Mike answer
Hepatitis C virus (HCV) was associated with higher morbidity and mortality rates due to liver complications. Acute HCV was usually monitored for six months and not treated. HCV‐infected subjects were unaware of their infection, which placed them at risk for transmission and disease progression. Common signs and symptoms of acute infection included fever, fatigue, dark-colored urine, nausea, vomiting, diarrhea with white-colored stool, abdominal pain, yellowing of skin, depression and anxiety. HCV have been directly related to conditions such as cirrhosis, thyroid, hepatocellular carcinoma, auto-immune rheumatic and glomerulonephritis. Active infection of HCV showed a strong relationship and risk factor for ischemic cerebrovascular accidents, ischemic heart disease, higher rates of diabetes mellitus and insulin resistance (Cacoub et al., 2017).Until 2011, the only available treatment for HCV was a combination of pegylated interferon and ribavirin, however the virologic response was 50%. In 2011, protease inhibitors combination were more effective with a virologic response of 75-85 % but with high toxicity and poor safety profile. Interferon alpha was the cornerstone of antiviral combinations in HCV infected patients. Virologic response rate of interferon treatment was 90-100% with a high tolerability, however these agents were limited if having late-stage disease (Nuno et al, 2016). Some examples of HCV pharmacological options were Mavyret, which was effective at clearing all six hepatitis C genotypes in as little of eight weeks. Another medication for HCV was Vosevi, which treated any genotype of the hepatitis C virus and for previously treated individuals that did not achieve viral clearance. If left untreated and the liver was so damaged then treatment included surgical, symptomatic management and possibly a liver transplant (Grover & Erlich, 2018).The goal of treatment was to achieve a sustained virologic response which represented undetectable levels and was considered a virologic cure. The direct acting new generation antivirals had the ability to clear HCV infection by 95% within three months (Nuno et al, 2016). A strategic plan needed to be defined to target stakeholders involved with HCV care. More attention was needed on subpopulations such as injection drug users, prisoners and migrants from high endemic countries. Focus should be on awareness, prevention, testing, access to medications and care, monitoring and evaluation in order to achieve elimination (Kracht et al., 2018).Cacoub, P., Comarmond, C., Desbois, A. C., & Saadoun, D. (2017). Rheumatologic manifestations of hepatitis C virus infection. Clinics in Liver Disease, 21(3), 455.Grover, A., & Erlich, D. R. (2018). STEPS: Glecaprevir/Pibrentasvir (mavyret) for the treatment of chronic hepatitis C. American Family Physician, 98(10), 601.Kracht, P. A. M., Arends, J. E., van Erpecum, K. J., Urbanus, A., Willemse, J. A., Hoepelman, A. I. M., & Croes, E. A. (2018). Strategies for achieving viral hepatitis C micro-elimination in the netherlands. Hepatology, Medicine and Policy, 3(1), 12-12.https://doi.org/10.1186/s41124-018-0040-9Nuño Solinís, R., Arratibel Ugarte, P., Rojo, A., & Sanchez Gonzalez, Y. (2016). Value of treating all stages of chronic hepatitis C: A comprehensive review of clinical and economic evidence. Infectious Diseases and Therapy, 5(4), 491-508.https://doi.org/10.1007/s40121-016-0134-x
