A Hep C Dictionary: Key to Acronyms and Terminology used in The Hepalogue

Words capitalised and/or in bold are either hyperlinked or are defined elsewhere in this dictionary.

(NB – This page is periodically updated with new links and definitions. The Hepalogue's URL migration has slowed things down a tad, so please... do bear with me, if I fall a little behind. - TGP)

AbbVie – Makers of the Viekira Pak. Makers of the fast-acting pangenotypic DAA formula Mavyret

AIVL - 'Australian Injecting & Illicit Drug Users League' is 'the national organisation representing people who use/have used illicit drugs and is the peak body for the state and territory peer-based drug user organisations' including HRVic.

Ascites - (Pronounced a-seat-ease) A condition associated with liver failure. The direct cause is most commonly Portal Hypertension - leading to fluid accumulation in the abdominal cavity and gross distension of the belly.

ALT – Alanine transaminase – an enzyme which, when measured in the blood, can reveal the presence of liver inflammation. A high level points to a high level of pathological HCV activity/inflammation in the liver. A low level the opposite.

APRI - AST to Platelet Ratio Index. An evaluation of liver Fibrosis derived from the results of a normal LFT. Though less accurate than a Liver Biopsy, it is often preferred because it is less invasive and simpler to perform.

AST – Aspartate Transaminase – an enzyme measused to indicate liver health.

BBV – Blood Borne Virus. A virus transmitted by blood to blood contact. i.e. HCV, HBV, HIV

Biopsy – See Liver Biopsy.

Brain Fog – A fogginess of the mind reported by many sufferers of Hep C. Though very poorly understood, it may conceivably be related to a compromised liver's lessened ability too filter toxins.

BMS – Bristol-Myers Squibb. Makers of Daclatasvir (Daklinza).

Bristol-Myers Squibb – See BMS

Burnet Institute - A research institute based in Melbourne with a focus on infectious disease and a major interest in Hep C.

Buprenorphine - an opioid agonist/antagonist used in Opioid Replacement Therapy/Pharmacotherapy

Chemsex - Sex engaged in under the influence of stimulant drugs, primarily methamphetamine

Cirrhosis – Significant loss of liver function due to a replacement of normal liver tissue with scar tissue. It often develops in long-term sufferers of Hep C. The term is derived from the Greek kirrhós (tawny) and refers to the distinctive yellowish colour of livers in patients with this condition (see: Decompensated Cirrhosis, Compensated Cirrhosis)

DAA – Direct Acting Antiviral. The new wave of Hep C drugs falls into this category

Daclatasvir – A NS5A inhibiting DAA made by BMS. Taken with Sofosbuvir to treat Genotype Three

Daklinza – The brand name of Daclatasvir.

Dasabuvir – A DAA. One of the four drugs in the Viekira Pak.

Decompensated Cirrhosis – Extreme, late-stage cirrhosis that may be accompanied by symptoms such as Jaundice, Ascites, Variceal Bleeding, Portal Hypertension and Hepatic Encephalopathy. Chances of developing HCC are also increased in those with this diagnosis.

Doherty Institute - 'The Peter Doherty Institute for Infection & Immunity is an unincorporated joint venture between The University of Melbourne and The Royal Melbourne Hospital, combining research, teaching, public health and reference laboratory services, diagnostic services and clinical care in infectious diseases and immunity.'

'The WHO Collaborating Centre for Viral Hepatitis is situated at The Doherty Institute and has been designated as one of only five Collaborating Centres for Viral Hepatitis globally. The Centre performs a broad range of activities supporting global control of viral hepatitis, including basic research and reference virology, surveillance, treatment and prevention initiatives, and training and capacity building.'

Elbasvir – A DAA. ‘A highly potent and selective inhibitor of the HCV NS5a replication complex.’ Combined with Grazoprevir it is sold by Merck & Co as Zepatier.

