Americas Pharmaceutical companies have a long-standing tradition of providing prescription medicines free of charge to physicians whose patients might not otherwise have access to necessary medicines. Pharmaceutical companies operate these programs, commonly referred to as patient assistance programs, voluntarily.

Many drug manufacturers offer patient assistance programs which can greatly decrease or entirely eliminate the costs of many medications. The requirements for program eligibility vary. Some programs may be applied for directly by the patient, other program applications must be initiated by the healthcare provider (physician, pharmacist or agency).

Below are a few telephone numbers you can call to ask questions and URLS to visit for more information:

Complications of HCV and Related Conditions:

WHAT ARE THE MAIN SYMPTOMS OF HEPATITIS C?

   http://www.hepu.org

Acute hepatitis C is almost indistinguishable from acute hepatitis B infection.
Patients with acute hepatitis C are frequently asymptomatic
(meaning that they have no symptoms), even when liver tests are abnormal.

Soon after contracting the infection many people have a flu-like illness with fatigue, fever, muscular aches and pain, nausea and vomiting.

About 10% of patients become jaundiced (their skin turns yellow).

Generally, these symptoms resolve and the patient has no symptoms of liver disease for many years. Symptoms may occur from two weeks to six months after exposure but usually within
two months.

What are the symptoms of chronic infection and cirrhosis? The symptoms of chronic infection range from no symptoms at all, to gradually progressive fatigue and lack of energy, to complete debility.

The effects of the virus vary widely between individuals.

The symptoms of cirrhosis include progressive fatigue, jaundice (yellow skin), icterus (yellow eyes), dark urine (the color of cola), abdominal swelling, muscle wasting, itching, disorientation and confusion, loss of appetite, and easy bruisability.

In an informal survey of hepatitis C symptoms,

Scott Warren polled 50 people on the HEPV-L list and compiled the following results:

FATIGUE, WEAKNESS, TIREDNESS - 72%

JOINT, MUSCLE PAINS - 52%

MEMORY LOSS, MENTAL CONFUSION - 50%

SKIN PROBLEMS-DRY\ITCHY\RASHES\SPOTS - 44%

DEPRESSION, ANXIETY, IRRITABILITY, ETC - 44%

INDIGESTION, NAUSEA, VOMITING, GAS - 34%

SLEEP DISTURBANCES - 32%

PAIN OR DISCOMFORT IN ABDOMEN - 32%

CHILLS, SWEATING, HOT \ COLD FLASHES - 26%

EYE OR EYESIGHT PROBLEMS - 24%

SENSITIVITY TO HEAT OR COLD - 22%

NO SYMPTOMS - 20%

VERTIGO, DIZZINESS, COORDINATION - 18%

FLU LIKE SYMPTOMS - 18%

HEADACHES - 18%

URINARY PROBLEMS, ODOR, COLORATION - 16%

FEVER - 16%

SLOW HEALING AND RECOVERY - 14%

SUCCEPTIBILITY TO ILLNESS \ FLU - 14%

WEIGHT GAIN, WATER RETENTION - 10%

MENSTRUAL PROBLEMS - 10%

APPETITE \ WEIGHT LOSS - 8%

SWELLING OF STOMACH, LEGS OR FEET - 8%

ORAL, OR MOUTH SORES \ PROBLEMS - 8%

EXCESSIVE BLEEDING - 4%

FATIGUE

The main symptom of most people with hepatitis C is chronic fatigue, ranging from simply
getting tired easily to extreme, debilitating fatigue.

UPPER RIGHT QUADRANT (URQ) PAIN (SIDE PAIN)

Even though the liver itself contains no nerve endings, and does not feel pain, many people with HCV experience a pain on the upper right side of their body, just beneath the ribs. This is thought by some to be "referredpain" from the swelling of the liver capsule due to the disease process.

This pain may also be referred to the right shoulder or to the back between the shoulder blades.

LOSS OF LIBIDO

Many hepatitis C patients find that they are no longer interested in sex. This tends to be especially true for those undergoing interferon treatment.

This is not necessarily directly related to the hepatitis, but is most likely due to the stress, discomfort and exhaustion caused by the struggle with a chronic illness.

RED PALMS

Red palms can occur in any chronic liver disease and are not specifically caused by the virus.
The cause for the redness is unknown, but it's speculated that it may involve upset hormone metabolism or microcirculatory changes.

NAUSEA

A few of the more popular nausea aids are chewing candied ginger, putting a (small) drop of peppermint oil on the end of your tongue, eating small frequent meals, dry crackers and weak
tea, and popsicles.

