What if I'm pregnant and I have hepatitis C?

Hepatitis C can be passed from a mother to her child during pregnancy and during delivery. Of all mothers who have antibodies to hepatitis C virus, approximately 2% transmit the infection to their child. Of mothers who have active hepatitis C virus circulating in their blood during pregnancy, roughly 5% transmit the infection to their baby. This risk of transmission goes up to almost 20% if the mother is co-infected with HIV.

You and your doctor should discuss and decide if you should receive treatment for hepatitis C during your pregnancy.

Can hepatitis C be prevented?

Hepatitis C can be prevented by avoiding close contact with a person who has the hepatitis C virus, and by avoiding situations which can increase your risk of getting hepatitis C. These situations include

• using injection drug,
• having multiple sexual partners, and
• getting tattoos and body piercings.

In the healthcare setting, it means following all procedures for infection control to minimize risks due to needle sticks, hemodialysis, and contaminated equipment. There is no protective vaccination for hepatitis C at this time, although research continues in this area.

Prevent Hepatitis C

Hepatitis C (HCV) is a virus that is contracted through contact with infected blood. It is curable, but could cause serious health problems if not detected and treated early. The best way to control the spread of HCV is to prevent spreading the virus, if you have it already, and avoid coming into contact with it, if you don't, by avoiding blood contact.

Avoiding Hepatitis C

• Avoid direct contact with blood or fluids if you work in a medical field. Always wear protective clothing, including gloves, and dispose of sharp objects or contaminated objects properly. If you work in another field using dangerous equipment, be sure to follow all safety precautions designated by your employer and OSHA.
• Never share needles, straws, or other equipment used with illicit drugs. Anything that comes into contact with your body should be kept personal, especially injecting needles. Straws and other items used to take cocaine or crushed prescription medicine can also transmit HCV since snorting often causes bleeding in the nose.
• If you do drugs, it’s best to stop immediately and get into a treatment program. If you can’t stop, make your priority using only your own personal equipment as a first step in putting your health first.
• Don’t share items used for personal hygiene. Blood can be transmitted through razors, scissors, nail clippers, and even toothbrushes (from bleeding gums). Avoid sharing any personal care items with anyone you know has HCV, and be sure to clean scissors and clippers with soap and water if used by others.
• Get tattoos and piercings only from licensed practitioners. Make sure they sterilize all equipment used between customers with an autoclave. Also ask if they use new needles and ink wells for each customer.
• There are chemicals that can be used to clean tattooing and piercing equipment, but an autoclave is the safest and best method of doing so.

Practice safe sex. 

• Although not often transmitted through sexual activity, hepatitis C may be spread this way in special cases.
•  Risk factors include having an STD, HIV, multiple partners, or engaging in rough sex practices.
• Men having sex with other men should always use condoms for intercourse.
• Always use condoms if having sex during your or your partner’s menstrual period or if one of you has an open sore on the genitals.

Stopping the Spread of Hepatitis C

• Get tested if you have risk factors. You can carry and transmit the virus even if you have no symptoms. 

Get tested for Hepatitis C if any of the following apply to you:

• You had a blood transfusion or organ transplant before 1992.
• You used blood products to treat hemophilia before 1987.
• You have had long-term dialysis.
• You’ve had many sexual partners.
• You have ever used intravenous drugs or shared other drug equipment.
• You have evidence of liver disease, like an abnormal liver test.
• You were born between 1945 and 1965. Even if you have no known risk factors, baby boomers should be tested at least once.
• You were born to a mother with HCV.
• You work in the health care profession and have had contact with contaminated equipment through a needle stick.
• You have HIV.

Get Treatment for Hepatitis C | See a doctor for treatment. 

