Adherence: Curing HCV

It is now possible to cure about 80% (8 out of 10 people) who take the
current HCV medications. Treatment, however, is not easy! The most
important person who will help you
achieve a cure is YOU. The best
tool we have to make it a reality is
adherence. This brochure will discuss
the reasons why treatment adherence is so important. You will learn that
the key to being adherent to taking the HCV medications is persistence
and planning ahead for any unforeseen problems.
Adherence to HCV medications means taking all of the medications
prescribed by a medical provider. But it is really more than that. It’s about
taking the medications at certain times,
eating the right types of food when taking
the medications, keeping all of your
medical appointments and getting lab
tests. Adherence to HCV medications will increase the chances of being
cured of hepatitis C and decrease some of the side effects. Adherence will
also help to prevent something called drug resistance.
INTRODUCTION
important!
• Ribavirin and HCV protease inhibitors have to be
taken with food. Ribavirin (food), telaprevir (not
low fat food) and boceprevir (light meal or snack).
• Drink plenty of clear fluids—this will help
to keep your body well-hydrated and it will
help to reduce some of the side effects
of treatment.
• HCV protease inhibitors should never be taken
alone—always take them with pegylated interferon
and ribavirin.
• Take the interferon shot before bedtime
and prior to a day off.
• The dose of the HCV protease inhibitors should
never be lowered.
• If you miss a dose of medicine ask your doctor or
nurse when you should take the next dose.
• Tell your doctor or nurse about any side effects
and get them treated before they become worse.
ADHERENCE
self-help tips
• Your doctor or nurse will give you instructions
about how and when to take the HCV medications.
If you do not understand any part of the
instructions ask questions and have them write
out the answers for you.
• Talk with your medical provider about
prescribed and over-the-counter
medications.
• Headaches can often be relieved by rest,
massage, and application of heat or cold
to the back of the neck.
• Light fever can sometimes be reduced
by sponging with lukewarm water.
• Get some exercise such as walking,
swimming, Qi Gong, etc.
• Seek help from a medical provider for
irritability, depression or anxiety. These
are treatable conditions.
• Moisturize daily with an over-the counter lotion with sunscreen.
• Eat small frequent healthy meals.
• Use relaxation techniques for stress.
• If any side effects become worse—
report them to your doctor or nurse.
curing
HCV
ADHERENCE
S
E
C
R
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O
RES
Visit the Hepatitis C Support Project / HCV Advocate website for
more information about hepatitis C and HCV treatment.
Partnership for Prescription Coverage
1-888-477-2669
www.pparx.org
Author
Alan Franciscus
Executive Director,
Hepatitis C Support Project
Editor-in-Chief,
HCSP Publications
Alan Franciscus
Webmaster and
Managing Editor
C.D. Mazoff, PhD
Design and Production
Leslie Hoex,
Blue Kangaroo Design
Genentech (Member of the Roche Group)
www.genentechaccesssolutions.com/portal/site/AS/
1-877-PEGASYS (1-877-734-2797)
Kadmon Pharmaceuticals
www.kadmon.com/docs/patients_assistance
1-800-405-8506
Merck (includes Schering-Plough subsidiary)
1-866-939-HEPC (4372)
www.merck-cares.com
NeedyMeds
www.needymeds.org
Vertex
1-888-552-2494
www.vrtx.com/patients.html
This information is provided by the Hepatitis C Support
Project, a non-profit organization providing HCV, HBV and
HIV/HCV coinfection education, support and advocacy.
Hepatitis C Support Project
P.O. Box 427037
San Francisco, CA 94142-7037
websites
Visit our websites to learn more about viral hepatitis:
www.hcvadvocate.org • www.hbvadvocate.org
www.hepatitistattoos.org
curing
HCV
ADHERENCE
Made possible by Merck & Co. Inc.
curing
HCV
hepatitis c
Hepatitis C is a virus that mainly affects the liver. The liver is the main
M
ost people think of HCV treatment
as injecting a medication and
taking pills. But treatment is much more
than that—it’s about eating well, getting
support, keeping appointments, getting
organ that the hepatitis C virus uses to replicate or make more copies
regular lab work, exercise, rest and stress
of itself. During this process of replication the hepatitis C virus makes
parts of treatment is the connection
mistakes in its genetic code—this means that the new copies of the
reduction. And one of the most important
between the mind and body—that is, if
you believe that treatment will work, you
hepatitis C virus are slightly different than the original hepatitis C viruses
will be more inclined to take all of the
that are in your body. This process is called mutation. To combat hepatitis
appointments, and therefore treatment will
C the immune system develops antibodies to fight off and kill HCV. But
since the virus has slightly altered itself it can evade the immune system.
The way that HCV constantly mutates is why HCV can survive in the body
so long and one of the reasons why so many people who are initially
infected with HCV develop chronic or long-term infection.
medications and keep all your medical
be more likely to work.
BELIEVE
side effects
HCV
medications have many side
effects, such as depression, anxiety,
diarrhea, nausea, vomiting and more that can
affect how and if you take all of the medications.
Depression can make you forgetful so you may
not remember to take the medications, keep
medical appointments or get lab work done.
Depression is an illness that can be successfully
treated. Make sure you tell your medical
provider if you think you need help.
There are side effects like diarrhea, vomiting
and nausea that can affect how much of the
medications are absorbed by the body. Diarrhea
should be addressed quickly since all the food
you eat, fluids you drink and medications
you take are flushed through the body before
nutrients or the medications can be processed.