DHHS - The Victorian Government's Department of Health & Human Services

EC Partnership - (Eliminate Hepatitis C Partnership) is a collaboration of service providers, government departments and researchers in Victoria who aim to increase uptake of treatment for Hep C among people who inject drugs (PWID). Collaborators include Burnet Institute, HRVic, DHHS & Hepatitis Victoria.

Epclusa – The brand name of a one pill per day treatment produced by Gilead Sciences. It contains Sofosbuvir and Velpatasvir and is effective across all genotypes of HCV. Available in Australia.

EOT – End of Treatment

FibroScan -A non-invasive ultrasound test which determines elasticity of the liver and thus the level of fibrosis

Fibrosis – Scarring of the liver.

Fix Hep C – A buyers club based in Australia which exports generic Hep C treatments from India and Bangladesh for individual patients around the world.

Genotype – Sub-species of the Hep C virus ranging from one to six. Genotype one is the most common in Australia, followed by Genotype three.

Gilead Sciences – Makers of Harvoni, Sovaldi, Epclusa and Vosevi

Glecaprevir - A DAA. Combined with Pibrentasvir it makes up Mavyret, a Pangenotypic HCV treatment from AbbVie. An HCV NS3/4A protease inhibitor.

Grazoprevir – A DAA. Combined with Elbasvir it is sold by MSD (Merck & Co) as Zepatier.

Harvoni – Combination therapy for Hep C Genotype One, containing Sofosbuvir and Ledipasvir. Produced by Gilead Sciences.

Harm Reduction Victoria - See HRVic

Hepatic Encephalopathy - A 'spectrum of neuropsychiatric abnormalities' caused by liver failure. Believed to involve the build up of ammonia in the blood, a substance that is normally removed by the liver. Often accompanied by other signs of liver failure: i.e. Jaundice, Ascites, Peripheral Edema.

Hepatitis B – A form of viral Hepatitis which is widespread across the globe. Though it is not curable (like Hep C) there are drugs which effectively contain it if taken regularly, and there is a vaccine (which in Australia is administered in infancy). Since HBV is blood-borne many of those with Hep C have also been exposed to Hep B . It is advised that those in high-risk groups be tested for the virus, then vaccinated or prescribed treatment.

Hepatitis Non A, Non B - Through the 1970s up until the year 1989, Hep C was known by this name.

HBV – Hepatitis B Virus. The virus which causes Hepatitis B.

HCC – Hepatocellular Carcinoma; the form of liver cancer most often experienced by long term sufferers of Hep C.

HCV – Hepatitis C Virus. This is the virus which causes Hepatitis C.

HRVic – Harm Reduction Victoria. A Peer-run organisation which assists and represents users of illicit drugs. Host of The Hepalogue

IDU - Injecting Drug User/s. Interchangeable with PWID

Interferon - Interferon Alfa 2B, a solution delivered by injection over a period as long as 48 weeks, was once the standard of care for Hep C. Its clearance rates were low and its flu-like side-effects were a significant burden. It was superseded by Pegylated Interferon

Jaundice - A symptom of severe liver disease in which the skin and whites of the eyes develop a yellowish pigmentation. This is due to the liver's inability to properly process bilirubin. The condition is often associated with itchiness, dark urine and pale shit.

Kirby Institute (The) - a leading global research institute dedicated to the prevention and treatment of infectious diseases. It is based in Sydney and associated with the University of NSW. The scope of their work is broad, but their national surveillance programs are particularly useful when it comes to understanding Hep C and its grip on Australia.

Ledipasvir – A DAA. One of the two drugs in Harvoni.

Liver Biopsy – a procedure in which a sample of liver is taken with a needle guided by ultrasound imaging. In the Hep C universe it has largely superseded by the FibroScan test and the APRI score.

LFT – Liver Function Test. A blood test which measures the levels of certain enzymes which point to the health of the liver. In cases of Hep C, ALT levels are the most useful indicator.

MATOD - Medication Assisted Treatment for Opioid Dependence (Also ORT, OST, See: Pharmacotherapy.)

