New direct-acting antivirals used in the treatment of hepatitis C can interact with a wide range of other prescribed drugs. These interactions happen because the direct-acting antivirals are processed by a pathway in the liver used to process many others drugs. This can result in large increases or decreases in the levels of other medicines, and may also result in declines in the blood levels of direct-acting antivirals.

Two studies published in the past month show the importance of expert monitoring of all the medications being used by a person taking direct-acting antivirals.

Canadian investigators reviewed the risk of psychiatric side-effects, such as depression and anxiety, during treatment with direct-acting antivirals. They concluded that although the protease inhibitors telaprevir (Incivek or Incivo) and boceprevir (Victrelis) did not increase this risk, they did pose a serious risk of undermining the activity of a wide range of medicines prescribed for psychiatric conditions.

During hepatitis C treatment any medications being taken for treatment of depression or anxiety, as well as antipsychotics and anticonvulsants, need to be reviewed carefully to ensure that drugs levels will not be seriously reduced by hepatitis C drugs.

Another study looked at people taking telaprevir or boceprevir at one hospital in the United States. It found that people taking numerous other prescription drugs and over-the-counter supplements alongside hepatitis C treatment were less likely to achieve a rapid virologic response (RVR) to treatment. Those who failed to achieve RVR were taking an average of nine other medications alongside their hepatitis C treatment. To prevent negative drug interactions, it is essential that a pharmacist or physician experienced in hepatitis C treatment conducts a thorough check of all medicines and pills being taken by the patient during hepatitis C treatment.

Several pharmaceutical companies are developing drug combinations for hepatitis C treatment that will not require the use of interferon. This is likely to make treatment easier to tolerate in the future. Many of these combinations will continue to include ribavirin, which is used alongside interferon in current treatment regimens. Ribavirin may cause anaemia. An analysis of one of the first studies of interferon-free hepatitis C treatment, the AVIATOR study, showed that reducing the ribavirin dose after the development of anaemia as a side-effect of treatment did not reduce the chance of a sustained virologic response (SVR). It will be important to see if this finding is reproduced in larger trials with different drug combinations.

Although it is well known that a fear of side-effects makes many people reluctant to take hepatitis C treatment, the ways in which people weigh up the risks and benefits of starting hepatitis C treatment is less well understood.

A study conducted in the United States set out to establish which factors were most important to people when making the decision about starting treatment, and what might influence that decision.

The study showed that expected health problems as a result of not treating hepatitis C encouraged people to start or complete therapy, while the prospect of treatment side-effects discouraged people from starting treatment.

People living with hepatitis C also reported that they were more likely to start or complete treatment if they were provided with test results and other information on the likelihood of treatment success.

Current costs for hepatitis C triple therapy comprising pegylated interferon, ribavirin and a first-generation direct-acting antiviral range from $38,568 for a boceprevir-containing regimen in the United Kingdom to around $67,000 for a course of treatment containing telaprevir in the United States.

But these costs could eventually fall, after 2025, as patents on new direct-acting antivirals now in development begin to expire. Indeed, they could fall as low as $200 for a 12-week course of treatment with two direct-acting antivirals plus ribavirin, according to new research presented in July.

This estimate is based on the fact that some of the key drugs now in later stages of development for hepatitis C treatment – sofosbuvir, faldaprevir, simeprevir and daclatasvir – have a similar molecular weight and chemical complexity to drugs used in HIV treatment. This makes it possible for expert pharmacologists to estimate, within a broad range, how much it will cost to make these products. The production costs of drugs used to treat HIV are well known and these costs have fallen dramatically over time as patents have expired.

Production costs might fall when manufacturers of generic versions of pharmaceuticals in India and other countries are able to produce their own versions of hepatitis C drugs, after patents begin to expire in 2025. Declines in costs will also require predictable demand in the form of national treatment programmes that commit to treating a large number of people each year. This was key to achieving an 80% reduction in the price of pegylated interferon in Egypt.

Treatment Action Group has published a very useful review of hepatitis C drug development. The guide includes details of all drugs by class of action against hepatitis C, and information on what stage the drug has reached in clinical trials. The guide also provides details of all the interferon-free combinations in development.

Another useful feature is a set of tables showing the sustained virologic response (SVR) rates that have been achieved when using the various interferon-free combinations. These tables are organised by genotype and treatment experience, and also provide information on the duration of treatment. They list any differences in response according to IL28B status and differences in response between genotype 1a and 1b.

The report also includes a review of progress towards hepatitis C treatment access in low- and middle-income countries.

For many of us in Europe who work in hepatitis, or are patient advocates, World Hepatitis Day on 28 July offers an opportunity to get people talking about hepatitis. This year’s theme is: This is hepatitis. Know it. Confront it.

The World Hepatitis Alliance is co-ordinating a campaign known as ‘three wise monkeys’ or ‘See no evil. Hear no evil. Speak no evil’. The idea behind the campaign is that hepatitis is often ignored, and it’s important for people to open their eyes and ears to it.

Find out more about the campaign on the infohep.org noticeboard.

The World Hepatitis Alliance has also put together campaign materials you can use, here: http://campaign-material.worldhepatitisalliance.org

Designs for posters and postcards are available in English, French, Spanish, Portuguese, Russian, Arabic and Chinese, with the message, “This is hepatitis. Know it. Confront it”.

You can customise these designs, using a tool on the website, by changing the images and the text.

Get people talking

There are lots of ways you can raise awareness of hepatitis, by arranging or taking part in an event, giving presentations, blogging, using social media, writing a letter to a newspaper, and talking to friends and colleagues. The main thing is to raise awareness of hepatitis, encouraging people to think about it and to be tested.

To share information about World Hepatitis Day awareness activities on Twitter you can use the hashtag #WorldHepDay

The European Liver Patients Association (ELPA) will be marking World Hepatitis Day with a focus on Croatia, in order to mark the accession of Croatia to the European Union on 1 July 2013.

The Croatian Association of Treated and Ill with Hepatitis “Hepatos”, a member of ELPA and the World Hepatitis Alliance (WHA), and the other associations from the Croatian Alliance of Hepatitis Patients (CAHP), are organising a series of activities linked to marking World Hepatitis Day.

The activities will be performed under the auspices of the Ministry of Health of the Republic of Croatia, the office of the World Health Organization in the Republic of Croatia and ELPA, in collaboration with the Referral Center for the Diagnosis and Treatment of Viral Hepatitis, the Office for Combating Narcotic Drug Abuse of the Croatian Government, the Red Cross and the member associations of the CAHP.

Activities will include a press conference in Zagreb with the participation of the Minister of Health, the head of the WHO office in Croatia, and the head of the Referral Center for Viral Hepatitis and ELPA.

Public events will take place in Zagreb, Split and the resort of Zrce (the ‘Croatian Ibiza’) including offering free and anonymous testing and counselling for hepatitis C and elastography scanning of the liver.

We aim to provide a comprehensive online database of organisations offering services to people with hepatitis or working in the field of viral hepatitis. We already list nearly 200 services in the European and Eastern Mediterranean region. You can also search for services by country.

Check the infohep database of services and organisations working in viral hepatitis to find out whether your organisation is already listed.

If we don’t have a listing yet, please add your details for review and inclusion in the database.