Download HCV Training Workshop

HCV Training Workshop
ALAN FRANCISCUS
EXECUTIVE DIRECTOR, HEPATITIS C SUPPORT
PROJECT
JOIN US ON TWITTER & FACEBOOK – HCVADVOCATE
BLOG: HCVADVOCATE.BLOGSPOT.COM
www.hcvadvocate.org
Version 17.5
HEPARDY!
 Answer in the form of a question
 Right answer = earn points
 Wrong answer = lose points
 Daily Double
 Wager points earned or up to 1000 points
Right answer – double points
 Wrong answer – lose points wagered

 First person who buzzes in has 10 seconds to answer
Judge’s decision final!
www.hcvadvocate.org
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People Who Make a Difference
 C.D. Mazoff
• Irina Gavrilova
 Lucinda Porter
• Christine M. Kukka
 Rose Christensen
 Liz Highleyman
 Leslie Hoex
www.hcvadvocate.org
• Clara Maltras
• Kate Frye
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www.hcvadvocate.org
www.hcvadvocate.org
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Numbers
•Website:
•Average 660,000 hits/week
•Educational Materials: 350,000 pieces
•
•
Not counting website downloads
Fact Sheets – 400-500 downloads weekly
www.hcvadvocate.org
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Legend: Completed
www.hcvadvocate.org
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Effect on HCV Community
•HCSP Educators: more than 15,000
•
50 people:
• In one year outcome is 750,000 people
•
Ultimate goal:
•
Improved education, support and services
www.hcvadvocate.org
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The Liver
www.hcvadvocate.org
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T
H
E
L
I
V
E
R
www.hcvadvocate.org
•
About 3 lbs (men) – size of a
football
•
Located in the upper right
side – beneath the rib cage
•
1.5 quarts of blood flow
through it every minute
•
Regenerates –grows or
shrinks
•
Chemical factory > 500
functions
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LIVER
• Sugar & fat metabolism & nutrient storage
• Stores some vitamins and minerals
•
Fat soluble vitamins: A,D,E, & K
•
•
People with HCV should be tested for deficiencies
Minerals: copper and iron
www.hcvadvocate.org
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LIVER
• Bile – regulates hormones – immune system cells
• Clotting factors:
•
Makes proteins to help the blood clot
• Filters substances:
•
•
•
Breathed in the air
Absorbed through the skin
Taken by mouth
www.hcvadvocate.org
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Healthy People:
•H e a l t h y p e o p l e — n o m o r e t h a n :
•
•
2 alcoholic drinks a day for men; 1 alcoholic drink a day for women
HCV – NO ALCOHOL
•B e c a u t i o u s a b o u t m i x i n g d r u g s e s p e c i a l l y w i t h
•
•
alcohol—
Acetaminophen (Tylenol) – 600 products
• Over 78,000 emergency room visits & 300 deaths a year (150 accidental)
NSAIDs:
• ~4000 annual deaths (little data)
•E a t a h e a l t h y , b a l a n c e d d i e t :
•
www.choosemyplate.gov
www.hcvadvocate.org
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Are you sure your doctor said we can have
two drinks a day?
www.hcvadvocate.org
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HEPATITIS
•Means:
Inflammation of the liver
•Causes:
•
Viruses, toxins, genetic disorders,
bacteria and parasites, alcohol and diet
www.hcvadvocate.org
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Hepatitis A (HAV)
•
US—New infections: 3,050 (CDC – 2012)
•
180,000 in 1997
•
Vaccine available since 1995 – 2 doses (0 & 6 months)
•
Estimated 33% have been infected with HAV
•
Resolves (not chronic)
•
Transmission: fecal/oral
www.hcvadvocate.org
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HEPATITIS B (HBV)
HCV AND HBV REDUCE SURVIVAL BY MORE THAN 20
YEARS
•US – 18,760 new infections (CDC – 2012)
•Vaccine available since 1982 – 3 doses (0, 1, & 6 months)
•US chronic: 700,000-1.4 Million
•
Worldwide: 350-400 million
