The Five: Fatigue —Alan Franciscus, Editor-in-Chief

1. Fatigue or feeling tired is the most common symptom of hepatitis C.  It is also the most common extrahepatic (occurring outside of the liver) condition of hepatitis C.  It is also one of the most common side effects of HCV therapy.  It can range from mild to moderate to so severe that it can affect almost every area of life.
   
   
2. Causes:  Fatigue can be caused by many factors besides hepatitis C.  Be sure to talk with your medical provider before jumping to a conclusion that the cause is hepatitis C.  Other factors that could be causing fatigue could be other extrahepatic manifestations of hepatitis C (thyroid problems, anemia, HCV treatment, depression, sleep problems, poor diet, lack of exercise, medications, alcohol use and so on). 
   
   
3. Self-help strategies:  After you have ruled out any other causes with your medical providers there are many strategies to help improve your energy levels.  We have an excellent Guide to Understanding and Managing Fatigue that can walk you through many self-help tips such as information on improving sleep, nutrition, exercise, meditation, complementary medicines and much more.
   
   
4. HCV Treatment:  Severe fatigue is one of the extrahepatic manifestations that can qualify someone for treatment.  Curing hepatitis C can also cure fatigue, though fatigue can worsen temporarily during treatment.  Be sure to talk with your medical provider about the fatigue you are experiencing and other symptoms.  Make sure to document all symptoms in your medical records.  For some people, it is hard to complain or even talk about their symptoms.  It is critical, however, to make sure that you document your complaints.  Medical records are important for treatment and disability records.
   
   One of the best ways to gauge your level of energy or any other factor is to use a scale of 1 to 10 and keep a journal.  Let’s say you have a wonderful day, full of energy, and you feel like your old self.  That would be a fatigue scale of 1.  Now let’s say you have a day where you are feeling sluggish but can still work.  Maybe that is a fatigue day of 4.  Then there are days when you can hardly get out of bed.  Let’s say that is a 10 on the scale of fatigue.  I think you get the idea.  Log it into a journal every day.  Take a copy with you to your medical provider and have them put it in your medical records.
    
   
5. Support: One way to fight fatigue is to join a support group (either on-line or in-person) and talk with others who are experiencing fatigue.   Try to remember to take care of yourself and to practice self-care tips to keep you well and healthy. 
   

http://hcvadvocate.org/news/newsLetter/2015/advocate0215.html#3

Cigna Signs Agreement with Gilead to Improve Affordability of Hepatitis C Treatment for Customers and Clients

• Improving customers' health at the most competitive pricing benefits all stakeholders
• Harvoni is the only Cigna preferred hepatitis C drug treatment for genotype 1

BLOOMFIELD, Conn., February 04, 2015 - Cigna (NYSE: CI) has reached an agreement with Gilead Sciences, Inc. (NASDAQ: GILD) to include Harvoni as the only preferred brand prescription drug treatment for customers with hepatitis C genotype 1, the most common form of the disease in the United States. Cigna clients and customers benefit from obtaining breakthrough clinical cure rates for hepatitis C while significantly lowering the cost of drug treatment.

“Cigna is committed to offering customers and clients the most affordable solutions that deliver improved health while containing both drug and total medical costs. We have selected Gilead’s Harvoni as the preferred drug treatment for hepatitis C genotype 1. Harvoni’s clinical effectiveness, safety and convenience, coupled with our innovative customer counseling, will deliver material health and financial outcomes for our customers and clients,” said Jon Maesner, chief pharmacy officer for Cigna Pharmacy Management.

Clinical studies have shown that 94% to 99% of individuals with genotype 1 hepatitis C treated with Harvoni achieve a sustained virologic response (SVR). Customers who have an SVR when tested 12 weeks after the completion of treatment are considered cured.

“Cigna continues to invest in analyzing real-world SVR outcomes with the leading hepatitis C treatments across the genotypes as we believe creating alignment around clinical and financial outcomes drives more affordable access to essential medications,” added Maesner. The agreement includes development of an innovative outcomes incentive alignment based on actual SVR results across Cigna's customer population.

