Treatments and Living Well

What are the treatments for hepatitis C?

New treatments are available to treat hepatitis C. They are effective, easy to take and have few side effects.

Not only do the new treatments have a 90-95% chance of curing hepatitis C, the length of the treatment is also much shorter than before.

They can be prescribed by general practitioners (GPs) as well as specialists, which makes it easier for people to be treated.

The new treatments are called direct-acting antivirals or DAAs and are taken as tablets.In some cases, other drugs called Ribavirin and Pegylated Interferon may be included in the treatment. Pegylated Interferon is given as injections. Treatment takes between 8 - 24 weeks and is recommended for all people living with hepatitis C.

Your doctor will explain which treatment is best for you and how long you will have to take it.

Before deciding to go on hepatitis C treatment, it’s important to find out as much information as you can. This factsheet will help you to understand the treatments. However, your doctor can answer any questions you may have.

What are the benefits of going on hepatitis C treatment?

Some of the reasons to go on treatment are to:

• Cure you of the virus
• Improve your health
• Prevent liver damage and liver cancer
• Live longer.

Who can have hepatitis C treatments?

The new treatments are available for anyone who has hepatitis C, is 18 years of age or older and has a Medicare card.

How much does the treatment cost?

The new hepatitis C treatments are subsidised under the Pharmaceutical Benefits Scheme (PBS) by the Australian Government. This means, that if you have a Medicare Card, the government covers most of the cost of the treatment and you only pay a small cost. If you have a Health Care or Pension Card the cost is even lower.

If you do not have a Medicare you are not eligible for government subsidised treatment. Speak to your doctor about other ways you can get treatment.

Getting ready for treatment

Before starting treatment your doctor will need to do some tests and will also need information about your general health and lifestyle. This will help your doctor decide which treatment is right for you and if you need to see a specialist.

Blood tests

You might need blood tests to:

• Confirm that you have hepatitis C
• Find out what genotype (type) of the hepatitis C virus you have
• Check for inflammation or damage to the liver.

Fibroscan

A Fibroscan is a machine that checks for cirrhosis (serious damage) of the liver. It is similar to an ultrasound and is not painful.

Other tests

Your doctor may do some other tests to check your general health, such as HIV, hepatitis B and pregnancy tests.

Your medical history

Your doctor will need to know if you have been on treatment for hepatitis C before, if you have other health problems and if you are taking other medications, including any complementary therapies. This is important as some medications can interact with (affect) the hepatitis C treatment making it less effective or cause harmful side effects. Hepatitis C treatment can also affect other medications you may be taking and cause harmful side effects.

Your lifestyle

For the medication to work, you will need to take it exactly as your doctor says. This is called adherence. Your doctor may ask you questions about your lifestyle, in case there are circumstances that may make it hard for you to take the medication every day. Your doctor can help you find ways to manage these and can tell you what to do if you miss a dose.

Complementary or traditional therapies

Some people use traditional or complementary medicines, such as acupuncture, homeopathy, Chinese medicine, herbal therapies, vitamin and dietary supplements to help with health problems. As some of these can affect hepatitis C treatment, it is important to tell your doctor about any complementary treatments you are taking or any that you are thinking of about.

Hepatitis C treatment and pregnancy

If you’re a woman, you cannot take hepatitis C treatment while you are pregnant or breastfeeding as the medications can harm your baby.

If you’re a man and are taking Ribavirin, your wife or partner should not be pregnant or become pregnant while you are taking treatment.

Ask your doctor about contraceptive methods that are safe to use with the hepatitis C treatment. If your treatment includes Ribavirin, your doctor may ask you to use two contraceptive methods.

After finishing your treatment, you and your partner will need to wait sometime before it is safe to fall pregnant. If your treatment includes Ribavirin, you will need to wait six months. If your treatment does not include Ribavirin, the wait is six weeks.

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

People who are on methadone or other drug treatments can be successfully treated for hepatitis C. Treatment is also recommended for people who are injecting drugs.

Successful treatment does not stop you from getting hepatitis C again. To make sure you don’t get hepatitis C again, it is important that you do not share injecting equipment.

Tell your doctor if you are on methadone or other therapies or if you are using drugs as your dose of hepatitis C medication may need to be adjusted.

Preparing for your medical appointments

It’s always a good idea to prepare a list of the things you want to know before going on treatment. Here are some questions you may want to ask your doctor:

• What is the best treatment for me?
• What tests will I need beforehand?
• How often will I have to take the treatment and how is it taken (tablets, injections)?
• How long will I have to be on the treatment?
• When will I know if I’ve been cured of hepatitis C?
• What are the possible side effects?
• If I miss a dose or accidently take too much, what should I do?
• What happens if I am taking medication for other medical conditions?
• What will happen if I stop the treatment suddenly?
• How much does it cost?
• Where do I get the medication?
• How often do I need to see the doctor while I’m on treatment?
• Can I still have sex?
• Can I travel overseas while on treatment?
• Will being on treatment affect my work or family life?

