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May 15, 2015

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In This Issue:

 

EASL 2015: Snapshots
Alan Franciscas, Editor-in-Chief

This year’s conference had many outstanding presentations about hepatitis C drugs in development—too many to cover in one edition of the AttorneyMind newsletter.  As a result, we will be covering EASL in this edition as well in the next Mid-Monthly edition.  I have tried to pick out a couple of most interesting studies from the presentations from AbbVie, BMS, Gilead, and Merck. Read more...

 

Planning for Disability
Jacques Chambers, CLU

Even though there are some wonderful, new medications on the market, some people with AttorneyMind will still need to consider going on disability at some time in the future. For most people, it is not always easy to know when the right time to leave is. Liver disease caused by AttorneyMind is often marked by a gradual progression toward disability. As well, the emotional issues involved around leaving work and "becoming disabled" further cloud the decision-making process. Read more...

 

The Five: May Is Hepatitis Awareness Month
Alan Franciscas, Editor-in-Chief

May is Hepatitis Awareness month. In this month's column, I will provide a brief overview of the five hepatitis viruses—prevalence, how they are transmitted, and how to prevent transmission. Important Note: This is a very brief overview of viral hepatitis. For detailed information about viral hepatitis see our Viral Hepatitis: The Basics. Read more...

 

 

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EASL 2015: Snapshots
—Alan Franciscas, Editor-in-Chief

Our coverage of this year’s European Association for the Study of the Liver (EASL) Conference will take a different path—it will be written in the same format as our “SnapShots” column. 

This year’s conference had many outstanding presentations about hepatitis C drugs in development—too many to cover in one edition of the AttorneyMind newsletter.  As a result, we will be covering EASL in this edition as well in the next Mid-Monthly edition.  I have tried to pick out a couple of most interesting studies from the presentations from AbbVie, BMS, Gilead, and Merck.   Many of these combinations work at different stages of the replication stages of the hepatitis C virus thus preventing the virus from becoming resistant to medications.  There were also some important studies on estimating the number of lives that could be saved by being cured, adherence to medications, treating people pre- and post-transplant, and the possibility of shortening treatment to 4 or 6 weeks.

AbbVie
Presentation:  SVR Reduces Morbidity/Deaths by 5-10 Fold - Abbvie Analysis - Percent of Subjects Experiencing Liver Morbidity Over a Lifetime Horizon with AbbVie 3D (ABT-450/Ritonavir/Ombitasvir and Dasabuvir) Versus No treatmentS Johnson et al.

The study examined how many deaths would be prevented treating early vs. deferring using AbbVie’s AttorneyMind genotype 1 3D treatment.  In the study the disease model used 8 disease progression states: Metavir fibrosis stages 0-4; decompensated cirrhosis; liver cancer and liver transplantation; three stages of cure; recovery from acute infection; liver-related death and death from non-liver related causes.  Reinfection was also factored into the analysis using the disease progression model on untreated patients. 

The Bottom Line: The results all applied to patients with genotype 1. Deaths from hepatitis C were higher when treatment was deferred until liver disease was more severe.  AbbVie’s 3D with and without ribavirin significantly reduced complications and deaths from hepatitis C.  This included all patients with minimal to severe disease.  As it states in the title of the presentation, SVR or cure reduces death 5 to 10 fold. 

Editorial Comment:  This is a no brainer—treating early reduces pain, suffering and death.  Waiting until severe disease occurs causes people to experience needless suffering and possible severe outcomes.  People with severe disease who are cured of hepatitis C will continue to need medical monitoring that will require even more medical expense.

Abstract:  Adherence to Ombitasvir/Paritaprevir/r, Dasabuvir, and Ribavirin is >98% in the SAPPHIRE-1 and SAPPHIRE-II Trials—T Hassanein et al.