Cigna is continuing to:

• Offer therapy support management through Cigna Specialty Pharmacy Services to every customer undergoing hepatitis C treatment.
• Conduct real-world outcomes assessments on existing and new hepatitis C drug treatments, including Harvoni, to further develop outcome-based strategies.

Cigna Medicare customers will also now have Harvoni as an additional formulary choice for treatment.

Terms of the agreement are not disclosed.

Read complete press release here
 

Gilead to discount its pricey Sovaldi drug

LOS ANGELES (MarketWatch)—The future appeared golden when Gilead Sciences Inc. reported its results Tuesday, with earnings per share blowing past forecasts and revenue beating estimates by more than half a billion dollars.

So why was Gilead’s GILD, -7.92%  stock down by double digits at one point Wednesday morning? The main driver of those results, the hit hepatitis C drug Sovaldi, will come down in price, the company says.

Gilead will begin offering discounts and rebates of up to 46% this year for the $1,000-a-day pill to insurers and others who pay for health care expenses, now that rivals like AbbVie Inc. ABBV, -6.73%  and Merck & Co. Inc. MRK, -2.90%  are entering the market.

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UPDATE 2-Merck says hepatitis C treatment to lose "breakthrough" status

Feb 4 (Reuters) - Merck & Co on Wednesday said the U.S. Food and Drug Administration intends to rescind its "breakthrough therapy" designation for the company's experimental combination treatment for hepatitis C because of other recently approved treatments.

Merck, in its fourth-quarter earnings report, said it plans to discuss the matter with the FDA, and still expects to seek U.S. approval for the treatment in the first half of 2015. It consists of a protease inhibitor called MK-5172 and a so-called NS5A inhibitor called MK-8742 that together had received the "breakthrough therapy" designation from the FDA.

The setback for Merck's treatment follows recent approvals of costly oral treatments for the liver disease from Gilead Sciences Inc and AbbVie that have wiped out all signs of the virus in more than 90 percent of patients after eight or 12 weeks.

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Ghana: Hepatitis C More Prevalent Than HIV/AIDS or Ebola Yet Lacks Equal Attention

Loyola’s HepNet study reveals high frequency of active infection and multiple risk factors in Ghana

Newswise — More than 180 million people in the world have hepatitis C, compared with the 34 million with HIV/AIDS and the roughly 30,000 who have had Ebola. Yet very little is heard about the hepatitis C virus (HCV) in the way of awareness campaigns, research funding or celebrity fundraisers.

One of the global regions highly affected by hepatitis C is West Africa. In developed countries, hepatitis C, a blood-borne disease, is transmitted through intravenous (IV) drug use. “In West Africa, we believe that there are many transmission modes and they are not through IV drug use, but through cultural and every day practices,” says Jennifer Layden, MD, PhD principal investigator on a study recently published in the journal Clinical Infectious Diseases. “In this study, tribal scarring, home birthing and traditional as opposed to hospital-based circumcision procedures, were associated with hepatitis C infection in Ghana.”

The study was conducted by HepNet, an international multidisciplinary group of physicians and scientists. “The other important finding was that a high percentage of individuals who tested positive for HCV had evidence of active infection,” says Layden. “This illustrates the need for treatment.”

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Doctors group joins fight against 'skyrocketing' drug prices

These doctors are concerned you won't be able to afford the medicines they want to prescribe you.

A national group of more than 140,000 physicians on Tuesday joined a coalition dedicated to reversing the growing trend of high-cost specialty drugs, which are being blamed for straining the finances of patients, insurance plans and public health coverage programs.

The move by the American College of Physicians came a day after the Obama administration said it is asking Congress to give it power to negotiate with drugmakers over the prices of costly prescription medication provided to Medicare beneficiaries.

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UK: Lesley Hughes now demanding apology for blood transfusion scandal blighting thousands of patients

At risk: Lesley Hughes who found out just last year she contracted hepatitis C from a blood transfusion. 

It was the blood that was supposed to give her life.

However, the 61-year-old says that blood has given her a death sentence after discovering just last year by chance that it infected her with the deadly virus hepatitis C. 

Last week the couple from the New Forest travelled to London where the issue was debated in parliament with MPs calling for a long-awaited national public apology and final settlement ahead of the results of a public inquiry into the scandal being published in March.

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