Outsmarting hepatitis C

Hepatitis C is a blood-borne virus that causes liver infection and inflammation. The illness can vary from being mild and acute, to serious and chronic. Serious diseases like liver cirrhosis or liver cancer often develop if people are infected for a long time and do not receive treatment. A vaccine cannot prevent hepatitis C.

Antiviral medicines treat infections caused by viruses. Treating HCV reduces the risk of liver scarring (fibrosis) or worsening existing liver disease.⁴

Use of antiviral treatments for hepatitis C infection in Australia has been low.² Reasons for this included unpleasant medicine side effects (ie, flu-like symptoms, anaemia, rash, and cough), needing to inject a medicine (called interferon), treatment lasting a long time (24–48 weeks) and low cure rates.⁵

More recently, new direct-acting antiviral (DAA) medicines have been developed. These medicines:

• can be used by more people with HCV
  
• often do not need interferon to be injected as well
  
• involve fewer tablets
  
• have high ‘cure’ rates
  
• have shorter treatment duration (8–24 weeks).^1,2
  

All people with HCV should consider antiviral therapy. Most people who start treatment will be cured. This means they will have undetectable levels of the hepatitis C virus in their blood 3 months after treatment has finished.^1,2

Like all medicines, these new HCV antivirals can cause side effects, including fatigue, headache and nausea.² People thinking about taking these medicines should talk with their doctor or pharmacist about how to manage side effects if they happen.

People treated with an antiviral medicine can reduce the chance of medicine interactions occurring by keeping an up-to-date medicine list and bringing it to their appointments. The medicines list should include information about all prescription and non-prescription medicines being taken, as well as any herbal preparations, vitamins and supplements.

The new PBS-listed antiviral medicines are available to anyone aged 18 and over with chronic hepatitis C, but certain medicines are more suitable for particular patients.

There are six main strains (genotypes) of HCV, and each strain can also have subtypes. In Australia, 90% of people with hepatitis C are infected with genotypes 1a, 1b or 3a.⁵

Identifying the genotype involved in each hepatitis C infection helps to determine the most suitable medicine for the infected individual. Other factors that can influence treatment options² include:

• presence of liver cirrhosis
  
• presence of other health conditions
  
• whether the person has been treated for hepatitis C infection before.
  

Currently interferon-free treatment options are only available for HCV genotypes 1, 2 and 3.² People with genotypes 4, 5 and 6 need to take a newer DAA medicine alongside an interferon and another antiviral agent called ribavirin.

Listing these prescription medicines on the PBS makes them affordable for more people with chronic hepatitis C, which should help to increase uptake. Normal PBS co-payment for a prescription of these medicines is currently $6.20 for concessional patients and $38.30 for general patients. Without this government subsidy, these medicines would be too expensive for most Australians.

The PBS listings also aim to improve the way people access these medicines and receive support during treatment.^1,2 The new medicines can be prescribed by GPs in consultation with a specialist, not just by specialists alone. This increases the number of prescribers in the community.^1,2

Approved pharmacies stock and dispense these hepatitis C medicines. People being treated for HCV should discuss their needs with their pharmacist before they start their medicines.

• Hepatitis Australia: Treatment for Hep C