BRAIN FOG

This is the mental fuzziness and forgetfulness that some people experience. It's not the same
as encephalopathy, and seems to occur in all stages of the illness. Some people have found
taking CoEnzyme Q10, also known as CoQ10, to be helpful (2 30mg capsules per day). Another listmember recommends taking Gingko Biloba.

ITCHING

The build-up of bilirubin in the skin may cause itching. Itching can be treated with antihistamines, or cholestyramine (which binds bile in the intestines). Actigall and Questran are two drugs reported to help with this problem.

VISION PROBLEMS

Some hepatitis patients complain of blurring vision, and dry eyes. This can be especially true while undergoing interferon treatment.

DIZZINESS

Some people have found that wearing "Sea Bands" helps with their dizziness. Sea Bands are elastic bands that can be bought, usually in sporting goods stores, which press against pressure points in the wrist. They were designed for use in seasickness.

DRY MOUTH

There are two products (mouthwash and toothpaste) by the name of Biotene, which are designed to help with the problem of a dry mouth and gum problems as a result of medication use. Several list members have reported great relief by using these products.

Also see our web site for more information on symptoms

WHAT OTHER MEDICAL PROBLEMS CAN BE RELATED TO HCV?

Chronic hepatitis C infection occasionally causes problems for parts of the body beyond the liver. The organs most often affected include the blood vessels, skin, joints, kidneys, and thyroid gland. If chronic hepatitis C infection causes liver cirrhosis (severe scarring of the liver rarely caused by hepatitis C), many problems may arise from the cirrhosisper se.

Potential problems from cirrhosis include fluid accumulation in the abdomen, bleeding into the stomach, jaundice, confusion, poor blood clotting, and susceptibility to infection.

Hepatitis has so many symptoms that it's easy to ascribe all new anomalies to this disease. But HCV patients are not exempt from getting other illnesses also, therefore it is important to regularly monitor your health and to consult with your doctor about the changes as they progress.

CRYOGLOBULINEMIA

One-third to one-half of people with chronic hepatitis C infection have cryoglobulinemia (antibodies in the bloodstream attached to the hepatitis C RNA that happen to solidify when cold). Hepatitis C is recognized as the most common cause of mixed cryoglobulinemia. Most of the people with cryoglobulinemia from hepatitis C have had their hepatitis for a long time or have cirrhosis. People with higher concentrations of hepatitis C RNA in their blood do not seem to have a higher risk of having cryoglobulinemia. Usually the cryoglobulins are in low concentration and cause no symptoms. About twenty-percent of people with hepatitis C and cryoglobulinemia have symptoms.

Symptoms most often associated with cryoglobulinemia include mild fatigue, joint pains, or itching. Occasionally, people with cryoglobulinemia develop vasculitis (inflammation of the blood vessels) which can cause purpura (purple skin lesions), Raynaud's phenomenon (the hands turn white, then blue, and then red from constriction and subsequent dilation of the blood vessels), or numbness
in the hands and feet. The presence of cryoglobulinemia does not effect people's response to interferon. In fact, some people with vasculitis have improvement in the vasculitis as their liver tests improve on interferon.

THYROID AND AUTOIMMUNE PROBLEMS

Chronic hepatitis C infection is also associated with many autoimmune diseases (where the body develops antibodies which attack parts of itself). For example, about one-tenth of people with chronic hepatitis C infection (more often in women and older people) have antibodies to the thyroid gland, one-half of whom may develop hypothyroidism (an underactive thyroid gland).

Additionally, interferon therapy causes hypothyroidism or hyperthyroidism (an overactive thyroid gland) in about one-tenth of those treated. People with hypothyroidism may suffer from fatigue poor memory, weakness, constipation, weight gain, muscle cramps, intolerance to cold, hoarse voice, coarse skin, and brittle hair. People with hyperthyroidism may suffer from anxiety, insomnia, weakness, diarrhea, weight loss, intolerance to heat, velvet-like skin, and brittle nails. Hypothyroidism can be treated with thyroid hormone pills. Hyperthyroidism can be treated with pills that block thyroid hormone synthesis. If the thyroid gland dysfunction is from interferon treatment and is caught early, the thyroid gland will return to normal once interferon is stopped.

RHEUMATOID ARTHRITIS-LIKE SYMPTOMS

Hepatitis C infection can present with rheumatic manifestations indistinguishable from rheumatoid arthritis. The predominant clinical findings include palmar tenosynovitis: small joint synovitis, and carpal tunnel syndrome. Risk factors such as transfusions and IV drug abuse or a history of hepatitis or jaundice should be included in the history of present illness of any patient with acute
or chronic polyarthritis or unexplained positive RF. In such patients, gammaglutamyl aminotransferase, serologic studies for hepatitis C, and other tests appropriate for chronic liver disease should be performed. - " Journal of Rheumatology, June 1996;23(6):979-983.