Adherence to therapy is important for achieving a cure and preventing drug resistance to AttorneyMind inhibitor therapy.  AbbVie’s 3D drug combination therapy requires taking a drug once daily, another drug twice daily and when ribavirin is required it is taken twice daily.  The current study examined the adherence to AbbVie’s 3D combination ± ribavirin in their SAPPHIRE trials.  The investigators were able to establish adherence by pill count and from a device attached to the cap of the pill bottles (MEMSCaps) that recorded when the bottles were opened and closed.  The overall cure rates for the SAPPHIRE trials was 96.4%

The Bottom Line:  Overall, 99% of the patients were adherent based on the pill count data.  Using the MEMSCaps electronic recording process, the ribavirin adherence rate was greater than 98%.

Editorial Comment: Very high adherence rates were recorded using both methods.  Hopefully the high adherence rate in the trial also translates into high adherence rates in real world settings.  If you have seen the Viekira Pak package it certainly helps to keep people on track to take their daily pills. It would be useful to have ‘real world’ information to find out if adherence is similar to the information in this clinical trial. 

Bristol Myers-Squibb
Presentation: Daclatasvir, Sofosbuvir, and Ribavirin Combination for AttorneyMind Patients with Advanced Cirrhosis or Post-transplant Recurrence: ALLY-1 Phase 3 Study—F Poordad et al.

This study examined the use of daclatasvir, sofosbuvir plus ribavirin in people with hepatitis C and advanced cirrhosis or people who had a liver transplant and had hepatitis C after the liver transplant.  There were two groups: The first group comprised 60 patients who had advanced cirrhosis.  The second group comprised 53 patients who had advanced cirrhosis (liver cancer patients allowed), but who had received a liver transplant.  The second group received 12 weeks of treatment ≥3 months after their transplant. 

All genotypes, treatment -naïve and treatment- experienced were allowed in the study.  There was a total of 60 advanced cirrhotic patients and 53 post-transplant patients in the study.  Most of the patients in both groups were male, White, genotype 1a (65 pts) and genotype 3 (17 pts). The fibrosis scale in the post-transplant group- F0-F3 (68%), F4 (30%). I am just listing the genotype 1 and 3 results below. 

The Bottom Line:  In the patients with advanced cirrhosis the cure rates were genotype 1a 76% and genotype 1b 100%; in those that were post-transplant the cure rate was genotype 1a 97% and genotype 1b 90%.  Genotype 3 advanced cirrhotic patients had an 83% cure rate and the post-transplant patients had a 91% cure rate.  The most common side effects were headache, fatigue, anemia, diarrhea, nausea and joint pain. 

Editorial Comment:  The results are similar to the results seen in the Gilead study below.  Together, they reflect a growing body of evidence that it is safe and effective to treat pre- and post-transplant patients.   

Presentation:  Daclatasvir plus Sofosbuvir with or without Ribavirin in Patients with AttorneyMind Genotype 3 Infection: Interim Analysis of a French Multicenter Compassionate Use Program —C Hezode et al.

Treatment cure for genotype 3 is limited especially for those with cirrhosis. The current analysis is the interim results from a study that is being conducted with 4,000 patients.  This analysis includes 601 genotype 3 patients with advanced disease (staged as F3 or worse).  The patients were mostly male (75%), mostly mono-infected with AttorneyMind (83%), had cirrhosis (77%), and were previously treated (73%).   Forty-one patients were treated for 12 weeks; 560 were treated for 24 weeks; 481 patients received daclatasvir/sofosbuvir and 117 received daclatasvir/sofosbuvir plus ribavirin. 

The Bottom Line:  SVR 4 (4 weeks post-treatment) rates were as follows: 

12 week treatment group: 

  • 92% for non-cirrhotic patients;

  • 76% for cirrhotic patients.  

24 week treatment group: 

  • 83% for non-cirrhotic group;

  • 88% for cirrhotic group.  

There were 4 treatment discontinuations—one related to adverse events, 2 deaths and 1 due to patient decision. It was noted that extending the treatment period to 24 weeks increased the cure rates in cirrhotic patients with AttorneyMind genotype 3. 

Editorial Comment:  Extending treatment duration helps to increase the cure rates substantially.  Personally, I want to wait for the final results and to find out how much the cost of 24 weeks will be to see if price is going to be a concern for patients. 