Going on treatment - time and commitment

Being ready for treatment is important.

The new treatments are easy to take and have few side effects. However, for the treatment to work, you need to be committed to take the medication exactly as your doctor says and for the full length of time.

Who can prescribe hepatitis C treatment?

General practitioners (GPs) are able to prescribe and supervise the new hepatitis C treatments in consultation with a specialist. However, as not all GPs choose to do so, you’ll need to check with your doctor.

For a list of GPs in NSW who prescribe hepatitis C treatments visit www.hep.org.au/services-directory/

People with cirrhosis (serious liver damage), other liver disease or serious medical conditions, and people who have been on hepatitis C treatment before, will need to see a specialist. Your GP may be able to do the initial assessment and will refer you to a specialist if needed. You can see a specialist and get your treatment at hospital liver clinics.

Will I need to see the doctor while I am on treatment?

You will see your doctor at the beginning and end of the treatment. In some cases, your doctor may ask to see you four weeks after you start treatment. Everyone is different, so ask if you need to see your doctor during the treatment and what tests you may need to have.

You will also have a check-up 12 weeks after finishing treatment. Your doctor will do a blood test to see if the treatment has worked. Most people will be cured, only about 10% of people will not be cured.

If you have problems with side effects, you should see your doctor to get help with them. If you have trouble remembering to take the medication, your doctor can help you find ways to remember.

If you need to start taking any other medication, it’s important to tell your doctor beforehand as it may affect your hepatitis C medication.

Where do I get my medication?

In most cases, you will be able to get your medication from your local chemist. However, not all chemists sell these medications, so you will need to check this with them. For a list of chemists near you who sell hepatitis C medications visit https://www.hep.org.au/services-directory/

If you are being treated by a specialist at a hospital liver clinic, you may need to go to the hospital pharmacy to get your medication. Your specialist will tell you where to get your medication.

You can only buy four weeks of medication at a time and in many cases, you will need to order the medication in advance.

It is important that you don’t have a break from taking your medication, so always buy your next lot of medication well before you need it, so you don’t run out.

Managing side effects

Most people taking the new medications don’t have any side effects. Some people have mild side effects.

Some side effects may include fatigue, headache, nausea, itchy skin and trouble sleeping. If you have any of these, do not stop taking your medication, but speak to your doctor about ways to manage them.

People taking Ribavirin and/or Pegylated Interferon may experience more side effects, but they usually don’t start until a few weeks after treatment begins.

The most important thing about managing the side effects of these medications is to keep positive and seek help. This is a time when you need to be gentle with yourself.

Here are some common side effects of Ribavirin and Pegylated Interferon and 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
Tirednessh	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 pain, hair loss (temporary), weight loss, mouth ulcers, poor eyesight including blurred vision and changes in libido.	For ways to manage these speak to your doctor

Looking after yourself while you are on treatment

Most people go through the treatment without much difficulty and are able to continue their normal work and family life. However, the type of treatment you are on and any other health problems you might have can make it more difficult. Here are some ideas that can help you stay well while you’re taking treatment:

Exercise
Exercise helps reduce tiredness from treatment and helps you feel better both physically and mentally. Do some gentle exercise every day, such as walking, swimming, gardening, stretching, tai chi, yoga.

Relaxation
Life is busy. Sometimes it’s hard to remember to take medication, manage any side effects, attend doctor’s appointments, work and maintain everyday life. Making time for relaxation can help. Try meditation, a walk in the park, a chat with a friend or any activity that makes you feel happy and positive.

Nutrition
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 remember to drink plenty of water.

Alcohol and other drugs
If you drink alcohol, reduce the amount you drink to less than seven 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 hard to monitor your treatment. Tell your doctor if you are using any illegal drugs as these may interact with and affect the treatment.

Avoiding other 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.

Can I travel overseas when I am on treatment?
Once you have started hepatitis C treatment, it’s important you don’t take breaks to ensure 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. That way you can plan your medical needs together.
• If your treatment includes injections you need to make arrangements to travel with needles and syringes. Carrying needles and medication while travelling may require a letter from your doctor. The letter should 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 if you lose or damage your medications in the country you are visiting.
• Always carry your hepatitis C treatment medication and other prescription medication in your hand luggage in case your other luggage is lost or delayed. If your medication needs to be kept cool, use a cooler bag with a frozen ice pack. The medication will 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 what you eat, and drink bottled water to avoid diarrhoea and other illnesses.

Support

It can be helpful to have good support before going on treatment, especially if your treatment includes the medications with more side effects (Ribavirin and Pegylated Interferon).

Family, friends, and health care workers understand what you are going through and can assist. They can help if you need reminders to take your medication and encourage you to continue if you are not feeling motivated.

If you’d rather not tell anyone you know about your hepatitis C, talk to your doctor or local hepatitis organisation about the support services available.