weeks in most people.
- By contrast, Peginterferon has to be injected once a week for up to 6-12 months.
- Can be used by patients who are non-responsive to, or ineligible for, Peginterferon.
- General practitioners can coordinate treatment.
- This improves continuity of care, and the lack of hospital-based therapy means shorter waiting times and increased time with the practitioner.
How can Ellen Health help?
In order to improve access to treatment and reduce the impact of Hepatitis C in the community, Ellen Health has teamed with Infections Disease Physician Dr. Astrid Arellano to create a collaborative treatment model with three stages:
Patients visit their GP at Ellen Health who will perform a Hepatitis C antibody blood test to screen for the disease. Liver function tests and Hepatitis B / HIV antibodies will also be obtained to assess liver health and co-infection. If the Hepatitis C screening test is positive, the GP will continue the initial workup. The most important part of this is a Hepatitis C PCR blood test; this test looks at whether the virus is present in your blood, and is often accompanied by tests for Genotype and viral load. Blood tests for alpha-fetoprotein (a liver tumour marker) and Hepascore (a new liver function test that can predict the extent of liver scarring) will also be obtained, as well as a liver ultrasound to look for portal hypertension and hepatocellular carcinoma (two consequences of advanced liver scarring and damage).
An appointment will be arranged with Dr. Astrid Arellano at her rooms in Palmyra. Here she will undertake a clinical assessment of how scarred the liver is, before formulating an appropriate medication regimen for the patient. If the patient has uncomplicated disease, then this may be the only time they need to see Dr. Astrid. However, if a patient has severe cirrhosis further follow-up may be required.
The GPs at Ellen Health will then prescribe the medications (if not already done so by Dr. Astrid), monitor the patient’s response to the drug and continue to look after their health needs.
The Ellen Health nurses will also be available to provide education and to help with patient compliance (ensuring that the patients are able to take all of their medications).
Who should get involved?
These new treatments are perfect for anyone who is Hepatitis C positive, especially for those who may not have considered treatment before (such as those with low grade liver inflammation and a low viral load). Anyone at risk of Hepatitis C is also encouraged to have a hepatitis screen.
Where can I find more information?
More information about Hepatitis C and the new treatments can be found at the following websites:
Your GP should also be able to answer any questions you may have.