Patients First: Overview – Preparing for Treatment: Part 2, by Alan Franciscus, Editor-in-Chief

Part 2 of this article discusses Medical Tests, Medications and Side Effect Management, among other things.

Medical Tests:
There may be tests your medical provider will order before you start treatment:

• Pregnancy test—If ribavirin is part of your treatment you will need to verify that you are not pregnant before starting treatment.  This is also true if you are a female partner of a male patient starting treatment.
• HCV-RNA or viral load test—This is used to confirm active infection and as a baseline test. 
• Genotype test—This test determines the strain of hepatitis C—there are seven genotypes.  Genotype 1 is the most common followed by genotype 2 and 3.  Genotype information is used to determine what HCV treatment to take and for how long to take it.
• Baseline tests—These include a variety of tests, such as a complete blood count (CBC), diabetes, thyroid and liver tests.  Your general health will be assessed, especially if you are older than 40 or 50 years old or at risk for various medical problems. 
• Medical and dental procedures—In some cases, it may be a good idea to have any serious medical, and dental procedures completed well in advance prior to beginning HCV therapy.  If the medical or dental procedure is not severe, you may be able to postpone it until after treatment, so your body has a chance to recover from treatment. Discuss this with your doctor.
• Immunizations—You can be immunized while on treatment.
• Anxiety—Current therapy can cause anxiety and though uncommon, depression. Talk with your medical provider if you are concerned about this.  Medication can provides relief relatively quickly. 

Medications
HCV treatment consists of pills.  Talk to your medical provider about how and when to take them.  Be prepared—ask your medical provider ahead of time if you miss a dose, when you should take the next dose.  If you plan on traveling, make a copy of your prescriptions to take with you. 
You may have to use a specialty/mail order pharmacy, rather than a brick and mortar pharmacy like Walgreens or CVS.  They both have similar services:

• Specialty pharmacies ship to your home or office.  With a regular pharmacy you control where and when to pick up the prescription.
• Both can offer support services—nurses, websites and other services to help manage your therapy.
• Both can remind you when to re-order or will automatically refill orders.

Side Effect Management
A favorable treatment outcome is associated with your ability to stay on the prescribed dose of medication for the entire duration of treatment.  In addition, completion of treatment goes hand in hand with good side effect management—this means treating the side effects before they become worse.  For more information about side effect management see the Resource section at the end of this article. 

Treatment side effects are usually temporary and should gradually fade away after treatment is completed.  This may take weeks or months; rarely up to a year. 

The most common side effects of current therapy are fatigue, headache, nausea, diarrhea, and insomnia.  However, it is important to know that not everyone has these particular side effects, and most people do not have severe side effects.  In clinical trials for current therapies, less than 1% of individuals had side effects that required discontinuation of treatment.

Preparing Your Body
HCV treatment is a process that requires getting the mind and body ready and in shape.  Alcohol, especially in large quantities, can accelerate HCV disease progression.  Some insurance companies and medical providers are denying HCV treatment to people who consume alcohol and drugs, including medical marijuana.  You may be required to abstain from alcohol and drugs for 6 months and attend a 12-step program.  Talk to your medical provider about any concerns or questions. 

Light to moderate exercise is recommended for most people with hepatitis C.  Check in with your medical provider before starting any exercise program.  Before beginning treatment, slowly build up to a comfortable level.  There are many ways to get exercise such as walking, yoga, and dancing to name a few.

Birth Control
If ribavirin is part of HCV treatment:
Women of childbearing age, their partners and female partners of male patients taking ribavirin must practice two forms of reliable contraception during to 6 months post-treatment.

It is essential that pregnancy be avoided throughout treatment and for six months after treatment has ended.  The guidelines are to use two reliable forms of birth control.  Reliable means using medically accepted contraceptive methods and using them correctly.  Whatever you choose, know how to use the method correctly.  Also, notice the word two.  This means that if you use two forms of birth control and one fails, then you have back-up protection.  If you or your partner needs information about birth control, talk to your medical provider or family planning center. 

Pill Containers/ Calendars
It is important to remember to take the pills every day.  The makers of HCV drugs make it very easy, but no one is perfect.  Plan ahead—get a calendar.  Mark off the day when you take the pill(s).  This can be a great motivation to know that you have completed one day of treatment, and you can look forward to the end of treatment and hopefully a cure. 

A Final Word
It is important to set a goal before treatment.  Why do you want to be treated?  Write them down and refer to them while on treatment.  It is an excellent way to stay motivated.  Just remember that, even though, the cure rates are very high not everyone can be cured at this time.   Planning ahead and staying the course will give you the best opportunity to be cured, and that is really all you can do.

