Hepatitis: A Basic Overview

1. Hepatitis: A Basic Overview Seattle, Washington

2. Topics of Discussion • What is hepatitis? • How is hepatitis C causedand prevented • Treatment (and CURE!!!) update • Hepatitis Education Project and YOU

3. HCV Cascade of Care

4. Rates of Mortality in WA State

5. State/Fed Prevention Funding

6. Hepatitis Affects Your • 2nd largest organ • Weighs 3-5 lbs • Has 500 functions • Filters and cleans your blood • Uncomplaining organ • Able to regenerate and heal

7. What is hepatitis ??? • “Hepa” means liver; “itis” means inflammation • Hepa + titis = Liver Inflammation • Liver inflammation can lead to scarring called cirrhosis

8. Long-term effects of hepatitis: Cirrhosis and liver scarring Healthy livers are plump and smooth Cirrhotic livers are nodular; bumpy and shrunken Hepatitis C is the leading cause of liver failure and liver transplant in the U.S.

9. Healthy vs. Cirrhotic Liver Function

10. What causes hepatitis? Alcohol Viruses are the most common causes of liver inflammation

11. Hepatitis Viruses Hepatitis A, B, and C… • all different • all cause liver inflammation • named in order of discovery, not severity

12. A, B, C Virus Transmission Comparison • Hep A • Fecal-oral transmission • Injesting contaminated food & water, unsafe sex • Prevention: Getvaccinated! Wash hands! • Hep B • Bodily fluids: Semen, vaginal fluid, blood • STD, mother-child, sharing drug/tattoo/piercing equipment • Prevention: Getvaccinated! Have safer sex! • Hep C • Bodily fluid: Blood only • Sharing drug/tattoo/piercing equipment, blood transfusion • Prevention: Use clean drug/tattoo/piercing equipment every time!

13. Hepatitis A and B Vaccines:Twinrix • Twinrix is a combo HAV/HBV vaccine • Safe and easy- 3 shots within 6 mos • Lifetime immunity • Won’t hurt if vaccinated twice • No need to restart if you have a break between shots • No vaccine for Hep C

14. Acute vs chronic infection *HCV is more common than HAV/HBV and more likely to become chronic

15. Hepatitis C is transmitted… through blood to blood contact! How does blood-to-blood contact happen?

16. Summary of Risks for Transmitting Hepatitis C Hepatitis viruses are NOT spread by casual contact such as hugging, kissing, sharing food or drinks, playing, sharing a house/bed/toilet

17. Injection Drug Use is the #1 way that HCV is spread in U.S. Sharing any injection drug equipment can pass hep C (and hep B) • “works” = needles, syringes, cottons, cookers, rinse water, tourniquets, gauze, drugs etc. *Cleaning needles reduces, but does noteliminate risk

18. Tattoos • Tattoos done in prison, jail, or other unsterile settings are the most risky • Use a new needle, ink, barrel, and gloves every time • Get tattoos at licensed shops (autoclave, disposable inks and needles)

19. Natural History of Hep C

20. Possible Complications of Cirrhosis • Portal hypertension (blood pressure) • Weakened blood vessels can cause bleeding, often in esophagus or stomach • Fluid retention • Liver cancer: up to 48% of liver cancer cases are related to HCV • Frequent infections • Malnutrition • Dark urine/Light colored stool • Brain fog

21. Hepatitis C: Testing Testing for HCV is a 2-step process: • Step 1:Antibody test looks for exposure to virus • Step 2:PCR or confirmatory test looks for actual virus

22. Genotype Testing • Genotypes: different strains of the virus • 6 different genotypes • 1,2,3 are most common • Genotype tells your doctor: • which medication to prescribe • how long you will need to take the medication • how effective the treatment will be

23. Liver Health Testing There are several different ways to evaluate the liver: • Liver Enzyme Tests • APRI Score and other blood tests • Ultrasound • Fibrosure • Fibroscan • Liver Biopsy

