Transcript The Liver - Hepatitis C

Hepatitis C Overview
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Introduction
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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
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Bile
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Immune System
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Detoxifies or Filters
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Clotting Factors
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Hormones
Regenerates Itself!
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Keep the Liver Healthy!
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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!
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Get vaccinated!
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HAV and HBV vaccines
Avoid toxic substances / fumes
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Hepatitis C Statistics
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U.S. Population
1.8% overall
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4 million Americans infected
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2.7 million chronically infected
Special Populations
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2.1% Mexican Americans
3.4% African Americans
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HCV Antibody tests
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HCV Elisa II or III
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HCV RIBA
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Most common antibody test
Usually only performed on people with no history
of risk factors
A positive antibody test indicates exposure
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It does not indicate current hepatitis C infection
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HCV viral load test performed to indicate active HCV
infection
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Viral Load Tests
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Viral Load tests
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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?
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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
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Genotype (1,2,3,4,5,6)
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U.S. population
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70% genotype 1
30% genotypes 2 & 3
Why Is a Genotype Test Important?
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Helps predict treatment response
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Liver Biopsy
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Gold Standard for Determining the
Health of the Liver
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Measure of inflammation
Extent of scarring (if any)
Rule out other diseases
Biopsy procedure
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Transmission- Prevention
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Direct blood to blood transmission route
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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
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Injection and Non-Injection Drugs
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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
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CDC – no need to change current sexual
practices – but there is a risk
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Prevention Tips
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Safer Sex
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For so called “high risk groups”
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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
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Mother to Child Transmission
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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
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Follow standard precautions
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Prevention Tips
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Tattoos & Piercing
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Considered a low risk in commercial setting
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Make sure disposable needles and separate ink
pot are used and that general safety
precautions are followed
Considered a higher risk in other settings
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Non-commercial settings such as in prison or
on the streets
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Shared Personal Items
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Household
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Cover cuts or sores
Do not share personal hygiene items
(toothbrushes, razors, etc.)
Professional Personal Care Settings
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Standard precautions
Disposable equipment
Bring own equipment
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HCV CAN NOT BE SPREAD BY:
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BREASTFEEDING
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SNEEZING
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HUGGING
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COUGHING
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FOOD OR WATER
SHARING EATING
UTENSILS OR
DRINKING GLASSES
CASUAL CONTACT
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Chronic Symptoms
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Fatigue – mild to
severe
Flu-like symptoms
(muscle/joint/fever)
‘Brain Fog’
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Liver pain
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Loss of appetite
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Headaches
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Gastro problems
and more……
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Disease Progression
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10-25% of HCV positive people
progress on to serious disease over 1040 years
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Fibrosis
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Cirrhosis
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Light scarring
Compensated vs. decompensated
Steatosis
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Fatty deposits in the liver
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Treatment Decisions
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General Treatment
Guidelines
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Optimal Response
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Stable Health
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Active HCV Infection
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Elevated ALT’s
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Compensated Liver
Disease
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Younger
Female
Low BMI & Weight
Less Steatosis
Low Viral Load
Minimal Liver
Damage
Genotypes 2 or 3
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Clinical Data - Treatment
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Prospective – well designed clinical trial
with measurable outcomes
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Gold Standard
Retrospective – review of data from
previous clinical trials
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Important for looking for trends and for
designing future studies
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Treatment
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What is interferon?
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General antiviral – immune booster
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By injection
What is ribavirin?
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Antiviral
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Used only in combination with interferon
Pill or capsule
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Approved Medications
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Interferon
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Infergen (InterMune)
Roferon (Roche)
Intron A (Schering)
Ribavirin
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Copegus (Roche)
Rebetol (Schering)
Generic
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Treatment - Standard of Care
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Schering – PEG-Intron + Rebetol (800mg)
 Genotype 1- 41% SVR (48 weeks)
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Genotype 2 thru 6 – 75% (48 weeks)
Roche – Pegasys + Copegus (1000-1200 mg)
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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
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Interferon
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Fatigue
Muscle/Joint pain
Nausea
Headaches
Anxiety
Depression
Dry Skin/Rashes
And more…..
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Ribavirin
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seems to make
interferon side effects
worse – especially
fatigue – Anemia
**(both men & women
must use birth
control)
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Managing Side-Effects
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Inject before
bedtime
Drink lots of water
Low doses of
ibuprofen or
acetaminophen
Pain medications
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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
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Viramidine
Helicase Inhibitors
Protease Inhibitors
Improved therapies not expected for 5
years or more
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Will likely be used with interferon/ribavirin
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Complementary Medicine
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Herbs – milk thistle, licorice root, etc.
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Always check with your doctor and
herbalist – some herbs are unsafe
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Acupuncture / Acupressure
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Traditional Chinese Medicine
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Lifestyle Changes That Help!
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Alcohol – Avoid or
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Exercise
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Stress Reduction
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Support Groups
reduce
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Get vaccinated –
Hep A & Hep B
Healthy balanced
diet
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Advocate for Yourself!
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Educate yourself
Establish a good
relationship with
your doctor
Bring an advocate
for doctor’s visits
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Ask questions
Keep copies of all
medical tests
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Keep a diary
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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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