Hepatitis B and C: Diagnosis, Treatment, and Costs in Taiwan

Liver

Hello Doctor: My brother had hepatitis B when he was a student, with liver enzyme levels close to 100.
A few months ago, while serving in the military, he underwent tests at the Tri-Service General Hospital in Taipei and found that he no longer has hepatitis B but has hepatitis C instead.
The enzyme levels have decreased a bit, but how could he have developed hepatitis C? Could it be that he has both hepatitis B and C? What is the current success rate of interferon treatment for hepatitis C? If the treatment is ineffective, what are the alternative treatment options? He is currently in the military; if he receives interferon at Tri-Service General Hospital, will it be out-of-pocket? Approximately how much would it cost? If he has both hepatitis B and C, what would be the best treatment approach? Thank you, Doctor!

Mary, 20~29 year old female. Ask Date: 2003/06/04

Dr. Yang Peizhen reply Gastroenterology and Hepatology

Hello! Your brother may be a carrier of Hepatitis B and could potentially have Hepatitis C, as he was previously not tested for Hepatitis C and mistakenly thought he only had Hepatitis B; or it is possible that Hepatitis C is newly acquired (though this is less likely).
The most important issue is how to determine which type of hepatitis he has, as the treatment methods differ significantly and their effectiveness varies.
The most accurate way is to directly measure the concentrations of Hepatitis B virus (HBV-DNA) and Hepatitis C virus (HCV-RNA) in the blood.
Even in cases of co-infection with Hepatitis B and C, usually only one type of hepatitis is expressed.
For the treatment of Hepatitis C, if only interferon is used, the success rate is about 20%.
However, if an oral antiviral medication, ribavirin, is added, the success rate can increase to 40-50% (the success rate may vary depending on the genotype of Hepatitis C; genotypes II and III have much better outcomes than genotype I).
Generally, treatment should last at least six months, so it is essential to first determine the genotype of the virus.
If it is genotype I, it is best to choose long-acting interferon (one injection per week, costing between 6000-8000 NTD per injection).
If it is genotype II or III, short-acting interferon can be chosen (three injections per week, costing about 1000-1200 NTD per injection).
The dosage of ribavirin is determined by body weight, typically 4-6 capsules per day, with the price still uncertain (as it has just been released), estimated to be in the hundreds of NTD, making it an expensive medication.
If short-acting interferon is ineffective, long-acting interferon can be considered.
If long-acting interferon is still ineffective, one may consider increasing the dosage or extending the treatment duration.
If it remains ineffective, we will have to wait for new medications to become available.
Currently, both interferon and ribavirin are out-of-pocket expenses, but some hospitals may provide certain medications for free as part of clinical trials, so it would be advisable to inquire at major medical centers.
For treating Hepatitis B, the medications available are oral Lamivudine and interferon injections, both of which are out-of-pocket with an efficacy of about 50%.
Each has its own criteria for selection, and if needed, you can consult a hepatologist for detailed advice.
Generally, even in cases of co-infection with Hepatitis B and C, only one type is usually expressed.
If, unfortunately, both viruses are present, the only option is to treat both viruses with interferon and ribavirin together.
Best wishes for health from Dr.
Yang Pei-Chen, Gastroenterology Department, Taoyuan Hospital, Ministry of Health and Welfare.

Reply Date: 2003/06/04

More Info

Understanding Hepatitis B and C: Diagnosis, Treatment, and Costs in Taiwan
Hepatitis B (HBV) and Hepatitis C (HCV) are viral infections that primarily affect the liver and can lead to serious health complications, including liver cirrhosis and liver cancer. In Taiwan, the management of these infections is guided by the latest medical research and public health policies, particularly under the National Health Insurance (NHI) system.

Diagnosis and Transition Between Hepatitis Types
Your brother's situation, where he was previously diagnosed with Hepatitis B and later found to have Hepatitis C, raises important questions. It is essential to understand that Hepatitis B and C are distinct viruses. It is possible for an individual to be co-infected with both viruses, but it is also possible for one virus to become more dominant or for the immune system to suppress one while allowing the other to become detectable. The liver enzyme levels (like GPT) can fluctuate based on various factors, including viral load and liver inflammation.

If your brother was diagnosed with Hepatitis C, it does not mean he "converted" from Hepatitis B to C; rather, he may have had a previous HBV infection that was not active at the time of testing. The presence of HCV can occur independently of HBV, and it is crucial for him to undergo further testing to determine the specific type of hepatitis he has and the extent of liver damage.

Treatment Options and Success Rates
For Hepatitis C, the treatment landscape has significantly improved over the past decade. Direct-acting antiviral (DAA) therapies have revolutionized HCV treatment, achieving cure rates exceeding 95% in many cases. Interferon-based therapies, which were once the standard, are now less commonly used due to their side effects and lower success rates compared to DAAs.

If your brother is undergoing treatment with interferon, it is essential to monitor his response to therapy. If he does not respond to the initial treatment, alternative DAA regimens may be considered, which are often more effective and have fewer side effects. The specific treatment plan will depend on various factors, including the genotype of the virus and any liver damage present.

Costs and Insurance Coverage
In Taiwan, the NHI covers many aspects of hepatitis treatment, but eligibility for coverage can depend on specific criteria, including liver function tests and the presence of significant liver damage. If your brother is receiving treatment at a military hospital (like the Tri-Service General Hospital), he may have access to subsidized care, but there may still be out-of-pocket costs associated with certain medications or treatments.

The cost of Hepatitis C treatment can vary widely based on the specific medications used. For example, a course of DAA treatment can range from NT$100,000 to NT$300,000, depending on the regimen and duration of therapy. If he is required to pay out-of-pocket, it is advisable to discuss payment options with the healthcare provider.

Co-infection with Hepatitis B and C
If your brother is diagnosed with both Hepatitis B and C, the treatment becomes more complex. The management of co-infection requires careful consideration of the interactions between the two viruses. In some cases, treating Hepatitis C can lead to a reduction in Hepatitis B viral load, but this is not guaranteed. The treatment plan would typically involve antiviral therapy for both infections, and the healthcare provider will tailor the approach based on the severity of liver disease and the specific characteristics of each virus.

Conclusion
In summary, your brother's situation necessitates thorough medical evaluation and monitoring. It is crucial for him to work closely with his healthcare team to determine the most appropriate treatment strategy based on his specific diagnosis and health status. Regular follow-ups, liver function tests, and possibly imaging studies will be essential in managing his condition effectively. Understanding the nuances of hepatitis treatment and the financial implications will empower him to make informed decisions about his health.

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