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Hep 202. Just when you thought you knew everything. Today We Will. Review Hepatitis 101 Take a more in-depth look at Hepatitis C Look at hepatitis C tests, nutrition, HIV co-infection, extra hepatic effects and treatment. Case Study Jane and Julia.

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Hep 202

Hep 202

Just when you thought you knew everything.


Today we will
Today We Will

  • Review Hepatitis 101

  • Take a more in-depth look at Hepatitis C

  • Look at hepatitis C tests, nutrition, HIV co-infection, extra hepatic effects and treatment


Case Study Jane and Julia


What Would You Tell Jane and Julia if You Were Bob?

Discuss in your groups:

  • What does hepatitis and viral hepatitis mean and what do you know about the five major types of viral hepatitis?

  • What are the signs and symptoms of hepatitis C?

  • What are the risk factors for hepatitis C and how can one prevent getting it?


Hep 101 overview
Hep 101 Overview

Liver inflammation

  • Hepatitis =

  • Hepatitis C

    • Name signs/symptoms, risk factors and prevention

Virus that causes

liver inflammation

  • Viral Hepatitis =

  • Name 5 identified types of viral hepatitis


How Does Hep C Damage The Liver?

BC Hepatitis Services, 2003



Viral Hepatitis

5 Major Identified Types:

A: oral-fecal transmission

B: sexual fluids & blood to blood

C: blood to blood

D: travels with B

E: oral-fecal transmission

Vaccine

Preventable

There are also other less common strains

Adapted from Corneil, 2003


Other types are being discovered
Other Types are Being Discovered!

  • Hepatitis G (HGV or HGBV-C)

    • Similar transmission to Hep C

    • Appears to cause chronic infection

    • Long term effects of virus on the liver still to be determined



More on hepatitis c
More on Hepatitis C

  • RNA Virus (Flaviviridae Family)

6 major variations maybe up to 11

+

50 to 90 subtypes

(e.g. Hepatitis C genotype 1 subtype B)

  • Type 1 is most common type found in North America

Unfortunately it is also the most difficult to treat


More info con t

Highly Debatable

More Info (con’t)

  • Other routes of transmission

    –Mother-to-child, breastfeeding, dialysis

  • Certain locations also increase risk

    • E.g. prisons because more individuals already have the virus than in general population







Tests
Tests Program, 2002

Screening:

Detects if the body has produce antibodies to Hepatitis C (anti-HCV)

1st test that is done when someone gets tested

  • Usually need a minimum of six weeks to detect antibodies. After 6 months 95% will have detectable antibodies


Tests1

Looks for virus RNA Program, 2002

Tests

  • Other tests are required to confirm the screening test and whether someone still has the virus

  • They look for the specific genotype and the amount of virus in the blood stream.


Tests2
Tests Program, 2002

  • Other tests are used to monitor liver function and damage

  • They include:

Corneil, 2003


Hepatitis c nutrition health tips
Hepatitis C Nutrition/Health Tips Program, 2002

  • Eat frequent smaller meals

  • Avoid Alcohol

  • May need to decrease iron intake

  • Protein intake may need to increase

    • 1-1.5g/kg/Day is generally recommended

Dieticians of Canada, Hepatitis C Nutrition Care, 2003


More tips
More Tips Program, 2002

  • Salt restrictions may need to be implemented depending on fluid retention

  • Consult with dietician or health care professional to best tailor needs

Dieticians of Canada, Hepatitis C Nutrition Care, 2003


Complimentary alternative therapies
Complimentary & Alternative Therapies Program, 2002

  • For the most part, are considered experimental due to lack of research

  • Some herbs have shown to have some benefit

    • E.g. Milk Thistle (Silymarin)

  • Just because herbs are natural does not mean they are all safe some can harm the liver!

Dieticians of Canada, Hepatitis C Nutrition Care, 2003


Milk Thistle Example Program, 2002


Other hcv related conditions
Other HCV-related conditions Program, 2002

These may occur when the immune system tries to fight off the virus

Dead antibodies deposit in the body causing

Blood & Kidney Disorders

Toxins in the blood may

deposit in the body

causing:

Skin Disorders

Mental Disorders


Hiv co infection
HIV Co-infection Program, 2002

Appears to increase rate of liver scarring and long-term

complications such as cirrhosis

Seems to

speed up

the rate of

viral

replication


Treatment
Treatment Program, 2002

Goal is to achieve a sustained virological response (SVR)

  • Means that virus RNA is no longer detectable after treatment over a sustained period of time (will still have antibodies)

    More likely to achieve a SVR if:

  • Treating genotype other than genotype 1

  • Low viral levels and liver damage at treatment onset

  • Low body weight or surface area


Treatment1

Pegylated Program, 2002

Interferon

+

Ribavirin

Treatment

  • Best treatment currently available is a combination of two antiviral drugs:


Treatment2
Treatment Program, 2002

  • Side effects can include:

    • Depression

    • Flu-like symptoms

  • Some cannot complete treatment due to side effects

  • Others may not qualify because

    • Liver is too damaged

    • Addicted to drugs and/or alcohol


Questions? Program, 2002


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