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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
slide4

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
slide6

How Does Hep C Damage The Liver?

BC Hepatitis Services, 2003

slide8

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

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

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
  • Other tests are used to monitor liver function and damage
  • They include:

Corneil, 2003

hepatitis c nutrition health tips
Hepatitis C Nutrition/Health Tips
  • 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
  • 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
  • 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

other hcv related conditions
Other HCV-related conditions

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

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

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

Interferon

+

Ribavirin

Treatment
  • Best treatment currently available is a combination of two antiviral drugs:
treatment2
Treatment
  • 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
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