•U S – 3 , 0 0 0 D E A T H S A Y E A R
•
Worldwide 660,000 annual deaths
www.hcvadvocate.org
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HBV Transmission
•
Bloodborne – can live outside the body for at least 7
days
•
Highly infectious in semen and vaginal
secretions – the majority of US infections
•
Sharing needles to inject drugs
•
Needlestick and blood exposure accidents
•
Sharing personal items
•
Mother-to-child transmission
www.hcvadvocate.org
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HBV Prevention
•Get vaccinated
•Do not share needles or works
•Safer sex
•Standard safety precautions
•Do not share personal items
•HBV-infected mother-to-child intervention
www.hcvadvocate.org
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Chronic HBV
Chronic ~5-6% Adults – 90% Infants
Drug/Brand name
Type
Year Approved
Resistance
Interferon alfa-2a
(Intron A)
Interferon
1991
None
Lamivudine
(Epivir-HBV)
Nucleoside reverse
transcriptase inhibitor
1998
14 - 32% at Year 1; 60 - 70% at year 5
Adefovir
(Hepsera)
Nucleoside reverse
transcriptase inhibitor
2002
0% at year 1; 29% at year 5
Entecavir
(Baraclude)
Nucleoside reverse
transcriptase inhibitor
2005
1.2% in treatment naïve at year 6; 57% in
lamivudine resistant at year 6
Peginterferon
alfa-2a (Pegasys)
Interferon
2005
None
Telbivudine (Tyzeka)
Nucleoside reverse
transcriptase inhibitor
2006
25% in HBeAg positive at year 2; 11% in
HBeAg negative at year 2
Tenofovir (Viread)
Nucleoside Reverse
transcriptase inhibitor
2006
0% at year 7; adefovir resistant HBV should be
treated with tenofovir and another HBV
antiviral
*These drugs are recommended as first line of treatment
www.hcvadvocate.org
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HCV Transmission / Prevention
Hepatitis C is spread by blood-to-blood
contact
HCV is the most common blood-borne
pathogen in U.S.
www.hcvadvocate.org
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HCV Survival
•
Hepatitis C virus lives on surfaces for up to 6 weeks
•
In syringes up to 63 days
•
Commercially available disinfectants kill HCV
•
Collected shared swabs – ~ 83% tested positive for HCV
•
HCV detected in used water for greater than 3 weeks
•
In bottles – HCV RNA detected even after rinsing out – plastic and
aluminum retained HCV RNA longer
•
~10% of filters wrapped in foil had HCV RNA after 24 and 48
hours
www.hcvadvocate.org
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Transmission/Prevention
•
Sharing needles and drug preparation tools
•
Blood products & solid organ transplantation before
July 1992
•
Clotting factors before inactivation in 1987
•
Sexual transmission (0-3%)
•
Mother-to-child (~4-10%)
•
Healthcare workers (~2%)
•
Hemodialysis
www.hcvadvocate.org
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Possible Transmission Routes
•
Tattoo & piercing*
•
Personal care salons
•
Shared household (hygiene) items
•
Coke/crank straws & crack/meth pipes
•
10% of routes can not be identified
* Higher in unsafe non-commercial settings: prisons/mental institutions/on the streets/home grown
www.hcvadvocate.org
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Safer Tattoos – www.hepatitistattoos.org
www.hcvadvocate.org
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Little or no data…….
• Dental and other procedures before
universal precautions
• Jet gun injections
• Transgender people
•
Sharing needles and re-assignment
surgeries
www.hcvadvocate.org
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HCV is Not Spread by:
•
•
•
•
•
Breast feeding
Food or water
Sharing eating utensils or drinking
glasses
Sneezing
Hugging
*Not spread by casual contact*
www.hcvadvocate.org
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Prevention:
•Do not share anything:
NEEDLES,
COOKERS, COTTON, TOURNIQUETS, WATER,
WATER CONTAINERS, ETC. – WASH HANDS
www.hcvadvocate.org