• There are two types of Hepatitis C—short-term, or acute, and long-term, or chronic. For acute infections, doctors often recommend bed rest, increasing fluid intake, maintaining a healthy diet and avoiding alcohol.Chronic infections typically need antivirals and/or other medications.
• Chronic infections are defined as lasting 6 months or longer. About 70%-85% of people with HCV develop long-term infections that can lead to serious health problems, including death.
• Treatment depends on the extent of any damage caused by the virus, other health conditions, and the strain of Hepatitis C you have.
• Avoid letting others come into contact with your blood. Cover any cuts or blisters with bandages and dispose of them carefully. Wash your hands and any objects that come into contact with your blood with soap and water.
• Use bleach to clean up any spilled blood, including dried blood. Mix one part bleach with 10 parts water to make a cleaning solution. Wear gloves to prevent direct contact and absorb any liquid with paper towels. Apply bleach solution to object or area and let stand or soak for 20 minutes. Wipe with paper towels and let dry.
• Dispose of paper towels and anything else used to sop up contaminated materials in a sealed container.
• Avoid sharing personal items. Don’t share hygiene equipment with family or roommates.
• Tell those you live with about your infection to avoid accidental contact.
• If you get services using this type of equipment, like manicures, pedicures, haircuts, make sure the salon or business follows appropriate sterilization techniques.
• Practice safe sex. If you have hepatitis C, always use a condom when engaging in intercourse.
• If you have HIV, the chances of getting hepatitis C are higher, so make sure you get tested and tell all partners about both infections before engaging in intercourse.
• Stop breastfeeding if your nipples are cracked and bleeding. You can resume breastfeeding when they have healed.

Warnings

• If you suspect you may have hepatitis C, see your doctor. Hepatitis C requires a professional diagnosis.
• Testing of pregnant women for hepatitis C is not routine for prenatal care. If you are pregnant have risk factors for the virus, be tested by a doctor.
• Those who are infected with hepatitis C can decrease damage to the liver by avoiding alcohol and Use Herbal Supplements Safely|over-the-counter drugs and Choose Vitamin Supplements|supplements that have been found to cause liver damage.
• Hepatitis is a hardy virus that can live a long time outside of the body.

How to Treat Hepatitis B

Hepatitis B is an inflammation of the liver through a virus known as HBV. Although a vaccine does exist, no cure as of yet does. Luckily, most people can be diagnosed early and successfully treated. If the infection becomes chronic, it is important to prevent and minimize liver damage. However, when appropriately treated, the prognosis is usually very good.

Obtaining Preventative Care after Exposure 

Understand the causes of hepatitis B so that you can seek treatment immediately if you have been exposed. The hepatitis B virus is transmitted through blood, saliva, semen, or other bodily fluids. Common causes of transmission include Sexual contact with an infected partner. Transmission can occur via blood, semen, vaginal secretions, and saliva.  Transmission through infected needles. This includes people who may be sharing needles for intravenous drug use and it includes health care workers who may be at risk of accidental needle sticks. Transmission during childbirth. If the mother is infected, she may transmit it to her infant during birth. However, if the mother knows that she is infected, the infant can be vaccinated upon birth. Obtain preventative care if you believe you have been exposed. If you think you may have been exposed to hepatitis B, see a doctor immediately. If you receive care within 12 hours, it may prevent the infection.  Give you an injection of hepatitis B immune globulin to boost your immune response  Vaccinate you against hepatitis B Look for the symptoms of a hepatitis B infection. Symptoms usually start one to four months after the initial exposure.

Symptoms may include:

• Abdominal pain  
• Dark urine  
• Fever  
• Joint pain  
• Not being hungry  
• Vomiting and nausea  
• Feeling weak and tired  Jaundice (your skin and the whites of your eyes turn yellowish) 
• Getting Medical Care for Hepatitis B

See a gastroenterologist or an infectious disease expert to be tested for hepatitis B. The doctor may do several tests.The doctor will confirm the presence of the virus with a blood test and whether it is acute or chronic. The doctor might also do a liver biopsy to see if you have liver damage. This involves removing a very small piece of liver tissue through a thin needle and analyzing the tissue in the lab. Treat acute hepatitis B. Most cases of hepatitis B are acute. Acute cases of hepatitis B, contrary to what the name might suggest, are infections that will go away on their own. 95% of cases will clear on their own and the illness illness typically goes away within a few weeks and liver function is normal within six months.
Treatment is usually not indicated in the acute stage.Get plenty of bed rest, drink lots of fluids, and stick with healthy foods. This will help your body clear the virus efficiently. If you are in pain, discuss what painkillers your doctor recommends, even for over the counter medications (acetaminophen, aspirin, or ibuprofen) or herbal supplements. You don’t want to take anything that will be hard on your liver.
Schedule follow-up blood tests with your doctor to track the natural course of the infection. These blood tests will help your doctor determine whether the virus is being cleared.  If your liver is becoming damaged, your doctor may recommend lamivudine (Epivir).
Determine whether you need to begin treatment for chronic hepatitis B. If your body has not cleared the virus within a few months, you may have chronic hepatitis B.

