Hepatitis c overview
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Hepatitis C Overview. Introduction. Advocacy & 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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Hepatitis C Overview

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Hepatitis C Overview

www.hcvadvocate.org


Introduction

  • Advocacy & 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

www.hcvadvocate.org


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

www.hcvadvocate.org


Chemical Factory-

>500 chemical functions

Bile

Immune System

Detoxifies or Filters

Clotting Factors

Hormones

Liver Functions

Regenerates Itself!

www.hcvadvocate.org


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 MyPlate (www.choosemyplate.gov)

www.hcvadvocate.org


Keep the liver healthy!

  • Get vaccinated!

    • HAV and HBV vaccines

  • Avoid toxic substances / fumes

www.hcvadvocate.org


U.S. Population

More than 3.9 million Americans chronically infected

HCV Populations

~1.5 % to 2% Mexican Americans

~3 % African Americans

Hepatitis C Statistics

www.hcvadvocate.org


HCV Antibody tests

  • HCV Elisa II or III

    • Most common antibody test

  • OraQuick

    • whole blood and fingerprick approved

  • A positive antibody test indicates exposure

    • It does not indicate current hepatitis C infection

      • HCV viral load test performed to indicate active HCV infection

www.hcvadvocate.org


Viral Load Tests

  • Viral Load tests

    • Hepatitis C RNA by PCR – > 5-10 IU/mL

    • HCV RNA by branched DNA Assay – > 615 IU/mL

    • TMA – > 5-10 IU/mL

  • Why Is a Viral Load Test Important?

    • To confirm active infection

    • Somewhat helps to predict treatment response & used to guide treatment duration

    • Indication that treatment is working

      ** Viral load does not correlate with disease progression**

www.hcvadvocate.org


Genotype Test

  • Genotype (1,2,3,4,5,6 and 7)

    • U.S. population

      • 70% genotype 1

      • 30% genotypes 2 & 3

  • Why Is a Genotype Test Important?

    • Guide treatment, what drugs and treatment duration

www.hcvadvocate.org


Liver Biopsy

  • Test for Determining the Health of the Liver

    • Measure inflammation, extent of scarring (if any), Rule out other diseases

    • Biopsy procedure

  • Non-invasive markers of liver inflammation – not yet perfected

  • FibroScan

www.hcvadvocate.org


Transmission- Prevention

  • Direct blood-to-blood transmission route

  • Can live on surfaces for up to 6 weeks

  • Bleach and other disinfectants kill virus, but probably not inside the needle

  • Not spread casually – need blood

www.hcvadvocate.org


Transmission

www.hcvadvocate.org


Prevention Tips

  • Injection and Non-Injection Drugs

    • Do not share needles, cookers, cottons, straws, pipes, water or any items that might come into contact with blood

    • Use bleach to clean – if no needle exchange is available

  • People in Stable Long-Term Monogamous Sexual Relationships

    • CDC – no need to change current sexual practices – but there is a risk

www.hcvadvocate.org


Prevention Tips

  • Safer Sex

    • For so called “high risk groups”

      • Multiple sexual partners, people with sexually transmitted diseases, infection with HIV or HBV

      • Any situation where blood is present

www.hcvadvocate.org


Prevention Tips

  • Mother-to-Child Transmission

    • Low risk – about 4-7% chance of hepatitis being transmitted to infant

    • Given the low rate of transmission, pregnancy should not be avoided.

  • Health-Care Settings

    • Follow standard (universal) precautions

www.hcvadvocate.org


Prevention Tips

  • Tattoos & Piercing

    • Considered a low/no risk in commercial setting that practices safety

      • Make sure disposable needles and separate ink pots are used and that general safety precautions are followed

    • Considered a higher risk in other settings

      • Non-commercial settings such as in prison, parties or on the streets

www.hcvadvocate.org


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 (best advice)

www.hcvadvocate.org


BREASTFEEDING

SNEEZING

HUGGING

COUGHING

FOOD OR WATER

SHARING EATING UTENSILS OR DRINKING GLASSES

CASUAL CONTACT

HCV CAN NOT BE SPREAD BY:

www.hcvadvocate.org


Fatigue – mild to severe

Flu-like symptoms (muscle/joint/fever)