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Prevention – more
•Do not share non-injection drug
equipment
•Coke/crank straws
•Crack/Meth pipes
•Tattoo / Piercing
•Sterilization, autoclave, separate ink pot,
new needles
www.hcvadvocate.org
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Prevention – more
•S e x u a l : 0 - 3 % – m o n o g a m o u s p a r t n e r s – c o u n s e l
•
Safer sex – additional risk through sex:
•
Multiple partners
•
Coinfection with HIV or HBV
•
Having herpes, lesions, sores, open cuts, wounds
•
Sexually transmitted diseases
•M O T H E R - T O - C H I L D
www.hcvadvocate.org
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More Prevention
•Health care workers
•bloodborne pathogen protection
•Razors / toothbrushes covered
•Cover all wounds
•Transfusions – estimated that less than one per 2
million transfused units of blood tainted with HCV
•People with HCV: Do not donate blood, sperm, eggs
or organs – EXCEPTIONS…..
www.hcvadvocate.org
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Lifecycle
•
Single-stranded RNA virus
•
Mainly infects liver cells—but also found in
other cells of the body
•
Cell culture discovered and available
www.hcvadvocate.org
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HCV Diagnostic Tools
HCV IDENTIFIED IN 1989
Important: Interpretation of test results and decisions about healthcare are a
collaboration between a medical provider and a patient
www.hcvadvocate.org
www.hcvadvocate.org
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Baby Boomers Account for the Majority of HCV
Cases in United States
Estimated Prevalence by Age Group
Number With Chronic HCV
Infection
(millions)
1.6
1.4
1.2
1.0
0.8
0.6
0.4
0.2
0
<1920
1920s
1930s
1940s
1950s
1960s
1970s
1980s
1990+
Birth Year Group
www.hcvadvocate.org
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Increased Diagnosis and Treatment
The Tipping Point?
Aged-Based
Testing
Templates
OraQuick HCV Antibody Test
The Centers for
Disease Control (CDC)
& the United States
Preventive Services
Task Force (USPSTF)
have recommended a
one-time test for
persons born between
1945 and 1965
Finger Prick & Whole Blood
Draw FDA Approved
Newly FDA-Approved
Antivirals
Cure rates up to 90%
In Development
•Results available within 20
minutes
•More testing within clinics
and mobile sites can lead to
increased consultations
about care, management and
treatment
Approval estimated –
end of 2014
Interferon-free
therapies will mean
that almost everyone
will want to be treated
>800,000 people
www.hcvadvocate.org
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HCV Antibody Tests
•H C V E L I S A I I I ( E I A ) , C I A : D E T E C T S A N T I B O D I E S
•
Signal to cut off ratio = 95% chance true antibody
positive
•
Home Access test kit
•
Window period – 2-26 weeks
www.hcvadvocate.org
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OraQuick HCV Rapid Antibody Test
• FINGER PRICK & WHOLE BLOOD:
FDA AND CLIA WAIVER APPROVED – 2011
www.hcvadvocate.org
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www.hcvadvocate.org
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www.hcvadvocate.org
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HCV RNA – Viral Load
•
PCR (polymerase chain reaction) – lowest range
•
TMA (transcription mediated amplification) – lowest range
•
DNA (bDNA) assay – highest range
•
Amount of virus per milliliter of blood
•
International units
•
Low – less than 800,000 IU/mL
•
High – more than 800,000 IU/mL
www.hcvadvocate.org
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How is Viral Load Used?
•
Confirm active infection
•
Soft predictor of treatment response
•
Confirm HCV medications are working
•
Dictate treatment duration for some HCV Medications
***Does Not Correlate with Disease Progression***
www.hcvadvocate.org
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Genotype & Quasi-species