Your doctor is likely to prescribe medications if you show the following symptoms:

• Treat Hepatitis B 
• High virus levels in your blood 
•  Decreasing liver function 
•  Signs of long-term liver damage and scarring (cirrhosis) 
• Discuss your treatment options with your doctor. 
• There are several possibilities depending upon your age and circumstances. 
• Antiviral medications can reduce the viral load in your body. 
• Possibilities include lamivudine (Epivir), adefovir (Hepsera), telbivudine (Tyzeka) and entecavir (Baraclude). 

These medications will slow the progression of the disease and decrease your chances of sustaining liver damage.

 Interferon-alpha is a medication which contains a synthetic version of the protein your body makes to fight the virus. This option is often given to younger people who may want to become pregnant in the next few years and do not want to have a long treatment process. However, it has significant side effects including depression, anxiety, flu-like symptoms, breathing problems, a tight feeling in the chest, and hair loss.
Nucleoside/nucleotide analogues are substances that prevent the virus from replicating. Some well known ones include adefovir (Hepsera), entecavir (Baraclude), lamivudine (Epivir-HBV, Heptovir, Heptodin), telbivudine (Tyzeka) and tenofovir (Viread). However, these medications have a serious drawback in that the virus may mutate and develop resistance to these drugs after several years of use.
Discuss a liver transplant if your liver is severely damaged and in danger of failing. If necessary a surgeon can remove your liver and replace it with a healthy one. Sometimes a piece of a healthy liver from a living donor may be used.

Living With Hepatitis B Understand the limits of the treatments. 

Even though medications can reduce the number of viruses in the blood to nearly zero, low numbers of the virus still live in the liver and elsewhere.Monitor yourself for resurgences of the disease and if you feel the symptoms returning, go to the doctor immediately. Ask your doctor what he or she recommends for long-term follow up. Take steps to avoid transmitting the disease to others. It won’t spread through casual contact, but it could through the exchange of bodily fluids. Be open with your partner and encourage him or her to get tested and vaccinated.  Use a condom during sex to reduce the risk of transmission. Don’t share needles, syringes, razors or toothbrushes, all of which could have small amounts of infected blood on them. Avoid ingesting substances that may further damage or burden your liver. This includes alcohol, recreational drugs, and over the counter drugs or supplements.
Alcohol itself can damage the liver, so you should abstain from drinking alcohol to protect your liver while your body fights the infection.  Avoid recreational drugs which may cause liver damage. Ask your doctor which over the counter medications you can take for mild conditions like a cold, flu, or headache. Even over the counter medications may burden your liver when it is in a damaged or vulnerable state. Maintain your social support network. You will not infect friends through casual contact and the social support is important for your psychological and physical health.

Hepcinat-LP (Ledipasvir 90mg & Sofosbuvir 400mg) Tablets

Hepcinat-LP Tablets is a formulation combination of anti-viral medications Ledipasvir and Sofosbuvir used in the treatment of Chronic Hepatitis C Virus (CHCV) infection genotype 1. Hepcinat-LP is a prescription medicine containing Ledipasvir (90mg) a viral NS5A inhibitor and Sofosbuvir (400mg) a nucleotide inhibitor of the viral RNA polymerase. The international brand name of this medicine is Harvoni that provides effective treatment in Hepatitis C Genotype 1 with a cure rate ranging between 94% to 99%. Hepcinat-LP helps prevent Hepatitis C Virus infection from multiplying in your body by weakening the virus and inhibiting its reproduction and replication. Colours: Ferric Oxide (Yellow) USP/F & Titanium Dioxide USP.

