aidsnorthbay.com – AIDS Committee of North Bay & Area - To assist and support all persons infected or affected by HIV/AIDS and/or Hepatitis C and to limit the spread of the viruses through eduction, awareness and outreach strategies.

Hepatitis C

ACNBA provides a wide range of services under the Hepatitis C program. Having received provincial funding in April 2011, Hepatitis C now makes up half of ACNBA’s mandate. Staff and office facilities have been expanded to provide proper support to the broadened program. A comprehensive list of Hepatitis C services can also be found under our Programs page.

What is Hep C?

Hepatitis C is the liver disease caused by the blood-borne Hepatitis C virus (HCV). Hep C causes inflammation of the liver which can eventually lead to cirrhosis (permanent and extensive scarring of the liver) preventing it from functioning normally. A small percentage of those with cirrhosis will develop liver cancer. The liver carries out many important and complex functions such as aiding in digestion, maintaining levels of cholesterol, storing vitamins, minerals, iron, sugar and filtering blood.

How is HCV Transmitted?

Hepatitis C can only be contracted if the virus gets into the bloodstream through any break in the skin or mucous membranes. This blood-borne infection can happen commonly through:

  • Sharing drug equipment including that used for injecting, snorting or smoking drugs
  • Using unsterile instruments for tattoos, piercings or acupuncture
  • Before 1992 Hep C could be contracted through blood products, organ transplants or dialysis. Blood is now thoroughly screened for Hep C in Canada.

Less commonly spread by:

  • Sharing razors, toothbrushes, tweezers, manicure or pedicure equipment
  • Sexual activity that includes contact with blood or the exchange of blood products
  • From an infected mother to baby, before or during birth
  • On the job needle sticks, sharps, cuts or mucosal exposure accidents in the health care, emergency services or public safety fields where infected blood is present

You cannot get infected by Hepatitis C through everyday contact such as holding hands, hugging, kissing or by sharing toilets, tableware, or kitchen utensils.

What are the Symptoms of Hep C?

Many people who have been infected by the Hepatitis C virus (HCV) do not exhibit any symptoms. However others may experience symptoms ranging from mild to severe. At onset you may have the following symptoms for a few weeks:

  • Mild fever
  • Headache
  • Muscle aches
  • Fatigue
  • Jaundice

Many people do not have symptoms until 10-20 years after getting HCV.  These symptoms may include:

  • Abdominal pain (where your liver is, under the right side of your rib cage)
  • Loss of appetite
  • Nausea
  • Vomiting
  • Depression
  • Memory loss
  • Itchy skin (pruritus)

People with cirrhosis could experience coffee coloured urine, pale coloured stools, abdominal swelling (ascites), the yellowing of their skin and the whites of their eyes (jaundice).

Testing

You can get tested for Hepatitis C at any time. If you think you have been exposed to Hepatitis C, you have to wait for 3 months before getting tested, otherwise the results may not be accurate.
Testing for Hepatitis C is done through 2 blood tests.

  1. Antibody Testing – This first test tells us if you have ever been exposed to Hepatitis C by looking to see if your body has antibodies to fight against the virus.  1 in 4 people are able to clear the virus without treatment.
  2. Hepatitis C RNA – Tells us if you have the virus.  If this test comes back positive it will also tell us what genotype of Hepatitis C you have.

Determining Fibrosis

In order to determine eligibility of treatment and length of treatment, amount of fibrosis needs to be determined.  At our clinic we use one of the following ways to determine fibrosis.

Fibroscan ­This is a non-invasive and painless test that generates a mechanical pulse at skin surface which is tracked as it passes through the liver. A score is given when the test is done and tells us how stiff your liver is and gives us your fibrosis score (0-4).

Fibrotest – This is a blood test which we look at a variety of markers.  The results of these markers are put into a mathematical equation.  The result of this equation correlates to a Fibrosis score.