Seven major genotypes (plus sub-types)
 Genotypes
numbered 1, 2, 3, 4, 5, 6, 7* (1a, 1b, etc.)
 Genotype 1 – 70% of US population with HCV
 Genotypes 2, 3 – 30% of US population with HCV
 Quasi-species
 High
error prone virus – mutates quickly
* Discovered in 2013
www.hcvadvocate.org
Version 17.5
Liver Tests
•
ALT: a non-specific marker of liver
inflammation
•
•
Not a good test to monitor people with HCV
AST, AP, GGT, bilirubin, platelet, prothrombin
time (PT)
www.hcvadvocate.org
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Liver Biopsy
*Measures liver
health
*Treatment
decisions**
*Benchmark
Note: Fewer
biopsies are being
performed because
of newer therapies
with cure rates >
90% and the use of
the Fibroscan
www.hcvadvocate.org
Metavir Scoring System – 0, 1, 2, 3, 4
No activity
Severe activity
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FIBROSCAN
•
•
FDA APPROVED – APRIL 2013
Imaging technology that uses a sonogram to
measure the speed of sound waves directed
through the liver to measure stiffness
•
Measures either minimal damage or severe
damage
www.hcvadvocate.org
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HCV Symptoms, Disease
Progression & Management
HCV AND HBV REDUCE SURVIVAL BY
MORE THAN 20 YEARS
www.hcvadvocate.org
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Drug Based Therapies
What may be needed
even before considering
treatment
www.hcvadvocate.org
Health Access
HCV Positive
Ann Shindo
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Future Disease Burden
 *Institute of Medicine (IOM) Report – 2010
 **Milliman Report – Annual cost of advanced liver
disease to $85 billion in the next two decades and Medicare
costs will increase 500%, from $5 billion to $30 billion
 ***Aging of the Hepatitis C Virus-Infected Persons
in the United States: A Multiple Cohort Model of
HCV Prevalence and Disease Progression –
Progression to cirrhosis will peak at 1.0 million in 2020
 ****Viral Hepatitis Action Plan
www.hcvadvocate.org
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U. S. Statistics
•C D C - N E W ( A C U T E ) I N F E C T I O N S :
21,870
•C D C - T O T A L C H R O N I C I N F E C T I O N S :
2.7 TO 3.9 MILLION
(not factored into above: prisoners, homeless, people in
mental institutions)
•P o p u l a t i o n s n o t a c c o u n t e d f o r i n a b o v e s t u d i e s – T r u e
Prevalence?:
PAGE)
www.hcvadvocate.org
5.2 to 7.1 Million Americans– (SEE NOTE
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Prevalence
• U.S. Population
• Baby Boomers
•
•
•
•
•
•
• ~2%
• 3.25% (76% of HCV
population)
• 90%
PWID > 10 yrs
• 66%
PWID < 10 yrs
• 19-69%
Homeless persons
• 29%
Prisoners
• 20%
Mental illness
Black American men (40-50 yo) • 10%
www.hcvadvocate.org
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HCV Deaths
•~ 1 5 , 0 0 0 d e a t h s a n n u a l l y *
• 2007: deaths from HCV (>15,000)
surpassed deaths from HIV (>12,000)
*Note: deaths underreported – HCV accelerates
deaths from other causes and is a contributing
factor in deaths, but not listed on many certificates
www.hcvadvocate.org
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Acute HCV
• Initial or acute infection
• Many people have no symptoms
• Flu-like—fatigue, nausea, fever, indigestion, loss of appetite,
night sweats, jaundice
• Lasts up to 6 months
•
Spontaneous (natural) clearing by gender:
• Women ~40%
• Men ~19%
• Treatment of acute HCV—the majority of people with acute
HCV can clear the virus with interferon monotherapy
www.hcvadvocate.org
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Chronic Infection
•L O N G E R T H A N 6 M O N T H S
•
Does not mean severe disease progression
• CDC ~75%–85% OF CASES BECOME CHRONIC
• STUDIES – 55% TO 85% BECOME CHRONIC
www.hcvadvocate.org
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Chronic Symptoms
 Fatigue – mild to
 Liver pain
severe
 Loss of appetite
 “Brain Fog”
 Flu-like symptoms
 Depression
 Headaches
 Gastro problems
 And more….
Symptoms don’t necessarily correlate with disease progression with the
exception of acute and end-stage liver disease
www.hcvadvocate.org
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DISEASE PROGRESSION
•10 to 25% have serious disease progression over a 10 to 40
year period – disease progression is not linear
•Inflammation
•Fibrosis
•Cirrhosis
•Steatosis
www.hcvadvocate.org
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Disease Progression
 Compensated cirrhosis—extensive scarring, but liver
is still working fairly well
 Decompensated cirrhosis—very extensive scarring
and liver function has become severely compromised