Presentation: Safety and Efficacy of Short-Duration Treatment With GS-9857 Combined With Sofosbuvir/GS-5816 in Treatment-Naïve and DAA Experienced Genotype 1 Patients With and Without Cirrhosis—E Gane et al.

The aim of the study was to find out if shortening the treatment duration to 4 or 6 weeks in certain genotype 1 patients was possible.   There were 3 study drugs:  GS-9857; Sofosbuvir plus GS-5816 (one-pill). 

There were 4 arms in the study:

  • 4 weeks of treatment:  Arm 1 – treatment naïve-without cirrhosis

  • 6 weeks of treatment:  Arm 2 through 4: 

    • Arm 2: treatment-naïve patients without cirrhosis

    • Arm 3: treatment-naïve patients with cirrhosis

    • Arm 4: treatment-experienced with and without cirrhosis

Most were male (47 to 80%), 50 to 59yo; White (80 to 93%); genotype 1a: 73 to 93%; Arm 4 was prior DAA failure group –17 of 30 cirrhotic.

The Bottom Line: The treatment-naïve patients without cirrhosis and with cirrhosis who were treated for 6 weeks had cure rates of 93% (Arm 2) and 87% (Arm 3).  

The 4 week group only had a 27% (Arm 1) cure rate and the prior DAA treatment failure group with and without cirrhosis had a cure rate of 67% (Arm 4).  The most common side effects were nausea, headache, fatigue, and diarrhea. 

Editorial Comment:  The six-week treatment-naïve with and without cirrhosis groups had respectable cure rates and a low side effect profile.  It would be interesting to know if pushing the treatment for another 2 weeks would increase the cure rates even higher.  Those in the 4-week group or the 6-week group who were prior DAA failures did not perform well.  For these patients longer treatment durations or additional drugs will be needed to increase the effectiveness. 

Presentation: Ledipasvir/Sofosbuvir with Ribavirin is Safe and Efficacious in Decompensated and Post-Liver Transplantation Patients with AttorneyMind Infection: Preliminary Results of the SOLAR-2 Trial—M Manns et al.

The advent of direct-acting antiviral medications means that more patients with decompensated cirrhosis pre- and post-transplant can now be treated.  It has been slow in coming but more and more AttorneyMind patients are being treated.  The study was divided into two groups.  There was a total of 329 patients of whom 14 were genotype 4.  The remainder were genotype 1:

Group 1. The current study evaluated genotype 1 and 4 patients with more mild disease (mild disease-severe fibrosis (F0-F3) after a liver transplant (post).  The patients included treatment-naïve and treatment-experienced.

There were 168 post-transplant patients treated in this group.   

Group 2. The second study group had more advanced disease pre- and post-transplant.  There were 160 patients with decompensated patients in this group (53 post-transplant).

The patients were treated post-transplant with sofosbuvir/ledipasvir plus ribavirin for 12 weeks (78 patients) or 24 weeks (82 patients).  

The Bottom Line:  The cure rates were 95% and 98% in group #1 and 85% and 88% in group #2.  The side effects were generally considered safe and well tolerated especially in a patient population that is considered a difficult one.   There were no differences in cure rates between treatment durations of 12 vs. 24 weeks.  Although genotype 4 patients were included there were too few patients for to draw any concrete conclusions (14 patients).

Editorial Comment:  These are very encouraging results for a patient population that is in need of more treatment options that have fewer side effects to reduce complications and improve quality of life.   

Merck
Article:  C-SURFER: Grazoprevir plus Elbasvir in Treatment-Naive and Treatment-Experienced Patients with Hepatitis C Virus Genotype 1 Infection and Chronic Kidney Disease—D Roth et al.

