by Samuel Gibbings, Needle Syringe Exchange Program (NSEP) Project Officer
In December 2015, it was announced that new direct acting antiviral treatment drugs would be listed on the Pharmaceutical Benefits Scheme (PBS) on the 1st of March 2016. The implications of these new treatments will likely have a great impact on those living with Hepatitis C.
Hepatitis C is a liver disease caused by the hepatitis C virus. The virus lives in the blood and in the liver cells where it can cause inflammation, and scarring (which is known as fibrosis) or cirrhosis when more serious. Hepatitis C is passed on when blood infected with the hepatitis C virus from one person enters the bloodstream of another person.
The new treatments listed on the PBS are:
• Harvoni® (sofosbuvir/ledipasvir) two drugs combined in one pill, taken daily
• Sovaldi® and Daklinza® (sofosbuvir and daclatasvir) separate pills, taken daily
• Sovaldi® and Ibavyr® (sofosbuvir and ribavirin) separate pills, taken daily
These new treatments are well tolerated, with only minor side effects compared to previous treatments. As seen in the pie chart below, Genotypes 1-3 account for a majority of people affected by Hepatitis C (96 per cent).
The following table provides a general guide on what treatments may be used for each genotype, or strain, and the Sustained Virological Response (SVR), where there isn't any evidence of the virus left in the blood after the treatment is finished:
|sofosbuvir and daclatasvir||1||90|
|sofosbuvir and ribavirin||2||93|
|sofosbuvir and daclatasvir||3, 4||95|
|sofosbuvir, interferon and ribavirin||6||90|
|interferon and ribavirin||5||60-70|
Treatment type and length will be based on a number of factors including: cirrhosis, chronic kidney disease, HIV co-infection, or if previous therapies have failed. For genotypes 1-3, most treatments will take between 8-12, but can be 24 weeks in length if a person has cirrhosis and have failed previous treatment.
For genotypes 4 and 6, treatment is still limited to the use of interferon and ribavirin, but introduces sofosbuvir (which provides a greater than 90 per cent chance of clearing the virus). The most common adverse side effects of ribavirin are fatigue, anemia, headache, skin irritation and insomnia. For genotype 5, treatment is currently limited to interferon and ribavirin.
It is also important to note that while these new treatments provide a good chance of clearing the virus, it does not provide immunity against future transmissions. This means that a person can get re-infected if they are once again exposed to the virus. The best way to avoid getting re-infected is to avoid: sharing injecting equipment, personal equipment, tattoo needles and to avoid blood to blood exposures.
For more information contact the Hepatitis Help Line on (08) 9328 8538 (metro areas), 1800 800 070 in the regional areas, or visit www.hepatitiswa.com.au