Conditions

Portal Hypertension / Ascites & Edema / Varices / Encephalopathy
• Liver Cancer
•
3% to 5% of people with chronic HCV will develop liver cancer – after
severe fibrosis or cirrhosis
• Transplantation: $577,100 – Annual costs of anti-
rejection medications: ~$30,000
www.hcvadvocate.org
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HCV Infection:
Extrahepatic Manifestations
Hematologic
Salivary
•
•
•
•
• Sialadenitis
Mixed cryoglobulinemia
Aplastic anemia
Thrombocytopenia
Non-Hodgkin’s b-cell lymphoma
Dermatologic
• Porphyria cutanea tarda
• Lichen planus
• Cutaneous necrotizing
vasculitis
Renal
• Glomerulonephritis
• Nephrotic syndrome
Endocrine
• Anti-thyroid antibodies
• Diabetes mellitus
Hadziyannis SJ. J Eur Acad Dermatol Venereol. 1998;10:12-21.
Ocular
• Corneal ulcer
• Uveitis
Vascular
• Necrotizing vasculitis
• Polyarteritis nodosa
Neuromuscular
• Weakness/myalgia
• Peripheral neuropathy
• Arthritis/arthralgia
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Liver Specialists
•G A S T R O E N T E R O L OG I S T
•H E P A T O L O G I S T
•T H E F U T U R E ?
•
Primary care, infectious disease specialists and
others
www.hcvadvocate.org
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Disease Management
Lifestyle Changes
•A V O I D A L C O H O L
•Lowers
immune response & HCV treatment response
•Helps HCV to replicate and mutate
•Increases levels of iron and fat in the liver
•A V O I D O R R E D U C E :
•Cigarette
•
smoking, drugs or any substance that can harm the liver
EAT A HEALTHY WELL BALANCED DIET
WWW.CHOOSEMYPLATE.GOV
www.hcvadvocate.org
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Disease Management
•H E P A T I T I S A & H E P A T I T I S B V A C C I N E
•A V O I D R A W & U N D E R C O O K E D S H E L L F I S H
•
HAV / Vibrio vulnificus
•E X E R C I S E
•
Moderation—balance activity with rest
www.hcvadvocate.org
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SUPPLEMENTS
 Avoid high doses of vitamins and supplements
 General recommendations:

Vitamin supplement (daily requirements with no iron)
 Always check-in with a medical provider
www.hcvadvocate.org
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Discrimination & Stigma
 Americans with Disabilities Act—allows for certain
protections
 Call the ADA (800-949-4232)
 Social Security Disability
 The effect of stigma
www.hcvadvocate.org
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Support Groups
•I N F O R M A T I O N A L & E M O T I O N A L
•
One of the few places where people with HCV can
connect, advocate, support and learn from peers
•H C S P S U P P O R T G R O U P I N A B A G
•
Support group manual on web site
www.hcvadvocate.org
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Pe rce nt
HCV Medical Treatments
95
85
75
65
55
45
35
25
15
5
HCV Medical Treatment
Genotype 1
Genotype 2, 3
Mono INF
www.hcvadvocate.org
INF + Riba
Peg-Intron + Riba Pegasys + Riba
Genotype
2014 Therapies
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General Treatment Guidelines
•O V E R A L L H E A L T H I S S T A B L E
•A C T I V E H C V I N F E C T I O N
•C O M P E N S A T E D L I V E R D I S E A S E
•
Decompensated generally only in transplant centers
•
Some case studies with successful DAA combinations
www.hcvadvocate.org
Version 17.5
Pre-Treatment Predictors of
Treatment Response
•I M P O R T A N T W I T H I N T E R F E R O N - B A S E D T R E A T M E N T
•
Less so with interferon-free therapies
•Y O U N G E R A G E – U N D E R 4 0 Y / O
•L I T T L E O R N O S T E A T O S I S , I N S U L I N R E S I S T A N C E
•L O W H C V R N A ( V I R A L L O A D )
•N O C I R R H O S I S
www.hcvadvocate.org
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Treatment Goals & Success
•G O A L S O F T R E A T M E N T :
•
•
•
•
•
Clear virus out of the body
Improve inflammation & scarring
Slow disease progression
Improve symptoms and quality of life, life expectancy
To put HCV behind and move on with life
•S U S T A I N E D V I R O L O G I C A L R E S P O N S E ( S V R )
•
HCV is undetectable during and 6 months following HCV medical
therapy
• 5 year follow-up >99% still HCV RNA undetectable
www.hcvadvocate.org
Version 17.5
Response to Therapy
• Adherence: Important for overall treatment
success—more important with new HCV inhibitors
• Rapid Virological Response (RVR) —4 week HCV
RNA negative
• Extended RVR (eRVR) HCV RNA—negative at
week 4 and week 12
www.hcvadvocate.org
Version 17.5
HCV Treatment
 Pegylated Interferon: Injected once-a-week
 Merck
/Schering – PEG-Intron
 Genentech/Roche – Pegasys
 Ribavirin: Pills taken twice a day
Approved: 2013
 Olysio (simeprevir) – protease inhibitor
 Sovaldi (sofosbuvir) – polymerase inhibitor
www.hcvadvocate.org
Version 17.5
Treatment of Chronic HCV Genotypes 2 &
Sovaldi (sofosbuvir) plus ribavirin*
3
 Sovaldi – once daily - no food requirement
 Ribavirin dosed by body weight – twice daily- taken
with food
 Treatment duration:


Genotype 2 = 12 weeks
Genotype 3 = 24 weeks
 Cure rates:
 Genotype 2 = up to ~93%
 Genotype 3 = up to ~84%
*including HIV/HCV coinfection
www.hcvadvocate.org
Version 17.5
Treatment of HCV Genotype 1:
 Treatment with an HCV inhibitor is only used in
combination with pegylated interferon and ribavirin
(PEG/RBV)
 Ribavirin taken with food–twice daily – dosed by
body weight
 Simeprevir (Olysio)–taken with food – once-a-day
 Sofosbuvir (Sovaldi)–no food requirement – once-a-
day
www.hcvadvocate.org
Version 17.5
Olysio (Simeprevir) plus
PEG/RBV
•T R E A T M E N T N A Ï V E – C U R E R A T E = 8 0 %
•
Genotype 1a – cure rate = 75%*
•
Genotype 1b – cure rate = 85%
•T R E A T M E N T E X P E R I E N C E D – C U R E R A T E = 7 9 %
•
Genotype 1a – cure rate = 70%*
•
Genotype 1b – cure rate = 85%
Treatment duration 24** or 48 weeks (Olysio for 12 weeks)
*Q80K: 58% CURE(NAÏVE) & 47% CURE (TREATMENT EXPERIENCED)
**MOST TREATED FOR 24 WEEKS
www.hcvadvocate.org
Version 17.5
Sovaldi (sofosbuvir) plus
PEG/RBV
Treatment Naïve – Cure rate = 90%
•
•
•
•
Genotype 1a - cure = 92%
Genotype 1b - cure = 82%
Cirrhosis = 80%
No cirrhosis = 92%
•
Black – cure rate = 87%
Non-Black – cure rate = 91%
•
Treatment duration – 12 weeks
•
www.hcvadvocate.org
Version 17.5
Sovaldi with and without
PEG/RBV
ALSO APPROVED FOR:
• HCV – HIV COINFECTION
• INTERFERON-FREE
•
•
Liver cancer pre-transplant
For those who can not take interferon
www.hcvadvocate.org
Version 17.5
Genotype 1: Olysio plus Solvadi
•
•
•
•
•
•
•
With and without ribavirin;
Treatment: 12 to 24 weeks
Cure rates 79% to 100%
Treatment naïve and experienced
No fibrosis to cirrhosis
In Phase 3 Studies
Applied for Supplemental New Drug Application
(sNDA)
www.hcvadvocate.org
Version 17.5
Side-effects
Interferon
 Physical
Fatigue, muscle/joint
pain, dry skin,
headaches
 Depression

Low white blood cells
 Low platelets

www.hcvadvocate.org
Ribavirin
 Anemia, rash, dry cough, anxiety,
mania, insomnia
 Black box warning:

Women of childbearing age, their
partners and female partners of
male patients taking ribavirin
must practice two forms of
contraception during to 6 months
post-treatment
 Low red blood cells
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Side-effects
Sofosbuvir
Simeprevir
 Fatigue
 Rash
 Headache
 Photosensitivity
www.hcvadvocate.org
Version 17.5
Managing Side Effects
 Time injection
 Daily moisturizing
 Drink lots of water
 Vary injection sites
 Low doses of ibuprofen or
 Anti-depressants
acetaminophen
 Plenty of rest
 Pain/sleep medications
 Small frequent healthy
 Light exercise
www.hcvadvocate.org
meals
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Programs
 Patient Assistance Programs
 Partnership
for Prescription Assistance
www.pparx.org
 Needy
Meds: www.needymeds.org
See
HCV Advocate’s Fact Sheets on
Pharmaceutical Patient Assistance
Programs
www.hcvadvocate.org
Version 17.5
INTERFERON-FREE
THERAPIES
 Submitted to FDA for Approval: AbbVie – ABT450/r plus ABT267
(co-formulated), ABT 333 – with and without ribavirin
 >90%
cure rates
 Submitted to FDA for Approval: Gilead – sofosbuvir, ledipasvir
(1 pill/once a day)

>90% cure
 HCV Advocate Drug Pipeline
www.hcvadvocate.org
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Clinical Trials
www.hcvadvocate.org
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Complementary Therapies
Herbs: Herbs can interact with other medications and have a
potential to be unsafe
 Always check-in with medical provider and use a
reputable herbalist
 Milk Thistle – the most common herb used by people
with HCV – Avoid with Olysio (simeprevir)
 May interact with and increase blood levels of some
substances
 St. John’s Wort – Avoid with HCV Inhibitors –
protease and polymerase inhibitors
www.hcvadvocate.org
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Complementary Practices
 Acupuncture

Thin needles are inserted into acupuncture points to
stimulate the flow and balance of qi (the flow of vital
energy)
 Acupressure

Finger pressure stimulated flow of qi
 Traditional Chinese Medicine

Whole body concept to restore qi balance
 Acupuncture, acupressure, t’ai chi, moxibustion,
massage, Qigong
www.hcvadvocate.org
Version 17.5
Turn In
 Participant checklist
 Plan
of action
 Evaluation
 Demographic
information
 Order by fax form
www.hcvadvocate.org
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NeedyMeds Drug
Discount Card
www.hcvadvocate.org
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What is the
NeedyMeds Drug Discount Card?
 A FREE drug discount card that can save users up to
80% off the cost of:

Prescription medications

Over-the-counter medications and medical supplies written as
a prescription

Pet prescriptions purchased at a pharmacy
www.hcvadvocate.org
Version 17.5
How Does it Work?
 No activation or registration needed
 Never expires
 No residency, income or insurance
guidelines.
 Accepted at over 63,000 pharmacies
including all the major and local chains.
 Bring the card into the pharmacy along with
a valid prescription from your doctor and
save!
www.hcvadvocate.org
Version 17.5
Are There Insurance Guidelines?
 No insurance guidelines
 The card cannot be combined with insurance
 Those who are uninsured can use the card
 Those that have a public (such as Medicare or
Medicaid) or private insurance plan can use the card
instead of their insurance if for example:

They have a medication not covered

They are in a coverage gap, like the “donut hole”

They have a high copay or deductible
www.hcvadvocate.org
Version 17.5
Print This Card
www.hcvadvocate.org
Version 17.5
Where Do I Get One?
 You can send a self-addressed stamped envelope to:

NeedyMeds Drug Discount Card
PO Box 219
Gloucester, MA 01931
 Or go online and print a card by visiting:
http://www.needymeds.org/drugcard/drugcard.pdf
www.hcvadvocate.org
Version 17.5
Help for Card Users
 Visit http://drugdiscountcardinfo.com
Or call (888) 602-2978
Additional Services:
 Information about patient assistance programs
 List of low cost medical clinics
 Webinars to explain services
www.hcvadvocate.org
Version 17.5