Can hepatitis C be cured?
The good news is yes, Hepatitis C (hep C) can be cured. The new medicines, known as direct-acting antivirals (DAAs) are taken orally, are more effective and have less side-effects. You may have to take the pill once a day for 12 weeks or 24 weeks up to the type of the virus. The number of weeks that you need to be on treatment has also reduced and this is likely to improve even further as more new drugs become available. The new medicines are effective in treating and curing hep C in more than 90% of people[i].
Who can access the new cures?
Anyone in around the world who is living with chronic hepatitis C can access the new medicines to cure their hep C at Pulse Clinic Bangkok. This is regardless of whether or not you are currently injecting drugs or you are accessing treatment for drug dependency.
DAA treatment are offered to HIV positive people with HCV coinfection. Hepatitis C virus treatment guidelines recommend everyone should be treated.
Since February 2017, DAAs are recommended in the UK and Thailand for all genotypes. No-one should need to use the old HCV treatment with pegylated interferon (PEG-IFN) and ribavirin (RBV) anymore.
How do I get treatment to be cured?
Getting treatment for hep C is easy. All you need to do is talk to our doctor. Your doctor will need to do some blood tests checking your liver function, HCV viral load and checking its genotype to help decide which medicines will work best for you. The medicines your doctor prescribes for you will depend on a number of things. These include: the genotype of hep C you have, whether you have developed cirrhosis (liver scarring) or whether you have other existing health conditions. If you have cirrhosis (liver scarring), or there are other conditions affecting your liver, you may be referred to a liver specialist before starting treatment. You will be treated as an outpatient and won’t need to stay overnight. Medicines for treating hep C are available at PULSE Clinic all year long.
Being treatment ready
The treatment experience is different for everyone. The new medicines now used to treat most people have very few side-effects, and you will be able to stick to a normal daily routine. The exact combinations of medicines to be taken will depend on a number of things, such as whether you have cirrhosis and the genotype of hep C you have. While it is now unlikely, it may be necessary for some people to take the new medicines in combination with the older ones, including ribavirin but rarely interferon. Taking a combination of medicines which includes interferon may increase your chance of experiencing significant side-effects, and you may need to be on treatment longer. This may mean taking time off work or making other changes to your normal routine. In this case, you may want to discuss with your doctor, nurse, family or friends about when to start treatment and how you might need to manage possible side-effects.
What is the treatment medication?
From March 2017, new medicines known as direct-acting antivirals (DAAs) became available in Thailand. The new medicines have proven to be > 90% effective in curing hep C. Treatment will usually be for a period of 12 weeks, but may be for up to 24 weeks for some people. As newer medicines become available, it is likely the need to check genotype and use the older medicines will decrease, making treatment for all people with hep C much simpler.
Since 2014, the following DAAs and fixed dose combinations have been approved – and more are in development.
- daclatasvir 30, 60, and 90 mg (Daklinza)
- dasabuvir 250 mg (Exviera)
- sofosbuvir / ledispavir 400 mg / 90 mg
- simepravir 150 mg (Olysio)
- sofosbuvir 400 mg (Sovaldi)
- ombitasvir / paritaprevir / ritonavir 2.5 mg / 75 mg / 50 mg (Viekirax)
- elbasvir / grazoprevir 50 mg /100 mg (Zepatier)
The following DAA medicines are currently available in Thailand:
• Harvoni® (Sofosbuvir + Ledipasvir)
• Sofosbuvir + Daclatasvir
• Sofosbuvir + Velpatasvir
How much will I have to pay for treatment?
Even though HCV guidelines now only recommend oral DAA treatment, the high price of these medicines means that in many countries they are only available to people who have advanced liver damage. Luckily hepatitis C treatment is affordable at Pulse Clinic.
Doctor consultation fee, Complete blood test including HCV viral load, HCV genotyping, Complete Liver Function, Kidney funciton costs 14,000THB.
Medications cost around 33,000THB per month (which can be paid off by credit card), you may have to take the medication up to 3 months, and in few cases up to 6 months.
After that we will provide you with continuous medical follow up every 6 months to see if the Hep C is completely gone.
The new medicines now being used to treat hep C have a lot fewer side-effects and are better tolerated. Side-effects may include fatigue, headache, insomnia and nausea, but they are uncommon and typically mild in severity. It is important to understand what the possible side-effects are for any medicines you will be taking and tell your doctor if you are experiencing these symptoms. Health professionals can help reduce your side-effects and also help you to manage them. What is meant by the term ‘cure’?
A ‘cure’ is indicated by a sustained viral response at week 12 after treatment(i). Your doctor will order a PCR viral load test 12 weeks after treatment finishes, and if the results show ‘virus undetectable’ (no virus) it means that you have successfully cleared the virus and there is no hep C in your body. Some doctors will order a further PCR viral load test 24 weeks after treatment.
Once you have been cured of hep C, your body will continue to make antibodies for ten years or more. Antibodies are produced as a part of your body’s natural defence system to infections. Having hep C antibodies does not mean you still have hep C. If your PCR test is still negative 3 months after completing treatment, the virus is no longer in your body. It is important to remember that while the antibodies remain in your blood, this does not protect you against getting hep C again. You should avoid blood-to- blood contact with others (including sharing injecting equipment) so you do not catch hep C again. Most people will start to feel better during treatment for hep C.
What if I don’t clear the virus
If you don’t respond to treatment, or relapse in the six-month period after treatment, it means that you have not cleared the virus, and treatment has not worked for you this time. It’s important not to feel that you have ‘failed’. The treatment has not been a waste of time and effort – even reducing the amount of virus in your liver for a short while provides a big benefit to your health and liver. Try to keep up with healthy eating and lifestyle, and stay in regular contact with your doctor, so that your health is regularly monitored every 6 months. Your doctor may also recommend re-treatment. By staying in touch with your doctor you will also learn of any new developments in hep C treatments.
Steps for HCV treatment at PULSE Clinics (Thailand)
1. You need to get tested for
1a. HCV viral load test (5600THB, result sent to your email in 10 working days)
1b. HCV genotyping test, (6800THB, result sent to your email in 10 working days)
1c. Baseline complete liver funciton test (1000THB, result in 1 day) to check how your liver is doing before treatment.
1d. Baseline kidney function test (300THB, result in 1 day) to check how your kidneys are doing before treatment.
If you have these lab investigations done already in your country send it to firstname.lastname@example.org or bring it with you on the day of doctor visit.
2. Our doctor can prescribe medication according to the international guidelines and Thai National Guidelines for HCV treatment which will be 3-6 months depends on the genotype, sometimes we also have medications that covers all genotype but that has to be ordered in advance.
3. Follow up for HCV viral load and liver function test every 6 months.
Hepatitis C Virus Infection Consensus Statement Working Group. Australian recommendations for the management of hepatitis C virus infection: a consensus statement (January 2017). Melbourne: Gastroenterological Society of Australia, 2017