Mavyret - A combination Hep C treatment created by AbbVie, awarded USA FDA approval in mid 2017. It contains two DAAs: Glecaprevir and Pibrentasvir. It is combatively priced and is the first Pangenotypic to be approved for an 8 week course.

Merck & Co – (Known in Australia as MSD (Merck, Sharp & Dohme). Makers of Zepatier (Elbasvir/Grazoprevir) for HCV genotypes 1 & 4.

MSD – Merck Sharp & Dohme – see Merck & Co

NAFLD - Non Alcoholic Fatty Liver Disease occurs when an excessive amount of fat is deposited (steatosis) in the liver in case where alcohol is not a factor. Roughly half of all Hep C patients (cured or not) have some degree of Fatty Liver Disease.

Narcan - See Naloxone.

Naloxone - (brand names: Narcan, Prenoxad, Nyxoid) An opioid antagonist which can reverse the effects of opioid overdose. Typically used by ambulance personnel in emergencies. It can be administered intramuscularly or by nasal spray.

Naltrexone - An opioid antagonist used in the control of opioid addiction (and also alcoholism). Most commonly taken each day in pill form, it will reduce the effects of any opioids. It should not be taken while opioids remain in the system due to the threat of precipitated withdrawal. Naltrexone implants exist but have a bad reputation, as does 'rapid detox' a procedure to which naltrexone is central.

NASH - Non Alcoholic SteatoHepatitis is a severe form of NAFLD where inflammation and damage to liver cells are present

NS5A - (Nonstructural protein 5A) A 'hydrophilic phosphoprotein' which plays a key role in HCV replication - and which has proved a successful target of a number of DAAs

NS5B - (Nonstructural protein 5B) A viral protein (RNA polymerase) with a key function in replication of the HCV genome. It has proved a successful target of a number of DAAs.

NSP - Needle and Syringe Programs are a core initiative in drug-related harm reduction. NSP sites (and workers) provide clean equipment to people who inject drugs (PWID). Among other health benefits, this reduces the likelihood of sharing and thus the communication of blood borne viruses (BBVs) like Hep C. (Also sometimes referred to as 'needle exchanges' or 'needle & syringe exchanges.')

Ombitasvir – An NS5A inhibiting DAA. One of the four drugs in the Viekira Pak.

ORT- Opioid Replacement Therapy (Also MATOD, OST) (See: Pharmacotherapy.)

OST - Opioid Substitution Therapy (Also MATOD, ORT) (See: Pharmacotherapy.)

Pangenotypic – Adjective used in reference to those DAA treatment combinations which cover all Genotypes of HCV. Epclusa and Mavyret are considered Pangenotypic.

Paritaprevir – A DAA. One of the four drugs in the Viekira Pak.

PCR – Polymerase Chain Reaction, a test which determines the presence and/or quantity of virus RNA in the blood.

Peer - (Stand by)

Pegylated Interferon - A more efficacious form of Interferon requiring fewer injections. In combination with Ribavirin it was the Hep C standard of care prior to the arrival of DAAs. This regimen (usually with a DAA added) is sometimes still used today.

Pharmacotherapy - (Also ORT, OST, MATOD) In this blog: the supervised use of Methadone or Buprenorphine (Suboxone/Subutex) to control opioid dependence.

Pibrentasvir - A DAA. Combined with Glecaprevir it makes up Mavyret, a Pangenotypic Hep C treatment from AbbVie. A HCV NS5A inhibitor.

Portal Hypertension - High blood pressure in the portal vein and its branches (which drain from the intestines to the liver). It is most commonly caused by Cirrhosis, and in extreme cases can lead to Ascites, Variceal Bleeding, Hepatic Encephalopathy and enlargement of the spleen

PWID – People Who Inject Drugs (Also IDU)

PWUD - People Who Use Drugs (A term that describes all those who use illicit substances, regardless of the method of consumption.)

Rapid-EC Study - A 2017 study performed in Melbourne by the Burnet Institute and EC Consortium examining whether RPOC techniques may encourage challenging populations (specifically current injectors) into treatment.