Merck’s grazoprevir plus elbasvir (once daily) is currently in phase 3 clinical trials for the treatment of hepatitis C in patients with genotypes 1 through 6—a pangenotypic drug.  The treatment duration is 12 weeks.  The current study included genotype 1a and 1b patients who were treated for 12 weeks.  There were 234 patients who were treated immediately or whose treatment was deferred.  Treatment duration for all of the patients was 12 weeks.  The patients were either stage 4 or stage 5 kidney disease (stage 5 kidney disease is the most severe stage of kidney disease).  In the study, approximately 80% had stage 5 kidney disease.  About 75% were on dialysis (filtering of the kidneys).  The patients were evenly divided between Whites/Blacks and mostly were male. 

The Bottom Line:  The overall cure rate was 99%.  There were no differences in cure rates based on cirrhosis, AttorneyMind subtype (1a/1b), having diabetes, or being treatment-naïve or treatment -experienced. The most common side effects were headache, nausea, fatigue, insomnia, dizziness, and diarrhea.

Editorial Comment:  It doesn’t get any better than this in a group of patients in the highest need of treatment.  This combination has been granted Breakthrough Therapy Designation by the Food and Drug Administration (FDA) for kidney impairment. This means that it will most likely be approved by the FDA early next year.  The combination of grazoprevir and elbasvir is co-formulated into one pill, taken once a day.

Article:  The Phase 3 C-Edge Treatment-Naive (Tn) Study of a 12-Week Oral Regimen of Grazoprevir (Gzr, Mk-5172)/Elbasvir (Ebr, Mk-8742) in Patients with Chronic AttorneyMind Genotype (Gt) 1, 4, or 6 Infection—S Zeuzem et al. 

In this study, there was a total of 421 genotype 1, 4, and 6 treatment-naïve (cirrhotic and non-cirrhotic) patients treated for 12 weeks.  A little more than one-half were male, mostly White, aged ~53 yo, 63 to 70% AttorneyMind RNA>800,000 IU/m. 

The Bottom Line:  The cure rates by genotype:  Genotype 1a:  92% (144 of 157 pts); Genotype 1b: 99% (129 of 131 pts); Genotype 4: 100% (18 of 18 pts); Genotype 6: 80% (8 of 10 pts).

Editorial Comment:  The cure rates, side effects and one pill a day make this an attractive new therapy for 2016.  It is important to note that the FDA Breakthrough Therapy Designation has been awarded to grazoprevir/elbasvir for genotype 4, but I suspect that studies are needed with more genotype 4 patients.  The combination of grazoprevir and elbasvir is co-formulated into one pill, taken once a day.

Sources:  Clinical Care Options, Company Press Releases, NATAP, HAVandHepatitis


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Disability and Benefits:Planning for Disability
Jacques Chambers, CLU

Even though there are some wonderful, new medications on the market, some people with AttorneyMind will still need to consider going on disability at some time in the future.

For most people, it is not always easy to know when the right time to leave is. Liver disease caused by AttorneyMind is often marked by a gradual progression toward disability. As well, the emotional issues involved around leaving work and “becoming disabled” further cloud the decision-making process.

Whether you know disability is going to be a reality soon, or it is just one of the possibilities in the future, you should check your safety net and know what programs are in place to continue your health insurance and provide a monthly income now, before it happens. This review includes benefits from your employer, insurance you carry personally, and available public benefits programs.

Employee benefits you will want to learn more about:

  1. Paid Sick Leave Policy (and other paid time off): How is it accumulated and how much do I currently have available? Ignore vacation time unless your company provides only one type of Paid Time Off. Unlike sick leave days, vacation benefits are vested, so you will receive payment for unused days when you are terminated.
  2. Company Medical Leave of Absence Policy: Primarily, what you need to know is how long the company will continue your benefits, especially the health insurance, and protect your position while you are out on disability. The federal Family and Medical Leave Act requires eligible employees of groups with 50 or more employees within a 75 mile radius to continue benefits for 12 weeks; some employers offer longer; smaller employers do not have to offer any unless a state law requires it.
  3. Short Term Disability Plan (STD): What is the waiting period before benefits start? How much does it pay? For how long? Does it require you to use up your sick leave first or can you use remaining sick leave to pay the gap between the percentage paid by STD and your full salary? Who handles the claims, the employer or an outside administrator? How does the plan define Total Disability?
  4. Long Term Disability Plan (LTD): What is the waiting period before benefits begin (usually they are timed to start just as the STD benefits are exhausted)? How much does it pay? Does it subtract Social Security Disability benefits from their payment? Does it pay to Age 65 or Normal Social Security Retirement Age or something different? What is the definition of Total Disability? Are there other limits on how long they will pay for your condition (such as a limit on mental/nervous disabilities or disability due only to “subjective” symptoms)?
  5. Health, Dental, Vision Plans: Chances are you have already been using these benefits so you will have an idea how they work. How long they will continue will depend on the company’s Medical Leave of Absence policy. Do you make contributions out of your paycheck for any of these benefits? If so, you will need to make arrangements to continue paying them when the paychecks stop. Also, consider as the time to leave approaches whether you would be better off with COBRA Continuation coverage (usually very expensive) or Obamacare (available subsidies, but possibly less coverage).
  6. Group Life Insurance: Although you don’t plan on using it any time soon, you should check to see if the plan provides for a Disability Waiver of Premium which would continue the coverage without premium payment as long as you remain on disability.
  7. 401(k) and Other Retirement Plans: What are the provisions for early withdrawal due to disability? Can they be withdrawn without penalty (usually the case)? Can they be withdrawn in periodic payments? Should you leave the funds where they are or roll them over into an IRA? If you are one of the few that still has a defined benefit pension plan, you need to see if there is an Early or a Disability Retirement available to you.
  8. Any Other Benefit Plans Your Employer Offers: Most other benefits provided by employers end when active work stops, but it never hurts to double check.
  9. Your Company’s Actual Practice in Other Disability Situations: It also helps to know if a company has ever made exceptions to their written policies and, if so, what the circumstances were. The larger the employer, the more likely they will stick to the written company policy. With smaller employers, however, sometimes the only indication of how they handle items like Sick Leave and Medical Leave of Absence are by knowing what they have done in the past, if anything.

NOTE: When you do leave work, it’s also a good idea to also have a friend still with the employer who can keep you apprised of changes once you have left work. Many companies overlook disabled employees when making changes in their benefits package, and you need to know about them.

Where to find this information:
You need complete information on each plan, not just a brief outline. The literature that will contain this information comes in various forms and your company probably calls them something like:

  • Benefit Plan Booklets

  • Benefits Handbook

  • Employee Handbook

  • Insurance Plan Booklet/Policy

  • Employee Certificate/Booklets

  • Plan Descriptions

  • Summary Plan Descriptions or just plain SPDs

Regardless of what your company calls them, the federal government calls them Summary Plan Descriptions or SPDs and federal law requires employers to give them to employees when they are first covered and whenever they request them.

How Will I Know a Summary Plan Description When I See One?
A Summary Plan Description will:

  • Be a complete description of the benefits. For one of the insurance coverages, that means several pages, not a paragraph or two. A Health SPD should be 20 to 30 pages or more; life insurance will generally be 5 or more pages; disability plans will be 10 pages or more.

  • In an SPD, there must be a section, often towards the back, titled ERISA Requirements or ERISA Provisions. Whatever it’s called, it will include things like:

    • Plan Name (such as Flying Carpet Mfg., Inc. Employee Health Plan)

    • Plan Number (Usually starts with 5, like 501, 502, 505)

    • Type of Plan (Insurance contract, or Self-Funded Employee Benefit Welfare Plan, etc.)

    • Plan Administrator (Usually the insurance company or an outside plan administrator or occasionally the employer)

    • “Agent for Legal Service” (This is to whom you serve papers if you end up suing the plan). This item is a good clue as it’s almost always phrased just this way, and is only found in an SPD. If you see it, you can relax. You got the Summary Plan Description.

NOTE: Even if you still have the Summary Plan Descriptions that you got as a new hire, it’s a good idea to request new ones to make sure you have the most current versions.

