Seven Tips to Boost HCV Therapy Adherence
In response to the growing number of people infected with the virus responsible for the most liver transplants in the U.S., drug companies are literally racing to find more effective treatments for chronic Hepatitis C. This urgency is because the current treatment is only about 50 percent effective for the most common Hepatitis C genotype in the United States. In addition, Hepatitis C’s ability to progress to cirrhosis, liver cancer or liver failure makes it an illness that cannot be ignored. Regardless of the imminent arrival of new and improved medications, improving treatment adherence is likely to help many more with Hepatitis C beat the virus.
Those who undergo the current standard of treatment for Hepatitis C (interferon and ribavirin combination therapy) know that completing the course of medications at their initially prescribed dosage is essential for achieving a successful outcome. However, the rash onslaught of potentially severe side effects makes adhering to Hepatitis C therapy a major challenge.
Defining Treatment Success
There are no guarantees that the Hepatitis C virus can be eradicated from an infected person. Thus, doctors are leery of using the word ‘cure’ when it comes to eliminating Hepatitis C. The clinical indicator we currently have to describe a successful course of Hepatitis C treatment is sustained viral response (SVR). When Hepatitis C genetic material cannot be detected in the blood following treatment AND six months following the end of treatment, SVR has been attained. Therefore, most studies aiming to define the success of a particular Hepatitis C drug combination use SVR as an endpoint.
Maximizing SVR: Adherence
The primary goal of therapy for Hepatitis C is to maximize sustained viral response rates. While SVR depends on numerous factors, adherence to therapy is one of the few that can be influenced by embarking on a multi-disciplinary approach.
Despite the known importance of treatment adherence in achieving viral eradication, adherence to Hepatitis C medications is suboptimal. As published in a 2010 edition of Value in Health: The Journal of the International Society for Pharmacoeconomics and Outcomes Research, researchers found that only about 60 percent of patients with Hepatitis C in the United States adhered to their prescribed therapy.
Based on several clinical studies on Hepatitis C combination therapy, over 20 percent of patients must decrease dose, temporarily discontinue, or prematurely stop ribavirin and/or interferon because of adverse events. As confirmed by the Value in Health study mentioned above, those with advanced liver disease are less likely to adhere to Hepatitis C therapy than those with early disease, a finding likely related to an increased susceptibility to adverse events.
Adverse Event Reduction
Besides a commitment to take the prescribed medications, minimizing adverse events (side effects) during Hepatitis C treatment is one of the most important aspects of adherence. A multi-disciplinary approach that includes the patient’s actions is suggested to improve adherence and give those with Hepatitis C their best chance of achieving SVR. The following suggestions are intended to help keep those taking Hepatitis C medications on this path:
- Keep Track of Your Dosing Schedule – Examples of this are using a pill box to keep track of and remember ribavirin, and a calendar to make sure you receive timely interferon injections. Accidentally missing doses is an unfortunate mishap that can put people on the losing side of treatment.
- Side Effect Monitoring and Reporting – Keep a detailed side effect diary and bring it with you to medical appointments. Discuss persistent or bothersome side effects as soon as possible with your physician. Most of the side effects from treatment can be managed effectively if treated before they become severe.
- Prioritize Nutrition – The food you eat and beverages you drink can aid or combat Hepatitis C treatment. Don’t even consider drinking alcohol or eating fatty, sugary or processed foods. Make sure you drink plenty of water and eat a healthy, balanced diet. Proper nutrition can make the difference between achieving SVR and being deemed a non-responder to Hepatitis C treatment.
- Keep Active – The immune system does not work optimally during inactivity. Besides boosting immunity and making you feel good, light to moderate exercise daily will reduce side effect severity.
- Acupuncture – Consider seeing a licensed acupuncturist while on combination therapy to improve your chances of SVR. In addition to helping relieve some of the treatment’s side effects, acupuncture is known to strengthen the immune response – a function that supports Hepatitis C treatment.
- Supplement with Milk Thistle – Although your physician should always be consulted prior to taking any supplements while on Hepatitis C treatment, research by the National Institutes of Health indicates that milk thistle could improve adherence to combination therapy. As published in a 2008 edition of Hepatology, researchers found those taking milk thistle extract during Hepatitis C therapy had significantly less fatigue, nausea, liver pain, anorexia, muscle and joint pain, and better general health than participants who did not take milk thistle.
- Stay Networked – Make sure to enlist the help of family, friends and/or a support group during the entire course of therapy. Feeling isolated during Hepatitis C treatment does not bode well for completing treatment, while having a support network has been shown to help people overcome the obstacles that typically interfere with adherence.
By improving adherence to Hepatitis C treatment, the chances of achieving a sustained viral response – or maybe even a cure – will correspondingly increase. Incorporation of the seven tips described above into combination therapy regimens will dwarf the current SVR expectation of 50 percent, as many more are able to successfully eliminate chronic Hepatitis C from their body.
http://www.clinicaloptions.com/Hepatitis/Resources/News%20and%20Comment/Expert%20Viewpoints/August%202010.aspx, Importance of Adherence to HCV Regimens, Melissa Palmer, MD, Retrieved October 1, 2010, Clinical Care Options, LLC, August 2010.
http://www.hcvadvocate.org/hepatitis/factsheets_pdf/Adherence_10.pdf, HCV Treatment: Adherence to HCV Therapy, Alan Franciscus, Retrieved October 1, 2010, Hepatitis C Support Project, 2010.
http://www.hepatitis-central.com/mt/archives/2007/05/a_cure_for_hepa.html, A Cure for Hepatitis C?, Nicole Cutler, L.Ac., Natural Wellness, 2010.
http://www.ncbi.nlm.nih.gov/pubmed, Treatment patterns and adherence among patients with chronic hepatitis C virus in a US managed care population, Mitra D, et al, Retrieved October 3, 2010, Value in Health, June-July 2010.
http://www.ncbi.nlm.nih.gov/pubmed/18157835, Herbal product use by persons enrolled in the hepatitis C Antiviral Long-Term Treatment Against Cirrhosis (HALT-C) Trial, Seeff LB, et al, Retrieved October 3, 2010, Hepatology, February 2008.