24. Yes! Hepatitis C is curable NomoreInterferon!

25. Treatment Goals • Kill the virus • SVR = CURE • Prevent cirrhosis • If cirrhotic, prevent further scarring • Get rid of fatigue and other symptoms

26. Hep C Treatment - Interferon Injected once a week Boosts your immune response • Fever • Headache • Nausea • Diarrhea • Hair Thinning • Thyroid Problems Side Effects: • Depression • Irritability • Fatigue

27. New Hep C Treatments are… • All oral medications (no more injections!) • Olysio (simeprevir) • Sovaldi (sofosbuvir) • Harvoni (ledipasvir+sofosbuvir) • Viekira Pak (4 medicine combo) • Ribavirin • 90 – 95% effective • 8 – 24 weeks • Few side effects (fatigue, headache, nausea, trouble sleeping, diarrhea)

28. Some factors affecting treatment options… • Genotype and other genetic factors • Amount of liver scarring (fibrosis) • Patient’s age • Previous treatment for hep C • Other medical conditions

29. How do I pay for treatment? • With insurance coverage • Public or Private • If no insurance: • Clinical Trials • Patient Assistance • Affordable Care Act • How? • Research online • Contact drug companies • HEP’s Medical Case Management (MCM) Program!!!

30. HEP’s Mission The Hepatitis Education Project is committed to providing support, education, advocacy and direct services for people affected by hepatitis and to helping raise hepatitis awareness among patients, medical providers and the general public

31. HEP History Lesson • Started in 1993 by a group of patients and medical professionals to support newly diagnosed patients • Formally incorporated in 1994: Aided patients through support groups and resource assistance • Opened one of the nation’s first hepatitis resource centers in 2000! • Provided local support at Seattle resource center and other agencies • Provided national support via telephone and video conference

32. Current Programs & Services • Testing and Vaccinations • Youth Outreach and Education • Medical Case Management • Support Groups in Seattle & Tacoma • Advocacy and Outreach Education in WA prisons and King County jail • Local, State, National, and Global Advocacy

33. Who do we work with? • Emphasis on supporting stigmatized communities including: • people experiencing poverty/unstable housing • people who use drugs or are in any stage of recovery • people who are incarcerated • Some partner agencies include: • Evergreen Treatment Services (ETS) • People’s Harm Reduction Alliance (PHRA) • Project NEON • Seattle Area Support Groups (SASG) • Aurora Commons • Youthcare • Teen Feed

34. Medical Case Management Program (MCM) MCM services (like all of HEP’s programs) are always… • FREE! • Non-judgmental, supportive, and compassionate • Client-driven • Available at any stage of a client’s hepatitis diagnosis

35. Medical Case Managers can help your clients… • Navigate the health care system • Access confirmatory (PCR) tests • Find a PCP and/or liver specialist • Enroll in health insurance/Medicaid • Access new HCV treatment including insurance appeals, patient assistance programs, charity care • Advocate for fair access to treatment • Take control of their own medical decisions

36. How do clients and community agencies access MCM? • Walk-ins, calls, or emails for support • HEP outreach program referrals • CBO and medical provider referrals *Once referrals are received, initial contact is made within one week

37. How to live healthily with hepatitis C • Avoid/reduce alcohol intake • See the doctor regularly • Have a liver cancer screening every 6 months – a year (if needed) • Talk to doctor about every supplement or OTC medication • Follow a healthy diet and exercise regularly • Get vaccinated against HAV/HBV • Avoid co-infection with HIV and/or HBV • If cured, prevent re-exposure

38. Some Helpful Resources! HCV Advocate (Fact Sheets) www.hcvadvocate.org HBV Advocate www.hbvadvocate.org National Hepatitis Corrections Network (NHCN) www.hcvinprison.org

39. Thank you! Maritime Building, Suite 302 911 Western Ave Seattle, WA 98104 206-732-0311 www.hepeducation.org