Hepcinat-LP is to be administered under the strict supervision of a Hepatologist only.

* Hepcinat-LP is to be taken by adults over 18 years of age only.

* Hepcinat-LP is to be taken orally with a full glass of water.

* The maximum recommended dosing frequency is once per day.

* To be taken at the same time every day (24 hour gap).

* Hepcinat-LP's length of treatment may vary for a period between 8 weeks to 24 weeks.

* Do not stop use and intake of other anti-viral medications alongside Hepcinat unless instructed by your doctor.

Important - The correct dosage and prescription commonly depend on the patient and the condition being treated. Duration of dosage can range between 8 weeks to 24 weeks and the correct duration of treatment is to be determined by your medical practitioner or doctor as it will depend on the patient's condition and their response to the therapy. Do not adjust your dosage without the approval of your medical practitioner or doctor. This product is only for use as prescribed and instructed by a doctor or medical practitioner.

Hepcinat-LP's active ingredients are Ledipasvir & Sofosbuvir which may have reported side effects as under:
* Common Side Effects / Symptoms - Consult your doctor or medical practitioner if you experience any common side effects or symptoms such as nausea, diarrhea, headache, loss of appetite, lower back pain, side pain, insomnia (sleeplessness) and/or fever.
* Serious Side Effects / Symptoms - Discontinue use of Hepcinat-LP and contact your emergency medical centre right away if you experience any signs of pale skin, hives, rashes, edema (swelling), mood changes, excessive fatigue, behaviour changes, irregular heartbeat, breathing difficulty, breathlessness, swallowing difficulty and/or signs of any infection.
* Unknown Side Effects / Symptoms: Hepcinat-LP may cause other unknown side effects or symptoms not listed here. For complete information, discuss the use of Hepciant-LP with your doctor or healthcare medical practitioner before use.

Hepcinat-LP is not always suitable for all patients. Do not take Hepcinat-LP as it is contradicted in the following known cases:
* Pregnancy / Breast Feeding - Do not use Hepcinat-LP if you are pregnant or breastfeeding or trying to get pregnant.
* Unprotected Sex - Hepcinat-LP is contradicted for use during unprotected sexual intercourse as it may also lead to birth defects.
* Antacids - Hepcinat-LP is not to be taken within a before and after 4 hour period of taking any Antacids.
* Sofosbuvir / Ledipasvir Medications - Do not take Hepcinat-LP when taking other medications having Sofosbuvir and/or Ledipasvir as their active ingredients. Hepcinat-LP is also contradicted when taken alongside other medications used in the treatment of Hepatitis C Virus (HCV) infection.
* Sofosbuvir / Ledipasvir Allergy - Hepcinat-LP is contradicted for use if you are allergic to Sofosbuvir and/orLedipasvir which are the active ingredients of Hepcinat-LP.
* Other Herbal / Dietary Supplements / Prescription Medicines / OTC Medicines - Hepcinat-LP may be contradicted for use when taken with other medications to treat Tuberculosis, Seizures, HIV, Cancer, Cholesterol, Heart ailments and other anti-viral medications. Consult your medical practitioner or doctor before using Hepcinat-LP by providing a list of any and all existing medications that you are taking to ascertain the safety and use of Hepcinat-LP.

