Drink and Drugs News DDN Wider Health Hep C_web | Page 6

HEPATITIS C
TREATMENT OPTIONS
NAVIGATING A WAY FORWARD
Recent medical advances have seen significant changes to the treatment landscape,
and whereas previously treatment had been lengthy, unpleasant and not always
effective, oral treatments can now take as little as eight to 16 weeks, are
generally well tolerated and have very high success rates
1
T
he London Joint Working Group on Substance Use’s report
into pilot testing in pharmacies found that almost 60 per
cent of participants were unaware of oral treatments and
still believed that a positive diagnosis meant a lengthy
course of treatment involving interferon. 2 The anecdotal
reputation of interferon is so poor that it could discourage
people from coming forward for testing and treatment, so clearly more
needs to be done to get the message across that times – and options –
have changed.
Reaching out to the undiagnosed is vital as many ODNs could
otherwise risk running out of people to treat. Raising awareness of the
currently available treatments could also help to tackle stigma – as
Hepatitis C Trust CEO Rachel Halford told DDN in October 2017, ‘if we
can raise awareness around today’s treatments then it all becomes more
common. So hopefully you’ll just go to your GP, get your prescription and
off you go, as with something like antibiotics. That ease of access in
itself would de-stigmatise it.’
“
Raising awareness of the
currently available treatments
could also help to tackle stigma
The standard of care for hepatitis C treatment has changed within
the last five years, with the availability of direct-acting antivirals. Choice
and duration of treatment will depend on the genotype, the severity of
any liver damage, whether someone has had HCV treatment before and
what other medications they may be taking. 3 Availability may also vary
according to where someone lives.
In the case of people with decompensated cirrhosis – when the liver has
stopped functioning properly – a liver transplant may be necessary to keep
them alive. Hepatitis C is the second-most common cause of liver transplants
in the UK, after alcoholic liver disease, with up to 600 people on the waiting
list at any one time. Although a complicated operation, most people will live
for more than ten years afterwards, with many living 20 years or more. 4
6 | DDN | Wider Health Series
TAILORING TREATMENT
Case study 1
Offering tailored support in a community setting is
often crucial to successful HCV treatment
Addaction is a leading UK drug, alcohol and mental health charity
which works with people across Scotland and England to help them
make positive behavioural changes. An important part of this work is to
increase understanding of hepatitis C and its risks, as well as improving
access to testing and treatment — which is vital to prevent people from
unknowingly passing on their infection, and to decreasing deaths.
“
Improving access to testing
and treatment is vital
The organisation treated a couple in their 30s, who both had HCV
genotype 1. Michael and Julie (names have been changed) were unable
to attend hospital appointments due to their rural, isolated location in
North Cornwall. They had had HCV for many years and didn’t feel they
were mentally stable enough to be treated with interferon. While
waiting for alternative treatment options to become available, they
moved house and their drinking increased.
Michael and Julie chose to be treated directly after an alcohol detox,
which they felt would give them an incentive to stay abstinent.
Addaction coordinated the couple’s detoxes, and despite the emotional
challenges of being apart, they both completed successfully.
Addaction’s BBV nurse, who has an honorary prescribing contract with
the local hospital, then provided the HCV treatment at home. Michael
and Julie were able to support each other and have both achieved a
sustained virological response.
www.drinkanddrugsnews.com