Rapid Point of Care - (RPOC) (Also POCT - Point-of-care Testing) A clinical methodology which seeks to simplify a treatment regimen in order to increase the uptake of treatment. For example, technological/clinical efficiencies may reduce the number and turnaround period of pathology tests, and the number of sites and/or appointments a patient is required to attend may be reduced. Though RPOC is of particular interest in countries which face special challenges, clinicians in Australia are investigating it as a means to encourage members of Hep C populations into treatment.

RAS – (See: RAV) Resistance Associated Substitution. The currently preferred descriptor for what used to be referred to as a RAV.

RAV – Resistance Associated Variants – Hep C virus particles which have developed resistance to certain drugs. Now, possibly in order to promote confusion, referred to usually as RAS.

Ribavirin – An older antiviral drug sometimes added to modern Hep C treatment regimens in cases of severe Fibrosis or Cirrhosis. Once commonly used in combination with Pegylated Interferon.

Ritonavir – One of the four drugs in the Viekira Pak.

RNA – Ribonucleic Acid – The genome of the Hep C virus is composed of RNA.

RPOC - See Rapid Point Of Care

Septicaemia - A now rarely used generic term for blood-poisoning and/or the microorganisms and their toxins infecting the blood. Today doctors tend to be more specific, referring to viremia, fungemia or bacteremia. Blood infection can be caused by injecting drugs.

Sofosbuvir – A DAA which suppresses HCV’s ability to replicate. (A nucleotide analog inhibitor of HCV NS5B polymerase.) Owned by Gilead Sciences and sold on its own as Sovaldi, with Ledipasvir in Harvoni, or with Velpatasvir in Epclusa.

Sovaldi – The brand name of Sofosbuvir

Steatosis - The buildup of fat in the liver.

Suboxone - A brand name formulation of buprenorphine and naloxone (Narcan) used as Opiate Replacement Therapy (ORT)/Pharmacotherapy. It generally comes in the form of a film which is dissolved under the tongue. The naloxone, an opioid antagonist, is added to dissuade diversion, particularly by injection. (Produced by Invidior.)

Subutex - A buprenorphine formulation produced by Invidior. It comes in the form of pills which are dissolved under the tongue. It is more strictly controlled than Suboxone owing to a higher perceived risk of diversion.

SVR – Sustained Viral Response, often followed by the numerals 8,12, 24 etc., denoting the number of weeks since HCV RNA was last detected in a patient's blood. SVR12 is generally considered a cure.

Variceal Bleeding - If a person with advanced liver disease/cirrhosis suffers from Portal Hypertension, this may in turn cause Variceal Bleeding. The high blood pressure can result in liver-associated veins swelling to accommodate blocked blood flow through the liver. (These enlaged veins are called Varices). If pressure on these expanded, thin-walled veins increases, they may rupture, causing significant blood loss.

Varices - Enlarged veins in the proximity of the liver. See Variceal Bleeding.

Velpatasvir – An NS5A inhibiting DAA paired with Sofosbuvir in Epclusa. (Owned by Gilead Sciences.)

Viekira Pak – A four drug combination therapy for Hep C Genotype One. Produced by AbbVie

Viral Load – The amount of virus particles present in the bloodstream. In the Hepalogue we are usually talking about HCV particles, though the term is also used in reference to HIV and other viral diseases. Measured in International Units per millilitre (IU/ml)

Vosevi - Created by Gilead Sciences and approved in the USA by the FDA in mid 2017, Vosevi contains Sofosbuvir and Velpatasvir (sold together as Epclusa) and the new DAA Voxilaprevir. It is marketed as a second-line (or 'salvage') treatment for patients who have failed treatment with other DAA combinations.

Voxilaprevir - A DAA. A NS3/4A protease inhibitor which is part of Gilead Sciences three-drug combo Vosevi

Zepatier – Brand name of a combination treatment for Genotype One by Merck & Co. It contains the DAAs Elbasvir and Grazoprevir.