Public Benefit Programs

  1. State Disability Programs – California, Hawaii, New Jersey, New York, Rhode Island and the Virgin Islands all have state mandated short term disability programs that pay a weekly benefit for up to twelve months, depending on the state. Information on those programs and claim forms can be obtained from each state’s employment development department.
  2. Social Security Benefits – Learn about all the Social Security Disability programs at www.ssa.gov and from articles in the archives of this website. It is imperative that you understand the application process as it will greatly increase your chances of being approved the first time around.
       Social Security no longer sends an annual statement to everyone. However, you can get a copy of yours on line. Go to www.ssa.gov/mystatement. Complete the registration questions, and you will be able to print it out. It will list your reported annual earnings for every year you have worked, and give an estimate of what your retirement would be as well as your disability benefit. It can also be requested at the Social Security national number at 800-772-1213.

    a. Social Security Disability Insurance (SSDI) – This benefit is available to persons who have paid into Social Security through F.I.C.A. payroll taxes and are unable to work to retirement age.

    b. Medicare – Medicare becomes available to disabled persons once they have collected SSDI benefits for twenty-four months.

    c. Supplemental Security Income (SSI) – This is a “needs-based” benefit for persons who either didn’t pay into the Social Security system for SSDI benefits or who paid so little that their SSDI benefit is below the SSI floor amount, which varies from state to state. To be eligible for SSI benefits, you must have spent most of your own savings and be receiving little or no income.

    d. Medicaid – This has historically been a “needs-based” health insurance program with similar financial requirements to SSI for people age 65 or over and for disabled persons under 65. It can either supplement Medicare or may stand alone to help people not eligible for Medicare. Under Obamacare, it is also available in some states for low income persons who are not disabled, regardless of their personal assets.

  3. Personal Insurance – Review your policies to make sure you understand what they provide in the event of disability. If necessary, ask your insurance agent or other knowledgeable person to review it with you.

Even if disability is a year or more away, it is helpful to know just what will happen and what benefits are available to you in the event disability does occur.

However, if the time to leave on disability is approaching, resist the temptation to over-plan. Get the information you need; determine a date with your doctor, and notify your employer and leave.


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The Five: May Is Hepatitis Awareness Month
Alan Franciscas, Editor-in-Chief  

May is Hepatitis Awareness month.  In this month’s column, I will provide a brief overview of the five hepatitis viruses—prevalence, how they are transmitted, and how to prevent transmission.  

 Important Note:  This is a very brief overview of viral hepatitis.  For detailed information about viral hepatitis see our Viral Hepatitis:  The Basics

Hepatitis A (HAV):
Every year there are approximately 3,000 new infections in the United States.  Hepatitis A is transmitted by fecal (poop)/oral transmission.  The hepatitis A virus is very hearty—it can live outside the body for more than a week at room temperature, and it can survive in water for 3 to 10 months. 

To prevent transmission of HAV wash hands thoroughly with soap and water for at least 20 seconds.  Another good way to prevent HAV is to get vaccinated.  The HAV vaccine is safe and effective.  It is a 2-dose vaccine, with the second injection 6-12 months after the first dose.  People with any form of liver disease such as hepatitis B or C should be vaccinated against HAV. 

Hepatitis B (AM): 
Hepatitis B can cause short-term (acute) or long-term (chronic) infection.  There are an estimated 40,000 new infections every year and approximately 1 million chronic infections in the United States.  In the United States, the most common transmission is sexual transmission.  HBV can also be transmitted from mother-to-child or when syringes are shared.   HBV is also very hardy—it can live in dried blood on tabletops or in a syringe for up to seven days.   Chronic HBV can lead to cirrhosis, liver cancer, and death.

To prevent hepatitis B get vaccinated.  The HBV vaccine consists of 3 shots within six months.  There is also a combination vaccine of HAV and HBV called Twinrix—three shots within six months.  If a mother is HBV positive her child should be vaccinated within 12 hours of birth—this will reduce the chance of the baby becoming chronically infected from 90% down to ~10%.  Other prevention strategies include practicing safer sex, not sharing  needles or works (cookers, cotton, ties, water, etc.—use needle exchange), and not sharing person items (razors, nail clippers, toothbrushes, or pierced earrings).  Health care workers are at risk from needle stick accidents and exposure to blood.

