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

Hepatitis C Overview

www.hcvadvocate.org


Introduction

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

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


Liver functions

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

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 healthy1

Keep the liver healthy!

  • Get vaccinated!

    • HAV and HBV vaccines

  • Avoid toxic substances / fumes

www.hcvadvocate.org


Hepatitis c statistics

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 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

  • 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 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

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

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

Transmission

www.hcvadvocate.org


Prevention tips

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 tips1

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 tips2

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 tips3

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

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


Hcv can not be spread by

BREASTFEEDING

SNEEZING

HUGGING

COUGHING

FOOD OR WATER

SHARING EATING UTENSILS OR DRINKING GLASSES

CASUAL CONTACT

HCV CAN NOT BE SPREAD BY:

www.hcvadvocate.org


Chronic symptoms

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

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


Treatment decisions

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

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

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

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


Treatment genotype 2 3

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

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


Side effects

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


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

Managing Side-Effects

Key: support from medical providers, family, friends, work – all areas of life & side effect management

www.hcvadvocate.org


Hepatitis c overview

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

    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

    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


    Lifestyle changes that help

    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


    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

    Advocate for Yourself!

    www.hcvadvocate.org


    Resources

    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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