This is also true for vomiting. Remember to
work closely with your medical provider to get
these and other side effects treated.
ADHERENCE
It is now possible to cure about 80% (8 out of 10 people) who take the current HCV medications.
Drug
Resistance
The way that the hepatitis C virus
replicates and mutates can affect how
well HCV medications work. HCV
protease inhibitors work by attacking the
virus and preventing or stopping the virus from making more copies of itself. But sometimes
the medications are not strong enough or not enough of the medicine is absorbed by the
body to stop the virus from replicating and mutating. This is called drug resistance. If a
person develops drug resistance the HCV protease inhibitors may no longer work.
Support
People on HCV treatment will need
support from all areas of life including
family and friends. If possible check out
a support group in your area. People who
have been on treatment or people who
are currently on treatment can help with
advice and encouragement that is so vital to completing therapy.
Exercise
Staying active is also another important
way to stay healthy. Talk with your doctor
or nurse about what types of exercise and
level of activity is right for you.
Sleep
Adequate sleep is important to staying
healthy. The right amount of sleep will
also make it easy to function during the
day and lessen some of the side effects
of HCV treatment. Try to get at least 8
hours of sleep every night. This can be
difficult because some of the side effects of HCV treatment like insomnia and itching can
make falling and staying asleep difficult. There are many steps and medications you can
take to relieve insomnia and itching that will help you to achieve restful sleep. See your
doctor or nurse for advice and find out whether you need medications to help you sleep.
Food, Diet &
Nutrition
A healthy diet that includes a lot of
vegetables, fruit and lean meat is
important for everyone, especially people
who are living with chronic hepatitis C.
Eating healthily is even more important if you are on HCV treatment. If possible consult
a dietitian before starting treatment or check out www.myplate.gov for information about
eating healthily. Food is also important when taking the HCV medications. Ribavirin and HCV
protease inhibitors are pills that should be taken with certain types of food so the body
can absorb the right amount of the drugs into the bloodstream. It is important to keep the
right level of the medicines in your bloodstream to help attack and kill the virus, and to help
prevent the virus from “escaping.” If the virus is able to escape the effects of the drugs the
virus can become resistant to the medications. If you develop drug resistance it would mean
that treatment will no longer work and other brands of HCV protease drugs may not work.
100% adherence
is a difficult goal
for most people to achieve—doses can be missed and the
right kind of food may not be always be available. Still, people
should strive to take all the medications as close to 100% of
the time as possible to increase the chances of being cured.
Your doctor or nurse will instruct you on how and when to take
the medications and what to do if you miss a dose.
A major symptom of hepatitis C and a side effect of
the medications to treat it are forgetfulness and lack of
concentration—this is called “brain fog.” This makes trying to
remember to take all of the medications all of the time even more
difficult. However, there are many simple tips that may help.
We have come a long way in our understanding of hepatitis C and the
medications used to treat it. We now have treatments that can cure about 80% or 8 out of
10 of the people who take it. HCV treatment is not easy and it is best to approach it as a
full-time job. This will help to maximize the chances of achieving the goal—a viral cure! Of
course, not everyone can be cured at this time even with 100% adherence. But regardless
of whether treatment is successful you should take pride in the fact that you did all you
could to make treatment a success. That fact alone should be reason to celebrate.
T
reatment of chronic hepatitis C for people
with HCV genotype 1 includes:
• Pegylated interferon is a shot taken once
a week
• Ribavirin is a pill taken twice daily with food
• An HCV protease inhibitor:
– Telaprevir (brand name Incivek) is a pill
taken every 7 to 9 hours with food that
is not low fat
– Boceprevir (brand name Victrelis) is a
pill taken every 7 to 9 hours with a light
meal or snack
• Use the pill blister packs, and/or daily bottles that came
with the pills or buy a pill organizer—this will help you keep
track of how many pills you have taken.
• Be prepared for any type of situation that may arise by
keeping a daily packet of pills and food in the car, at work
or over at a friend’s house. Drug stores sell small plastic
zip lock bags to use for daily packets. Snack bars come
in low and high fat options that are easy to carry with you
wherever you may go.
• The pharmaceutical companies have many support services
for people who are taking their medications—resources are
provided at the end of this brochure. Use all and any that
are available.
• Keep all medical appointments and tests—this will help you
and your doctor or nurse make sure the treatment is working,
and it will help to identify and manage the side effects.
important!
Note: Check with your
doctor or nurse about the
type of foods you should
eat and when you should
take the pills.
curing
HCV
TIPS
• Keep a regular schedule of eating and sleeping, and
build in time for relaxing. A regular routine will help with
remembering when to take the medications. For example,
if you take your morning medications with breakfast,
eating breakfast will be a “trigger” for you to remember to
take the pills.
• Use alarms to remind you to take the medications. There
are vibration alarms to use when out in public.
•Develop a network of support services that includes
medical providers, family, and friends. Consider checking
out a support group in your area—people who are living
with hepatitis C and who have been through treatment
can provide tips and support to get you through the
difficult times.
• Treat side effects before the side effects become worse.
being studied to treat
If treatment doesn’t work this time around, remember there are many medications that are
don’t lose hope!
cured—so
be
can
c
hepatitis c and there will be a time in the future when everyone with hepatitis