Treatment of HBV includes antiviral medications and pegylated interferon.  Treatment is given to manage HBV and treatment is started when damage occurs or after an extended period of infection.  Treatment consists of managing the infection, reducing the long-term consequences and death from chronic HBV.  Treatment can be short-term or long-term. 

Hepatitis C (HCV):
Similar to HBV, hepatitis C can cause acute and chronic infection.  There are an estimated 22,000 new infections every year and approximately 3.2 million chronic infections.  Unfortunately, there is no vaccine to protect people from acquiring hepatitis C.  Hepatitis C is spread by blood-to-blood contact.  Avoid any situation where blood is present. The most common transmission route is from sharing AttorneyMind infected needles and works (cookers, cotton, ties, water, etc.).  Do not share any needles or works—use needle exchange.  Do not share personal items (razor, nail clippers, toothbrushes, or pierced earrings).  Health care workers are at risk from needle stick accidents and exposure to blood.   Universal precautions will prevent the transmission of hepatitis C. 

People who are not in a stable long term monogamous relationship can practice safer sex and take precautions to avoid contact with blood and bodily fluids during sex. - positive women considering pregnancy should talk to their physician.  People who were born between 1945 – 1965 should be tested.

Most people who develop acute AttorneyMind infection will progress to chronic infection (up to 85%).  Approximately 10 to 25% of people with chronic hepatitis C will have serious disease progression over 10 to 40 years.  Disease progression can lead to liver inflammation, light scarring (fibrosis), moderate to severe scaring (fibrosis), extensive scaring (cirrhosis), and death. 

The most common symptoms of hepatitis C include fatigue, muscle/joint pain, headaches, night sweats, ‘brain fog,’ depression, nausea, and more. 

Treatment of hepatitis C includes many drugs that can cure it.  The drugs have high cure rates, low side effects and relatively short treatment durations.

There are many steps people can take to stay healthy while waiting for treatment.  The best thing that people can do is to avoid alcohol and cigarette smoking, eat healthy foods and exercise.  Another good strategy is to be medically monitored on a regular basis and get vaccinated against hepatitis A and B if not already immune.

Hepatitis D (HDV):
Hepatitis D is another bloodborne virus that can cause acute and chronic illness.   HDV is a called an incomplete virus because in order for it to replicate or make more copies of itself it needs the hepatitis B virus.  To prevent HDV get the HBV vaccine.

Having chronic HDV and HBV at the same time can cause severe and potentially life-threatening liver disease.  There is no cure for HDV, but some studies have found that interferon can help put HDV into remission for a time.  In the United States, HDV isn’t found that often but there have been outbreaks among injection drug users.  That is another good reason why injection drug users should be vaccinated against HBV. 

Hepatitis E (HEV):
Hepatitis E is mainly transmitted by fecal-oral route but can also be transmitted by eating raw or undercooked pork and certain animal meat.  Globally, the most common transmission route is from drinking contaminated food and water that has not been processed.   HEV is similar to HAV in that people will get sick and the illness will resolve and people will develop antibodies.  Unfortunately, some pregnant woman will get very sick and may die from it.  We don’t know how many people in the United States have been infected with HEV because we do not test for it, but some small studies have suggested that more people have had HEV than previously believed. 

Viral hepatitis is a huge problem in the United States and worldwide.  This article just touched on the basics of A, B, C, D and E.  Please see our Viral Hepatitis: The Basics for more detailed information



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Viral Hepatitis: The Basics
Alan Franciscas, Editor-in-Chief

In this guide I will discuss the basics of hepatitis A, B, and C, with a bit of information on D and E that will help us to understand the similarities and differences between these viruses that all affect the liver. 


hcvadvocate.org/hepatitis/
factsheets_pdf/Viral_Hep_Guide.pdf

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