St. Joseph’s/Candler pharmacists answer four common questions about hepatitis C

SJ/C recently started the Liver Treatment Program to assist patients with medication and education

Healthcare professionals have learned a lot about hepatitis C since it was discovered 30 years ago. While there’s still no vaccine for the liver infection, new treatment is curing hepatitis C patients at an extraordinary level.

“The treatments we have now and we will be using are actually curative in the majority of cases,” says Chelsea Keedy, PharmD, Clinical Pharmacy Specialist at St. Joseph’s/Candler. “It’s really an exciting time for the treatment of hepatitis C because these medications usually end up with the patients completely cured and avoiding any down-the-road consequences of leaving the virus untreated.”

St. Joseph’s/Candler recently started the Liver Treatment Program to help patients that have Hepatitis C start treatment and obtaining medications. The program also provides education and ensures follow-up, including coordinating all associated labwork. The program is offered to patients each Thursday from 12:30 p.m. to 4:30 p.m. at the Center for Infusion Therapy in the Heart and Lung Building on the Candler Hospital campus.

It is teamed by Dr. Suzanne Anderson, Pharmacists Keedy and Bruce Jones and other SJ/C co-workers. Keedy and Jones recently answered some common questions about hepatitis C.

What is hepatitis?

Hepatitis is characterized by inflammation of the liver, and when the liver is inflamed or damaged, liver function may be affected. The liver carries out many important functions including making bile, changing food into energy and cleaning alcohol and poisons from the blood.

Hepatitis is most often caused by a blood-borne virus. The most common hepatitis viruses are:

• Hepatitis A: usually a short-term infection
• Hepatitis B: starts out as a short-term infection but can remain in the body
• Hepatitis C: also starts out as a short-term infection but can remain in the body and cause a lifelong infection

Each can cause similar symptoms or no symptoms at all, but they spread in different ways and can affect the liver differently. There are vaccines to prevent hepatitis A and hepatitis B; however, there’s no vaccine for hepatitis C.

“If not treated, hepatitis C can progress down the road to more serious things,” Keedy says. “Since it targets the liver, it can lead to end-stage liver disease, even cancer, but all this can often be avoided with treatment.”

Who can get hepatitis C?

Anyone could potentially be at risk of getting hepatitis C since there is no vaccine. However, there are certain populations that are a greater risk of the disease including:

• People born between 1945-1965 (Baby Boomers)
• People who received a blood transfusion before 1992
• People with a long-term history of hemodialysis
• People with a history of IV drug use or sharing needles
• Anyone infected with HIV

The Centers for Disease Control and Prevention estimates approximately three million Americans are living with hepatitis C. Approximately 75 percent of those were born between 1945-1965.

“Unfortunately, standard protocols and screening methods for blood products were not in place years ago,” Keedy says. “Today, we have more information on what can be transmitted through blood and there are regulations and standards that ensure patient safety.

“I think there can be a stigma around hepatitis C that should not necessarily be there,” Keedy continues. “Many hepatitis C cases have nothing to do with a person’s lifestyle or anything they did wrong. It’s just because you were born within that birth cohort that you may have been exposed to things that people born after 1965 were likely not exposed to.”

The Liver Treatment program recommends that screening be aligned with the CDC recommendations, anyone born between 1945-1965 should be screened for hepatitis C at least once in their lifetime. Individuals that fall into other high risk populations also should be screened.

How do you test for hepatitis C?

Hepatitis C testing is a two-fold test that involves one blood draw. Since most patients admitted to the hospital have their blood drawn anyway, hepatitis testing can be added to labs already drawn, Keedy says.

The first test is an antibody test and can tell if someone has ever been infected with the hepatitis C virus. Antibodies are chemicals released into the bloodstream when someone gets infected. There are two possible results:

• Negative, meaning a person has never had hepatitis C.
• Positive, meaning hepatitis C antibodies were found and the person has at some point been infected with the virus or may be currently infected with the virus.

A positive result does not mean a person has active hepatitis C. There are three different possibilities for a positive result:

• The patient had hepatitis C in the past and has been treated successfully.
• The patient had hepatitis C in the past and self-cleared the virus (a very small percentage of cases).
• The patient has active hepatitis C.

To determine the exact reason for positive results, a second confirmatory test is done. This is called a hepatitis C RNA test. RNA is the virus’ genetic material. A positive result of the second test confirms whether the virus is still active.

How do you treat hepatitis C?

Hepatitis treatment has come a long way just in the past decade, says Bruce Jones, PharmD, BCPS, Infectious Disease Clinical Pharmacy Specialist. Treatment used to require a lot of injectable medications that caused many side effects and often didn’t cure the disease. Today, medications are taken by mouth once or twice a day for two to four months. After that, most patients are cured.

“In my lifetime, at least up to now, this is probably one of the greater developments in infectious disease that you can take something as serious as hepatitis C and we now have a safe and effective cure for the virus,” Jones says. “This was a bad disease if you had active hepatitis C even 15 years ago. These new drugs have really changed everything – there are pills you can swallow; the side effects are much better than old treatments; and the success rate is greater than 90 percent. It’s really an amazing thing.”

If someone does test positive for hepatitis C, they can be treated by their primary care physician or referred to the St. Joseph’s/Candler Liver Treatment Program. Our team of physicians and pharmacists perform physical exams, talk about potential side effects of the medication (nausea being most common), any possible interactions with other medications and help find the most affordable treatment plan. They also monitor a patient’s blood work to ensure RNA levels are decreasing and the medication is working.

“The benefit we have is we are a one-stop shop,” Jones says. “You come to the infusion center and see a physician and/or pharmacist. We go through any side effects or issues you may be having. Then you go to the lab in the next building and right across from that is the pharmacy where you can fill your prescriptions.”

Referrals for appointments are required for the Liver Treatment Program. For more information, please call 819-8407.