Hepatitis C and You

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What You May Not Know About Hepatitis C (HCV)

HAV HBV HCV

Differences Between Hepatitis A, B and C

Transmission Contaminated Food / Water

(e.g., when traveling)

Blood and Bodily Fluids

(e.g., sexually transmitted)

Blood

(e.g., transfusions, health care workers)

Vaccine Available?

  

What You May Not Know

• Hepatitis C (HCV) now kills more people than HIV/AIDS in the U.S. (16,600 in 2010) • 1 in 30 baby boomers is infected • About 75% of people who die from HCV were born between 1945 and 1965 • 45% of people infected with HCV report no known risk • ALT screening (routine liver test) misses > 50% of chronic cases

HCV in the U.S.

Deaths from HCV vs. HIV

20 000 15 000 10 000 5 000 0 2004 2005 2006 2007 2008 2009 2010

Source: Centers for Disease Control

HIV HCV HBV

HCV in the U.S.

• Affects 3-5 times more people than HIV/AIDS • Most common chronic blood borne infection • 40-60% of adult liver transplants in the U.S.

• U.S.: 4 million (1.6%) people infected

HCV World-Wide

• Western Countries: Most common cause of chronic liver disease • About 170 million (3%) are chronically infected world wide

Modes of Transmission

Sexual Contact Piercing / Tattoo Intranasal Drugs Injected Drugs Mother to Infant Occupational Exposure (Needle) Hospital Stay Transfusion Before 1992 HCV Organ/Tissue Transplant

Source: NIH Consensus Development Conference Statement 2002

Natural History after Acute HCV Infection After 12 Months

Hepatitis C Symptoms

• Acute patients: Most have few or no symptoms • Chronic patients: Many have no symptoms until they develop complications of cirrhosis • Common symptoms (e.g., fatigue, anorexia, other flu like symptoms) correlate poorly with severity of liver disease • Quality of Life: Frequently impaired, even before cirrhosis (complications from liver disease)

Some Possible HCV Symptoms

Symptoms usually take more than 10 years to develop.

Vagueness Depression Anxiety Fatigue Malaise Liver Pain or Discomfort Some people never have any symptoms Dry Eyes Dry Mouth Itching Rashes Poor Appetite Indigestion Nausea Feeling Sick Aches and Pains in Muscles Joints

Your Risk of Having HCV is Higher if You:

• Were born between 1945 and 1965 • Have every injected illicit drugs, even once • Have HIV • Have received hemodialysis treatments • Have received a blood transfusion or organ transplant before 1992 • Are (or were) a health care worker and had been exposed to infected blood

Factors in Disease Progression

• Heavy alcohol consumption Heavy • Approx. 2 drinks/day • 30 g/day in men, 20 g/day in women • 40+ years old at the time of infection • Male gender • Coinfection: HIV / HBV • Immunosuppression • Obesity Source: NIH Consensus Development Conference Statement. 2002. Poynard et al. Lancet. 1997;349:825-832.

Untreated HCV

Possible Long Term Complications

• Increased cirrhosis, liver cancer, liver failure • Increased skin, joint and muscle problems • Increased incidence of vascular disease: Circulation

problems, heart attack, stroke

• 3x higher rate of type 2 diabetes after age 40 • Increased incidence of kidney disease / possible failure • Increased incidence of autoimmune thyroid disease

Untreated HCV

Possible Long-Term Complications

After 20 Years After 40 Years 47% 45% 45% 50% 40% 30% 20% 10% 0% 31% 7% 20% None to Mild Mild to Moderate Cirrhosis

Liver Problems

4% 1% Failure/Cancer

Current Treatment

• Standard: Injected Pegylated Interferon + oral Ribavirin • Additional (for genotype 1): Oral Boceprevir or Telaprevir • Duration: Typically 24-48 weeks; depends on response and genotype • Side Effects 1 • As with any chemotherapy, side effects can be expected • Dosage adjustment and other methods can reduce side effects 1 If you are currently undergoing treatment or are considering starting treatment, please discuss possible side effects with your physician.

Improved Treatment

• Simeprevir: approved by the FDA in November 2013.

• Same class as telaprevir and boceprevir (protease inhibitor) • Approved for genotype 1 infection in combination with peginterferon and ribavirin • Sofosbuvir: approved in Dec. 2013 • New class of antiviral therapy (nucleotide analog) • For genotype 1 in combination with peginterferon/ribavirin • For genotypes 2/3 with ribavirin and without interferon • Advanced clinical trials • Testing interferon-free and ribavirin-free treatment regimens, including genotype 1

Who Should Get Tested for HCV?

What group is 5x more likely than other adults to have HCV?

People born between 1945 and 1965

How many deaths could be prevented if all baby boomers got tested for HCV?

120,000

Why All Baby Boomers Should Get Tested

The CDC recommends testing of all baby boomers • High rates of experimental drug use in the ‘60’s and ’70’s  • No widespread blood-supply screening before 1992

Getting Tested for HCV

• Contact your physician, your health department or local clinic to find out how to get tested • Results can take between a few days and a few weeks • Rapid tests are available at some clinics • The first blood test, a Hepatitis C Antibody Test , determines if you have ever been exposed to HCV • If you have been exposed, then an RNA test is needed to determine if you are currently infected with HCV

Cost of Testing

• Under the Affordable Care Act, most private health insurance must now pay the full costs of screening. State Medicaid programs receive extra funding for this.

• If your insurance doesn’t pay for testing, the antibody  test will cost between $50-75. • Some free testing is also available.

Why Get Tested?

• A simple blood test could save your life and prevent you from infecting others • HCV is the leading cause of liver cancer and liver transplants • Symptoms are so vague, most people don’t know they have HCV  until serious problems develop • New treatments can eliminate the virus in most cases • Even if you don’t get treated: • You can adjust your lifestyle to reduce chances of progression • You can be careful about spreading your HCV to others

Greenview Hepatitis C Fund

•

www.hepcfund.org

• Supports HCV research to find a cure • Supports educational efforts to increase awareness • All donations large or small are accepted and appreciated •

Contributes over 85% of total revenue (more than 95% of cash donations) directly to Hepatitis C research

• Recent Success: • Provided seed money for research at the University of Michigan to cut off HCV's lifeline • Led to a $1.08 million NIH grant