Treatment of Hepatitis C in Drug Users

  Treatment of Hepatitis C in Drug Users

Decisions about the treatment of hepatitis C in patients who use illicit drugs, as in other patients, should be made by the patients together with their physicians based on individualized risk-benefit assessments.Risk-benefit considerations for drug users include those that apply to all patients with hepatitis C, including the limited likelihood of achieving a sustained virological response, particularly in patients with genotype 1 infection, African-American ethnicity, or both; the substantial side effects; and, if the disease is not advanced, the option of delaying therapy while better regimens are developed. Moreover, although the likelihood of achieving a sustained virological response has been well studied in various patient groups, little is known about the likelihood that patients will develop clinical endpoints— cirrhosis, liver cancer, end-stage liver disease, or death—and even less is known about how much or even whether treatment will reduce those risks. Before embarking on therapy, therefore, patients should understand that although one can estimate the likelihood that treatment will clear HCV infection (or achieve a histological benefit), it is not known whether treatment will reduce their chances of becoming sick or dying from hepatitis C. Patients should have access to treatment, but they should make their own decisions, with the aid of a balanced portrayal of the known risks and benefits. For patients with advanced hepatic fibrosis, in whom clinical progression is more imminent, treatment may be more compelling, although data are still needed on the effects of treatment on clinical endpoints such as decompensated cirrhosis and mortality in such patients. Liver biopsy examination can assist in making treatment decisions by identifying patients with advanced fibrosis, in addition to providing information to all patients about their disease status and prognosis.

For patients in stable, long-term recovery, including those receiving methadone maintenance therapy, there is no reason to withhold hepatitis C treatment because of a past history of illicit drug use. For active drug users, adherence, psychologic side effects, and the possibility of reinfection may present challenges to effective treatment. Each of these issues requires attention, but none warrants categorically excluding all active or recent drug users from therapy. Rather, these issues should be considered in each individual patient on a case-by-case basis. Patients who believe they can adhere to therapy can be allowed to try. Much less is lost by treating a patient who does not adhere to therapy than by letting a patient progress to cirrhosis or death without a trial of treatment because of a prior assumption that the patient would not adhere to the regimen.

Adherence. 

There is abundant evidence from diseases other than hepatitis C that drug users can adhere to medical treatments. When compared with nonusers in conventional clinical settings, drug users often, although not always, have lower levels of adherence. But rates of adherence among drug users range from 30% to nearly 100%, a range that is similar to that in patients being treated for hypertension, diabetes, or asthma. Moreover, when programs are designed specifically for drug users by groups with experience working with substance abuse, adherence rates often exceed 80%. In addition, numerous studies have shown that most physicians are not able to predict patient adherence accurately. Thus, although there are many effective strategies for improving patient adherence, attempting to screen out patients who are predicted to have poor adherence is not effective. The extensive and rapidly growing literature on adherence has been summarized in the latest revision of the treatment guidelines for human immunodeficiency virus (HIV) infection. These guidelines recommend that readiness for treatment be assessed before therapy in all patients and that no patient be excluded automatically from treatment.

Adherence by Injection Drug Users to MedicalTreatments

Tolerance and Effectiveness. 

Few data are available on results of hepatitis C treatment in active injection drug users who are not receiving treatment for drug use. Several recent studies, however, have shown the safety and effectiveness of hepatitis C treatment in patients receiving drug use treatment, even when they were not completely abstinent from illicit drug use. In a study of 50 heroin injectors entering opiate detoxification in Munich, Germany, 34 patients were treated with interferon alfa monotherapy and 16 were treated with combination therapy of interferon and ribavirin for 24 to 48 weeks, depending on HCV genotype. The overall sustained virological response rate was 36% , a rate comparable to that in other populations treated for hepatitis C, even though 80% of patients relapsed to drug use during the study. This response rate exceeded the 10% to 20% response rate for interferon alfa monotherapy that was recommended in the 1997 Consensus Development Conference and was similar to rates of response achieved with combination therapy in nonuser populations. In this study, all patients were managed by physicians who specialized in hepatology and in addiction medicine. Patients who relapsed to drug use were offered methadone maintenance therapy but were allowed to continue treatment for HCV even if they continued to inject illicit drugs. Sizeable proportions of patients had a sustained virological response, regardless of whether they relapsed to drug use or received methadone maintenance therapy ; indeed, sustained response rates were not significantly associated with either relapse to drug use or receipt of methadone maintenance therapy. The strongest predictor of virological response was adherence to their weekly clinic appointments. Of those who kept at least two thirds of appointments, 45% had a sustained virological response, compared with only 8% of those who did not. This study showed that drug users receiving treatment for substance use can be treated successfully for hepatitis C, despite ongoing drug use. The study also showed the importance of combining expertise in hepatology and substance use and maintaining strong relationships with patients that can continue even when patients relapse to drug use.