Cirrhosis image: http://sanguen.com/wp-content/uploads/2013/05/liver-staging.png

Hepatitis C Treatment Coverage in Ontario

Prescription Drug Programs in Ontario

  • People who receive social assistance (Ontario Works or Ontario Disability Support Program) or who use Trillium Drug Program (Available for Ontarians who have high drug costs and do not qualify for drug coverage through a different program) may be eligible for prescription drug coverage
  • In Ontario, Peg-interferon, Ribavirin, Victrelis and Incivek are among the drugs that are eligible for coverage under the Exceptional Access Program (EAP)

A request must be submitted for approval before you are eligible for coverage. Your specialist can submit this. Some of the factors that are considered when approving funding for hepatitis C medications include: a positive HCV RNA test, HCV genotype, level of fibrosis, presence of cirrhosis, Child-Pugh score

  • Registered First Nations and recognized Inuit people may be able to access coverage for their hepatitis C medications through the Non-Insured Health Benefits (NIHB) program.

Private Health Insurance

  • Some health insurance policies offered through private insurance companies include coverage for prescription drugs
  • Often the patients need to apply to the Trillium Drug Program to cover the remainder of the cost

Drug Company Enrollment Programs

The companies that make Hep C medications have programs to help people get coverage for treatment.

  • Hoffman-La Roche has the PegAssist program for people that will be taking peg-interferon alpha-2a and ribavirin (known as Pegasys). PegAssist will also help with getting coverage for protease inhibitors if needed.
  • Merck has the MerckCare program for people that will be taking peg-interferon alpha-2b and ribavirin (known as Pegetron) and/or Victrelis.
  • Vertex has the IncivekCare program for people who are being prescribed Incivek.Source: Sanguen Health Center (link) http://sanguen.com/hepatitis-c/hepatitis-c-treatment-coverage-in-ontario/

Treatment

Pegylated Interferon

  • Our bodies produce interferons, and it produces more when we are fighting off a virus. When the interferons are fighting off infections, it can cause fever, muscle pain, headache, chills, joint pain and fatigue
  • This treatment is injected because stomach enzymes would destroy the pill before it could work
  • Interferon attaches to healthy cells and helps them defend against the virus
  • Interferon helps focus the immune system on the invading virus (stops multiplication)
  • Interferon helps the body get rid of cells infected by Hepatitis C virus and helps to prevent health cells from infection
  • Pegylated Interferon is injected subcutaneously into the stomach or legs (not into a muscle or vein) once a week so that the body can slowly absorb it.
  • Should be refrigerated 2-8 degrees Celsius

Ribavirin

  • This is an antiviral that fights infection, but cannot be used on its own.
  • Taken twice a day with fatty food
  • Does not need to be refrigerated

Victrelis (Boceprevir)

  • Protease inhibitor medication that prevents certain virus cells from multiplying in your body
  • Used in combination with Peg-interferon and Ribavirin for Hep C treatment
  • You should take this pill with food, keep it refrigerated
  • Medication is taken every 8 hours
  • You have a four week lead in with Peg-interferon and ribavirin before starting this medication.
  • Treatment length varies based on how your body responds, treatment history and cirrhosis (28, 36 or 48 weeks)

Incivek (Telaprevir)

  • Protease inhibitor medication that prevents certain virus cells from multiplying in your body
  • Used in combination with Peg-interferon and Ribavirin.
  • You should take this pill with a fatty food, keep it refrigerated
  • Medication is taken every 8 hours
  • Telaprevir is taken for the first 12 weeks with Peg-interferon and Ribavirin, then you just take Peg-interferon and Ribavirin for 12-36 weeks
  • Treatment length varies based on how your body responds, treatment history and cirrhosis (24 or 48 weeks)

Galexos (Simeprevir)

  • Recently approved in Canada
  • Can be used in combination with other treatments
  • A once daily oral tablet
  • Simeprevir is a protease inhibitor
  • Indicated in Canada for the treatment of chronic hepatitis C genotype 1
  • This is not covered under ODB, only some private drug insurance

For more information: http://hepcbc.ca/2013/11/galexos-simeprevir-approved-by-health-canada/

Sovaldi (Sofosbuvir)

  • Recently approved in Canada
  • Can be used in combination with other treatments
  • A once daily oral tablet
  • Sofosbuvir is a nucleotide analog inhibitor. This drug interferes directly with the HCV life cycle by suppressing viral replication.
  • This is not covered under ODB, only some private drug insurances

For more information: http://hepcbc.ca/2013/12/sovaldi-sofosbuvir-approved-by-health-canada/

For more information on Hepatitis C please contact Keri McGuire-Trahan NP-PHC, MN, IBCLC and/or Kelsey Secord RN, BScN and/or Kristina Rancourt  or call 705-497-3560