FIBROMYALGIA

Fibromyalgia is the name for a condition that typically includes widespread muscle pain, fatigue and abnormal sleep patterns. Until a few years ago, doctors called the condition fibrositis or muscular rheumatism and believed that for the most part, the condition was "all in the patient's head". Today, fibromyalgia is recognized by medical organizations as a genuine and serious problem.

The symptoms of fibromyalgia typically include pain in many muscles, and around ligaments and tendons, persistent fatigue, waking up feeling tired even after a full night's sleep, headaches, bouts of constipation and diarrhea, abdominal pain, painful menstrual periods, sensitivity to cold, numbness or tingling, and difficulty exercising.

Symptoms vary widely among patients and tend to wax and wane over time. An illness, injury, cold weather or emotional stress may trigger a fibromyalgia episode or make ongoing symptoms worse.

A study at the Oregon Health Sciences University and Portland Adventist Hospital suggests hepatitis C may trigger fibromyalgia ("Fibromyalgia: A prominent feature in patients with musculoskeletal problems in chronic hepatitis C, A report of 12 patients," by A. Barkhuizen,
G.S. Schoepflin, and R.M. Bennett, Journal of Clinical Rheumatology, Vol. 2, No. 4, August 1996) .

This study is the first to show a link between the two illnesses.It was determined that the between the hepatitis C virus and fibromyalgia followed three distinct patterns:In nine patients, fibromyalgia developed as a long-term complication of the hepatitis, arising on average 13.4 years after the virus was acquired.In two patients, fibromyalgia arose simultaneously with the hepatitis C infection.In one patient, pre-existing fibromyalgia was significantly worsened by the hepatitis C.
It is unknown why the hepatitis C virus and fibromyalgia may be linked, but the authors suggest that hepatitis C causes chronic activation of the immune system that leads to muscle aching, fatigue, mental changes, sleep abnormalities, and alterations of the neuroendocrine system.The patients with both hepatitis C and fibromyalgia could be distinguished from most other patients with fibromyalgia alone because they had symptoms unusual to fibromyalgia. These symptoms included synovitis (inflammation of the membrane around a joint, bursa, or tendon) and vasculitis (inflammation of a blood or lymph vessel). In addition, laboratory findings pointed to a disease process other than fibromyalgia.

DERMATOLOGICAL MANIFESTATIONS

The main dermatologic disorders in HCV infection include (1) vasculitis (mainly cryoglobulin-associated vasculitis, the cause of which is HCV in most cases, and, possibly, some cases of polyarteritis nodosa); (2) sporadic porphyria cutanea tarda; (3) cutaneous and/or mucosal lichen planus; and (4) salivary gland lesions, characterized by lymphocytic capillaritis, sometimes associated with lymphocytic sialadenitis resembling that of Sjoegren's syndrome.

Hepatitis C virus is the cause of, or is associated with, various dermatologic disorders. In patients with such disorders, HCV infection must be sought routinely because antiviral therapy may be beneficial in some of them. - Arch Dermatol. 1995; 131:1185-1193

PORPHYRIA CUTANEA TARDA (PCT)

Porphyrins are a group of compounds that are mainly synthesized in the bone marrow. They play an important role in many chemical reactions in the body, e.g. with proteins to build hemoglobin. They are later converted to bile pigments mainly in the liver. Porphyrinuria increase of porphyrins in theurine) may be caused by chronic liver diseases. Hepatitis C is a major cause of porphyria throughout the world and may cause many symptoms, including excess blood iron - important in conjunction with an interferon therapy (since elevated blood iron seems to reduce the effect of interferon).

Porphyria cutanea tarda is a rare deficiency of a liver enzyme essential for cellular metabolism. The enzyme deficiency may cause sun exposed skin to blister, ulcerate, turn dark, or bruise. Hair may increase on the forehead, cheeks, or forearms, and the urine may turn pink or brown. It now appears that hepatitis C is the most common trigger of porphyria in people who are predisposed. Topical sunscreens do not prevent the skin lesions. Avoidance of alcohol and removal of iron by repeated phlebotomy (blood removal) or taking medication that binds to iron sometimes helps. Chloroquine (an anti-malaria drug), which removes a toxic by-product of the enzyme deficiency, may help, as well.

