The Liver - Hepatitis C
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Transcript The Liver - Hepatitis C
Hepatitis C Overview
1
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
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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
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Liver Functions
Chemical Factory>500 chemical
functions
Bile
Immune System
Detoxifies or Filters
Clotting Factors
Hormones
Regenerates Itself!
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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
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Keep the liver healthy!
Get vaccinated!
HAV and HBV vaccines
Avoid toxic substances / fumes
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Hepatitis C Statistics
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
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HCV Antibody tests
HCV Elisa II or III
HCV RIBA
Most common antibody test
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
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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**
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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
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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
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Transmission- Prevention
Direct blood to blood transmission route
Not spread casually
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Transmission
Shared
Needles
All Drug
Paraphernalia
Blood Before
1992 - transfused,
Sexual
Transmission
(1-3%)
Mother to
Child <5%
Healthcare
Workers –
needle sticks
Shared Household items –
Tattoos /
Piercing
<10% of
routes can not
be identified
products, procedures
razors & toothbrushes
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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
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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
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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
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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
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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
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HCV CAN NOT BE SPREAD BY:
BREASTFEEDING
SNEEZING
HUGGING
COUGHING
FOOD OR WATER
SHARING EATING
UTENSILS OR
DRINKING GLASSES
CASUAL CONTACT
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Chronic Symptoms
Fatigue – mild to
severe
Flu-like symptoms
(muscle/joint/fever)
‘Brain Fog’
Liver pain
Loss of appetite
Headaches
Gastro problems
and more……
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Disease Progression
10-25% of HCV positive people
progress on to serious disease over 1040 years
Fibrosis
Cirrhosis
Light scarring
Compensated vs. decompensated
Steatosis
Fatty deposits in the liver
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Treatment Decisions
General Treatment
Guidelines
Optimal Response
Stable Health
Active HCV Infection
Elevated ALT’s
Compensated Liver
Disease
Younger
Female
Low BMI & Weight
Less Steatosis
Low Viral Load
Minimal Liver
Damage
Genotypes 2 or 3
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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
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Treatment
What is interferon?
General antiviral – immune booster
By injection
What is ribavirin?
Antiviral
Used only in combination with interferon
Pill or capsule
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Approved Medications
Interferon
Infergen (InterMune)
Roferon (Roche)
Intron A (Schering)
Ribavirin
Copegus (Roche)
Rebetol (Schering)
Generic
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Treatment - Standard of Care
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
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Side-effects
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)
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Managing Side-Effects
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
Key: support from medical providers, family,
friends, work – all areas of life
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Experimental Therapies
Viramidine
Helicase Inhibitors
Protease Inhibitors
Improved therapies not expected for 5
years or more
Will likely be used with interferon/ribavirin
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Complementary Medicine
Herbs – milk thistle, licorice root, etc.
Always check with your doctor and
herbalist – some herbs are unsafe
Acupuncture / Acupressure
Traditional Chinese Medicine
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Lifestyle Changes That Help!
Alcohol – Avoid or
Exercise
Stress Reduction
Support Groups
reduce
Get vaccinated –
Hep A & Hep B
Healthy balanced
diet
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Advocate for Yourself!
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
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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
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