Hepatitis C Overview

1. Hepatitis C Overview

2. Introduction • Self-Advocacy through Education! • The information in this presentation is designed to help you understand and manage HCV and is not intended as medical advice. HCV medical care is a partnership between patients and their medical providers

3. The Liver – A Chemical Factory • Largest internal organ • Size of a football • Approximately 3 lbs in the average sized male 1.5 quarts of blood flow through it every minute

4. Chemical Factory- >500 chemical functions Bile Immune System Detoxifies or Filters Clotting Factors Hormones Liver Functions Regenerates Itself!

5. Keep the Liver Healthy! • If you have HCV – Avoid Alcohol • Avoid mixing drugs – prescription, over the counter, herbs/supplements and street drugs • Eat a healthy, balanced diet based on the food pyramid

6. Keep the liver healthy! • Get vaccinated! • HAV and HBV vaccines • Avoid toxic substances / fumes

7. U.S. Population 1.8% overall 4 million Americans infected 2.7 million chronically infected Special Populations 2.1% Mexican Americans 3.4% African Americans Hepatitis C Statistics

8. HCV Antibody tests • HCV Elisa II or III • Most common antibody test • HCV RIBA • Usually only performed on people with no history of risk factors • A positive antibody test indicates exposure • It does not indicate current hepatitis C infection • HCV viral load test performed to indicate active HCV infection

9. Viral Load Tests • Viral Load tests • Hepatitis C RNA by PCR - >10 IU/mL • HCV RNA by branched DNA Assay – > 50 IU/mL • TMA – > 5-10 IU/mL • Why Is a Viral Load Test Important? • To confirm active infection • Helps to predict treatment response • Indication that treatment is working ** Viral load does not correlate with disease progression**

10. Genotype Test • Genotype (1,2,3,4,5,6) • U.S. population • 70% genotype 1 • 30% genotypes 2 & 3 • Why Is a Genotype Test Important? • Helps predict treatment response

11. Liver Biopsy • Gold Standard for Determining the Health of the Liver • Measure of inflammation • Extent of scarring (if any) • Rule out other diseases • Biopsy procedure

12. Transmission- Prevention • Direct blood to blood transmission route • Not spread casually

13. Transmission

14. Prevention Tips • Injection and Non-Injection Drugs • Do not share needles, cookers, cottons, straws, pipes or any items that might come into contact with blood • Use bleach to clean • People in Stable Long-Term Monogamous Sexual Relationships • CDC – no need to change current sexual practices – but there is a risk

15. Prevention Tips • Safer Sex • For so called “high risk groups” • Multiple sexual partners, people with sexually transmitted diseases, coinfection with HIV or HBV • Any situation where blood is present

16. Prevention Tips • Mother to Child Transmission • Low risk – about 5% chance of hepatitis being transmitted to infant • Given the low rate of transmission, pregnancy should not be avoided. • Health-Care Settings • Follow standard precautions

17. Prevention Tips • Tattoos & Piercing • Considered a low risk in commercial setting • Make sure disposable needles and separate ink pot are used and that general safety precautions are followed • Considered a higher risk in other settings • Non-commercial settings such as in prison or on the streets

18. Shared Personal Items • Household • Cover cuts or sores • Do not share personal hygiene items (toothbrushes, razors, etc.) • Professional Personal Care Settings • Standard precautions • Disposable equipment • Bring own equipment

19. BREASTFEEDING SNEEZING HUGGING COUGHING FOOD OR WATER SHARING EATING UTENSILS OR DRINKING GLASSES CASUAL CONTACT HCV CAN NOT BE SPREAD BY:

20. Fatigue – mild to severe Flu-like symptoms (muscle/joint/fever) ‘Brain Fog’ Liver pain Loss of appetite Headaches Gastro problems Chronic Symptoms • and more……

21. Disease Progression • 10-25% of HCV positive people progress on to serious disease over 10-40 years • Fibrosis • Light scarring • Cirrhosis • Compensated vs. decompensated • Steatosis • Fatty deposits in the liver

22. General Treatment Guidelines Stable Health Active HCV Infection Elevated ALT’s Compensated Liver Disease Optimal Response Younger Female Low BMI & Weight Less Steatosis Low Viral Load Minimal Liver Damage Genotypes 2 or 3 Treatment Decisions

23. Clinical Data - Treatment • Prospective – well designed clinical trial with measurable outcomes • Gold Standard • Retrospective – review of data from previous clinical trials • Important for looking for trends and for designing future studies

24. Treatment • What is interferon? • General antiviral – immune booster • By injection • What is ribavirin? • Antiviral • Used only in combination with interferon • Pill or capsule

25. Approved Medications • Interferon • Infergen (InterMune) • Roferon (Roche) • Intron A (Schering) • Ribavirin • Copegus (Roche) • Rebetol (Schering) • Generic

26. Schering – PEG-Intron + Rebetol (800mg) Genotype 1- 41% SVR (48 weeks) Genotype 2 thru 6 – 75% (48 weeks) Roche – Pegasys + Copegus (1000-1200 mg) Genotype 1 – 44-51% SVR (48 weeks) Genotype 2 & 3 – 82% SVR (24 weeks) Genotype 2 thru 6 – 70% SVR (48 weeks) *FDA Package Insert Treatment - Standard of Care

27. Interferon Fatigue Muscle/Joint pain Nausea Headaches Anxiety Depression Dry Skin/Rashes And more….. Ribavirin seems to make interferon side effects worse – especially fatigue – Anemia **(both men & women must use birth control) Side-effects

28. Inject before bedtime Drink lots of water Low doses of ibuprofen or acetaminophen Pain medications Light exercise Daily moisturizing Vary injection sites Anti-Depressants Plenty of rest Frequent small meals Managing Side-Effects Key: support from medical providers, family, friends, work – all areas of life

29. Experimental Therapies • Viramidine • Helicase Inhibitors • Protease Inhibitors • Improved therapies not expected for 5 years or more • Will likely be used with interferon/ribavirin

30. Complementary Medicine • Herbs – milk thistle, licorice root, etc. • Always check with your doctor and herbalist – some herbs are unsafe • Acupuncture / Acupressure • Traditional Chinese Medicine

31. Alcohol – Avoid or reduce Get vaccinated – Hep A & Hep B Healthy balanced diet Exercise Stress Reduction Support Groups Lifestyle Changes That Help!

32. Educate yourself Establish a good relationship with your doctor Bring an advocate for doctor’s visits Ask questions Keep copies of all medical tests Keep a diary Keep an open mind Advocate for Yourself!

33. Resources – www.hcvadvocate.org • HCV Advocate Newsletter • Education Materials in English, Spanish, Russian, French, German, Tagalog, Chinese, Vietnamese • Medical Writers’ Circle • Fact Sheets in English, Spanish, French, Russian • National Support Group Listing • Recommended links • Information on hepatitis C, hepatitis B, HIV/HCV Coinfection