LICHEN PLANUS

Occasionally, people with chronic hepatitis C develop a skin condition called lichen planus. It is a grouping of small, itchy, irregular, flat-topped reddened bumps. The bumps often have a network of very fine gray lines on their tops. The bumps show up most often on the wrists, shins, lower back, or genitals. Lichen planus also frequently occurs in the mouth, where it looks like a white, net-like plaque. It sometimes shows up as mouth ulcers and can be treated with a steroid mouth rinse called Dexamethasone Elixir or Nystatin tablets.

CYCLES AND FLAREUPS

Hepatitis flareups tend to occur in cycles, where for a while you may feel pretty good, then bad (maybe days to weeks for each period), then good again.

It can be frustrating to obtain some relief, but then not know whether you have recovered or if you are merely between cycles.

Some people claim that they begin to feel better in the Spring, then start to feel worse again in August/September, with a low point usually around November/December.

Also see our Related Conditions Pages for more information

Hepatitis C and Dental Health

There are a range of dental problems experienced by people who are living with hepatitis C.  These problems then contribute to overall poor dental health.

Dry mouth

Many people with hepatitis C experience a dry mouth.  This may be made worse by certain medications e.g. methadone or anti-depressants.  Saliva provides lubrication that allows for speech, taste and chewing food.  It also prevents bacteria, viruses and fungi from causing infections in the mouth, such as tooth decay and gum disease.  Comfort may be improved by taking frequent sips of water, chewing sugarless gum (this will stimulate salivary flow) or by using a salivary substitute. 

Tooth decay

Tooth decay happens as a result of several factors including poor oral hygiene (inadequate removal of dental plaque), high carbohydrate consumption, lack of fluoride applied to the teeth or reduced salivary protection.  In early stages decay may be reversible.  Prevention of tooth decay is best achieved by good oral hygiene using a soft bush and fluoride toothpaste.  Reduce intake of sweetened foods and beverages.  Do not brush immediately after a sweet snack but instead smear the teeth with a small amount of fluoride toothpaste.  Chewing sugarless gum will stimulate salivary flow and neutralise acid.  Applying a small amount of fluoride gel with a toothbrush or finger once a day, will harden and protect them.

Caution: Products containing significant amounts of fluoride, such as supplements (gel, mouth wash), should not be swallowed and must be kept out of reach of children. 

Gum infections

Healthy gums are pink, firm and do not bleed when brushed.  The earliest sign of gum infection is bleeding from the gum margin on brushing.  Other signs are swelling or redness of the gums, receding gums, loose teeth and persistent bad taste or bad breath.

The main cause of gum infection is plaque, a colourless sticky film of bacteria and food debris that forms on the teeth.  The bacteria produce toxins which cause the inflammation.  If plaque is left undisturbed it will harden to form calculus.  Some people have a lower resistance to gum infection than others e.g. those on interferon.  Smoking may also lead to a worsening of the gum condition.

Gum infection may be prevented by thorough tooth brushing with a soft toothbrush angled at 45 degrees to the gum margin and moved in tiny circles.  This should be done carefully once every day.  Dental floss should be passed gently between the contacts of the teeth and rubbed up and down on adjacent tooth surfaces.  Interspace brushes may be used where there are spaces between the teeth.  Some antibacterial mouthwashes contain high levels of alcohol and should be avoided.  Periogard is alcohol free and is an excellent mouthwash.  Reduce or cease smoking and make regular dental visits for cleaning.

Caution: People with liver cirrhosis, platelet abnormalities and other bleeding disorders and those taking interferon should discuss the need or special precautions with their dentist, prior to treatment.  Modifications may need to be made to their home prevention regime. 

Sensitive teeth

If enamel is lost from the surface of the tooth, or if the root surface is exposed a sharp pain may be felt when having hot, cold or sweet food and drinks.  Causes of sensitive teeth are poor tooth brushing technique, frequent intake of erosive foods (lemons, grapefruit, wine, vinegar and fizzy drinks), frequent vomiting or gastric reflux and grinding of teeth (often whilst sleeping).  A dentist may provide a splint which is worn during sleep and protects the teeth from wear.  The use of desensitising toothpaste or fluoride gel applied with a finger or a toothbrush may improve this condition.  If sensitivity does not improve or is severe, consult your dentist. 

Mouth infections

The presence of a dry mouth or taking of some medications e.g. interferon, may predispose to mouth ulcers and/or thrush.  For mouth ulcers the use of chlorhexidine gel will improve comfort and aid healing.  If the ulcer does not heal within two weeks it should be checked by a dentist.  For thrush eating natural yoghurt daily will help but it may be necessary to take an antifungal medicine e.g. nystatin lozenges or drops.  Any dentures should be soaked for one hour in a dilute Milton’s solution.  If the thrush does not improve or is severe it should be checked by a dentist. 