Resources: Patient Assistance Programs

• Help with Medicines
  www.hcvadvocate.org/hepatitis/easyfacts/
  e_Patient_Assistance.pdf
• Patient Assistance Programs
  www.hcvadvocate.org/hepatitis/factsheets_pdf/
  Patient_Assistance.pdf
• Pregnancy Drug Categories
  www.hcvadvocate.org/hepatitis/factsheets_pdf/
  Treat_pregcat.pdf
• Making Treatment Decisions
  www.hcvadvocate.org/hepatitis/
  Treatment_Decisions.asp

For Part 1 of this article click here

http://hcvadvocate.org/news/newsLetter/2015/advocate0515.html#2

Overview – Preparing for Treatment: Part 1 – Alan Franciscus, Editor-in-Chief

Treatment of hepatitis C has made great advances from the early days.  Back when interferon was first approved, the cure rates were about 10%.  The list of just the most common side effects could take up an entire page.  Now, we have medications that can cure 90 to 100% of patients who undergo therapy.  Even better, the side effects of the newer treatments are much easier to tolerate.  This article will discuss what it takes to prepare for treatment. 

Support and Resources
Start by gathering resources.  Trusted resources such as your medical provider, a support group, and a reliable internet site are safe places to start.  An important issue for people thinking about treatment is to learn as much as possible about treatment.  Talk to others who have been on treatment—they are some of the best experts.  Facebook is another resource where you can learn about treatment and receive support.  There are various Facebook accounts for the brand name drugs—HARVONI and VIEKIRA PAK—that provide a wealth of information about what people are experiencing while on treatment.  A caveat: Sometimes the sickest patients may use these sites more than those who feel well, and may have more side effects and complaints.

The pharmaceutical companies also have many resources that can be useful for investigating treatment issues and receiving support.  

Financial Preparations 
Whether you are dealing with your pharmacy, insurance company, medical provider or a patient assistance program—be prepared to provide the following information:

• Patient’s name
• Patient’s address
• Patient’s phone number (home and cell)
• Patient’s date of birth
• Identifying number—social security account number or a membership number.

Note:  Every time you call your insurance company or medical office, keep comprehensive notes—include the date, name and any issues that you discussed.  If it was over email, print it out and keep it with your other records.  If your medical office has an online record keeping system, print it off and keep it in a secure place. 

Insurance
HCV treatment is very expensive; some insurance companies have exclusivity agreements for individual HCV medications.  Check with your insurance carrier if there is a preferred HCV drug.  This could limit the choice of drugs.  Find out how much your share of expenses will be.  Additionally there are costs associated with medical appointments and lab tests.  Factor all these costs into what you have to pay.

Try to get answers to the following questions:

• Do you have prescription coverage?
• If so, what will your out-of-pocket expenses be?
• Do you have any reason to think your medical insurance will stop during treatment, such as a probable job lay off or a reduction in work hours?
• If you do not have prescription coverage, what is the cost of HCV treatment?
• How often will you have lab tests done and what is the co-pay?
• How often will you need to see your medical provider and what is the co-pay?  Remember, HCV treatment is typically 12 weeks but for some people it can range from 8 to 24 weeks.
• Insurance or not, can you afford the costs associated with HCV treatment?

Patient Assistance Programs:
The pharmaceutical companies that make the drugs to treat hepatitis C have programs that can provide the medications if you qualify.  Additionally, there are other programs that help with the co-pays.  A list of the Patient Assistance Programs can be found below and on our website.  There are also programs that can help people through the entire process of physician visits, insurance issues, and specialty doctors. 

The Workplace
In the past, some patients were unable to work while on interferon-based therapies.  Now that we have interferon-free therapies with fewer side effects, this is mostly an issue for people with more advanced liver disease.  In fact for most people, the workplace issue will mainly involve scheduling medical appointments and lab work. 

Remember you do not have to tell your employer you have hepatitis C or that you are taking hepatitis C medications.  Everyone has the right to time off for medical reasons.  However, it is not always that easy, so you should check in with your employer about your rights and responsibilities.  Also check in with your state health department about your rights.  It is also important to think through the worst-case scenario.  Some people are worried that they may feel sick especially at the beginning of therapy.  This is normal.  It might help to schedule a couple of days off at the beginning of treatment.  Talk with your employer about your sick leave policy, how much you have available and what your employer’s policies are.  You may also be able to use your vacation.  There is also the Family and Medical Leave Act (FMLA)—see if you qualify for this benefit. 

The most important issue is likely to be the time that you will need to take off for doctor appointments and lab tests. 

Part 2 of this article will discuss Medical Tests, Medications and Side Effect Management, among other things.

Resources:

Help with Medicines

Patient Assistance Programs