‘Brain Fog’

Liver pain

Loss of appetite

Headaches

Gastro problems

Chronic Symptoms

  • and more……

www.hcvadvocate.org


Disease Progression

  • 10-25% of HCV positive people progress on to serious disease usually over 10-40 years

    • Fibrosis

      • Light scarring

    • Cirrhosis

      • Compensated vs. decompensated

    • Steatosis

      • Fatty deposits in the liver

www.hcvadvocate.org


General Treatment Guidelines

Stable Health

Active HCV Infection

Compensated Liver Disease

Optimal Response

CC genotype

Younger

Low BMI & Weight

Less Steatosis

Low Viral Load

Minimal Liver Damage

Treatment Decisions

www.hcvadvocate.org


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

www.hcvadvocate.org


Treatment

  • What is interferon?

    • General antiviral – immune booster – injection

  • What is ribavirin?

    • Antiviral - used only in combination with interferon - pill or capsule

  • What is an HCV inhibitor

    • Direct Acting Antiviral (DAA) – blocks viral replication

www.hcvadvocate.org


Approved Medications

  • Interferon – Pegylated (long-acting interferon)

  • Ribavirin

  • HCV Inhibitors

    • Victrelis (boceprevir) – Merck

    • Incivek (telaprevir) – Vertex

    • Olysio (simeprevir) – Janssen

    • Solvadi (sofosbuvir) – Gilead

www.hcvadvocate.org


Standard of Care:

Sofosbuvir plus ribavirin

Genotype 2 – 12 weeks = 93% cure rate

Genotype 3 – 24 weeks = 84% cure rate

Treatment - Genotype 2 & 3

www.hcvadvocate.org


Genotype 1 -

  • Standard of care:

    • Cure rates up to 90%

    • Treatment duration 12 to 48 weeks

    • Simeprevir, pegylated interferon plus ribavirin

    • Sofosbuvir, ribavirin with and without pegylated interferon

www.hcvadvocate.org


Fatigue

Anemia

Muscle/Joint pain

Nausea

Headaches

Anxiety

Depression

Dry Skin

Rashes

Anal itching

Photosensitivity

and more.....

Ribavirin can cause birth defects– black box warning:

Women of childbearing age, their partners and female partners of male patients taking ribavirin must practice two forms of effective contraception during to 6 months post-treatment

Note: the majority of side effects are from interferon and ribavirin

Side-effects

www.hcvadvocate.org


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 & side effect management

www.hcvadvocate.org


Patient Assistance Programs

  • Partnership for Prescription Assistance

    • www.pparx.org

  • Needy Meds: www.needymeds.org

  • HCSP Fact Sheet lists all the pharmaceutical patient assistance programs

  • www.hcvadvocate.org


    Experimental Therapies

    • Sofosbuvir plus ledipasvir submitted to FDA for approval (genotype 1) >90% cure rate

    • AbbVie interferon-free therapy phase 3 trials are completed and AbbVie is expected to apply for FDA approval soon. Approval expected 2014

    • HCV Advocate’s Drug Pipeline

    • www.clinicaltrials.gov – search button, type in: HCV

    www.hcvadvocate.org


    Complementary Medicine

    • Herbs – milk thistle, licorice root, etc.

      • Caution: St. Johns Wort should not be taken with an HCV Protease Inhibitor; Milk Thistle should not be taken with simeprevir/Olysio

    • Acupuncture / Acupressure

    • Traditional Chinese Medicine

    www.hcvadvocate.org


    Alcohol – Avoid or reduce

    Get vaccinated – Hep A & Hep B

    Healthy balanced diet

    Exercise

    Stress Reduction

    Support Groups

    Lifestyle Changes That Help!

    www.hcvadvocate.org


    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!

    www.hcvadvocate.org


    Resources –

    • HCV Advocate Newsletter

    • Education Materials in various languages

    • Over 200 fact sheets & guides

    • National Support Group Listing

    • Recommended links

    • Information on hepatitis C, hepatitis B, and HIV/HCV Coinfection

    www.hcvadvocate.org


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