Denture care

Dentures should be rinsed after meals and brushed daily with a soft brush and a mild soap.  Toothpaste contains an abrasive and will wear away dentures.  Dentures should be left out at night and placed in cold water whenever they are not in the mouth.  If dentures are developing a stain a small amount of vinegar or bleach may be added to the water.  Dentures should fit well to maintain the health of the mouth.

Caution: Unusual lumps, swelling or persistent mouth ulcers should be reported to your dentist.

 http://www.hepccouncilsa.asn.au/dental.html

Dietary and lifestyle Advice

The following dietary recommendations are intended to be used as a general guide for people with hepatitis C. The aim of such advice is to minimize digestive symptoms such as nausea, bloating, loose bowels, constipation and abdominal pain/discomfort and provide food which may have a liver protective role eg foods containing antioxidants ie: capsicum, tomatoes, beetroot, carrots, green tea.

One of the limitations in providing dietary advice is that individuals have very different tolerances, requirements, likes and dislikes for certain foods. Therefore, individual assessment and modification of the diet may be necessary. It is useful to note reactions to foods to get an idea of individual tolerance. If fatty or rich foods create nausea or queasiness they are obviously not tolerated well and so are best avoided. A balanced diet is important for general health. A generous amount of green vegetables in your daily food intake can have a cleansing effect, and beetroot has a detoxifying effect upon the liver. The broader your range of vegetables, fruits, nuts, cereals and grains the better you are treating your digestive system while increasing your healthy nutrient intake. Having a consistent diet of healthy nutrients will greatly assist your energy levels, combine this with regular low to moderate exercise and you will notice your general feeling of well being begin to increase.

The following foods and drinks have specific benefits for someone with hepatitis C - eg. foods rich in antioxidants such as betacarotene, vitamin C & E, and zinc all help protect cells against oxidative stress and inflammatory damage. This is meant as a guide only, and any specific advice should be sought from your GP, dietician, nutritionist, naturopath or other accredited health care professional.

Antioxidants: Betacarotene (Provitamin A) Carrots, pumpkin, dark green leafy vegetables, spinach, silverbeet, parsley, beetroot, squash, sweet potato, rockmelon, apricots, mango.

Vitamin C & bioflavonoids: Citrus fruits, kiwi fruit, berries, blood plums, capsicum, green leafy vegetables, broccoli. Vitamin C is destroyed by prolonged cooking so eat these foods raw or lightly steamed to retain maximum Vitamin C content.

Zinc: Raw nuts and seeds eg almonds, walnuts, pumpkin seeds, whole-grains and breads, lentil and mung bean sprouts, hommous (ground chickpeas), split peas, shellfish and fish, red meat. (Use lean red meat with all visible fat trimmed off).

Garlic: Raw Garlic has general immune stimulant properties as well as being an antioxidant. Eat 1-4 cloves daily in salad dressings, dips or simply swallow pieces whole.

Whole grains and fibre: Whole grains provide a range of vitamins and minerals as well as complex carbohydrates for energy. Fibre reduces constipation and helps to lower cholesterol and triglycerides.

Whole grains: Brown rice, oats in porridge & muesli, wholegrain or wholemeal breads.

Soluble fibre: Oatbran, Psyllium husks, Fruits & Vegetables with their skins, legumes and beans.

Bitter Foods: Promote digestion. Bitter lettuce & greens. Grapefruit or grapefruit juice. Lemons.

Protein (Complete proteins): Lean red meat, skinless chicken breast, fish.

Beverages: Water - up to 2 litres a day.

Fresh fruit or vegetable juices eg. carrot, apple & beetroot, grapefruit, lemon juice in water.

Dandelion root coffee: Traditionally used for a range of liver problems. 1-2 teaspoons simmered in 1 or 2 cups of water for 5 minutes. Strain and add milk or soya milk if desired. You can also buy ground and roasted dandelion root which can be brewed like coffee in an espresso machine, plunger, dripolator or filtered.

Peppermint, fresh ginger root, spearmint, chamomile, fennel seed and aniseed teas:

These teas can all be used for nausea, bloating or intestinal cramps. Prepare by steeping 2-3 teaspoons in a cup of boiling water in a teapot for 5-10 minutes. Stronger preparations (up to 2 tablespoons) will have a much stronger relaxing effect on the gut.

Green Tea: is not fermented and does not contain tannins. Green tea is packed with antioxidant properties making it an excellent liver cleanser and blood purifying agent.

·         Most herbal teas are recommended over tannin tea.

·         Green Tea and Roast Dandelion are ideal substitutes for regular tea and coffee.

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