Ask the Doc: HEPATITIS C TREATMENT FOR ACTIVE DRUG USERS?

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HEPATITIS C TREATMENT FOR ACTIVE DRUG USERS?

Zepatier® treated Hepatitis C patients successfully even though they were on methadone or buprenorphine as treatment for chronic heroin/opiate use.

Zepatier® is also better than Harvoni® for those who have kidney problems; they are both one pill once a day. Few people have to stop them due to side effects. For HIV patients, their antivirals may need to be adjusted or changed during the three months on the medication.

 

HEPATITIS C LIVERS TRANSPLANTED TO OTHERS

A recent study showed that those who received livers from successfully treated Hepatitis C patients had a higher risk for the Hepatitis C to reappear in the new patient. The donors were treated with the latest, powerful drugs and showed a “cure,” that is they had no virus in their blood tests after treatment. This is quite interesting showing that those who receive the “new” liver weren’t able to continue to control the tiny amount of Hepatitis C virus—this is probably due to them being on medications to prevent rejection of the “new” liver by lowering their immune functions some. Currently we are checking Hepatitis C “cured” patients for virus levels every 6 to 12 months. (see below)

 

HEPATITIS C TREATMENT FOR ONLY 8 WEEKS?

There is some data, and the FDA approves this, that shows that only 8 weeks of Harvoni® is enough to have a good result. Of course you have to have the proper genotype of Hepatitis C and a low enough viral load and approval of your provider. I don’t see anything yet that says this can be considered in those who have HIV and Hepatitis C.

With the introduction of Zepatier® as competition and that it can treat more genotypes than other medications, the prices have come down quite a bit and probably have come down more since I wrote this. This just keeps getting better and better!

 

DEATH RATES IN USA GOING DOWN

There is a steady decline of death from many causes, but the rates of death from Parkinson’s disease, Alzheimer’s disease, and cancer held steady. So keep the death rates down by getting a flu shot in October so you and others around you don’t get the flu which can lead to severe pneumonia. Live a healthy lifestyle.

FENTANYL DEATHS

Illegally manufactured fentanyl is causing much of the deaths from opioids (heroin, morphine class of drugs). The problem with fentanyl is that it is so potent. A tiny amount has the same effect (good or bad) compared to heroin. Most opioids we use are prescribed in milligrams, but fentanyl is prescribed in micrograms (about a 1000 times less has the same effect).

OVER 65? AVOID THESE MEDICATIONS IF POSSIBLE

Maybe you should check your parents’ or older friends’ medication bottles. Much research has shown that a red flag should go up if you or your loved one is on one of these medications and they are over 65 years old. The main reasons are (you may need to check with your provider to double check you are or are not on one of these):

Decreased mental function (older antihistamines like Xanax®, diazepam, sleeping pills, Benadryl—diphenhydramine, or muscle relaxants (e.g. Flexeril®, baclofen, Soma®). These can result in depression, bad decisions, falls, accidents.

Higher risk of low blood sugar causing brain damage or poor brain function (glyburide, or glipizide). These can also result in the same effects as above.

Risk of brain or other major bleeding (Ticlid®-ticlodipine for stroke or heart attack risk).

These may be the best medications for them, but they must understand the risks. Maybe there is something less risky but just as beneficial? Those over 65 break down most medications slower so one has higher levels causing more toxicity risk.

ANTI-ACID PILL OVERPRESCRIBED?

Maybe you are on a medication that should be stopped. A recent survey of nursing home patients showed that many were on these medications, like omeprazole, for no good reason. These medications are so strong and seemingly harmless that they are prescribed widely. Patients and providers are hesitant to stop them. Treatment for ulcers, gastritis, or heartburn should only last 1-2 months and it should be gone; a few need these medications long term. So if you are on one of these medications, discuss with your provider if you can try and stop it. It is not good to take medications unnecessarily, even more so for years.

MENINGITIS IN GAYS IN SOUTHERN CALIFORNIA

Just a reminder to get your shot especially if you and another might share a glass by accident or kiss on the lips. HIV also increases the risk of effective transmission from saliva and worse disease.

The vaccine consists of 2 doses, 2 months apart and then a booster every 5 years if needed by what is going on in the community. Contact your health care provider if you desire the vaccine. If you need further help, contact your local County clinic or public health department.

Los Angeles County (213) 974-7284

Long Beach (562) 570-4400.

San Diego County(619) 692-8501 or (760) 740-4000

Riverside County 800-720-9553

San Bernardino County(888) 818-8988

Be Safe! Wear protection. Keep those questions coming.

Daniel Pearce, D.O., FACOI

Clinical Associate Professor of Medicine, Loma Linda University School of Medicine

Adjunct Professor of Internal Medicine and HIV, Touro University California College of Osteopathic Medicine and Midwestern University Arizona College of Osteopathic                      Medicine

HIV Specialist, Assistant TB Physician, Riverside County Public Health Department

Hepatitis C Specialist and Researcher, Southern California Liver Centers, Riverside

Researcher, Inland Empire Liver Foundation and Clinical & Translational Research Center

REFERENCES: Medscape®

 

 

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