Hepatitis C

1. Hepatitis C

2. What is Hepatitis? • Hepatitis: A general term meaning inflammation of the liver • Hepatitis can be caused by: • Alcohol • Drugs • Chemicals • Toxins • Autoimmunity (your immune system attacks your own body) • Viral infections

3. Overview of the Liver • Largest internal organ • Has over 500 vital functions • Involved in many digestive, vascular, and metabolic activities

4. What does the Liver do? • Functions as the body's chemical processing plant • Stores iron, vitamins, minerals, sugars • Produces bile, cholesterol, lymph • Regulates blood clotting, glucose, hormone levels • Cleans the blood of bacteria and toxins • Processes food, alcohol, drugs • Converts food and drink into forms the body can use • Oxidizes triglycerides to produce energy

5. What does the Liver do? Basically, the liver processes everything we eat, drink, swallow, breathe, and/or absorb!

6. Hepatitis C • Caused by the hepatitis C virus (HCV) • Incubation period 6-7 weeks • Often no signs or symptoms • About 4.1 million in U.S have been infected • Estimated 115,000 infected in WA • About 55-85% of adults have chronic infection

7. HCV Transmission • Primarily transmitted via direct blood-to-blood contact • highly infectious • Stable in environment for at least 16 hours but no longer than 4 days • Most common transmission through the sharing of drug paraphernalia

8. HCV Transmission cont. • Also blood transfusions & products before 1992 • Perinatal transmission • Needle stick/healthcare exposure • Other blood risks low/unknown risk • tattooing/piercing • intranasal cocaine use • shared personal items

9. Prevention of HCV Transmission • Avoid blood exposure: • New syringe, cooker, cotton etc. every time for injection • Use universal precautions • Don't share personal items that may contain blood (toothbrush/razor) • Use barriers and lubricants • Cover open cuts and wounds • Ensure instruments used for tattooing, piercing, and accupuncture are new or sterilized

10. HCV Transmission: Sharing Injection Equipment • Studies have found high rates of HCV in IDUs who didn't share syringe, but shared cooker, cotton, water or other paraphernalia • People who inject other things (steroids, vitamins, hormones) may also be at risk • IDUs should use new, sterile equipment every time • clean hands, injection site and surface too • Unknown if bleach kills HCV

11. HCV Transmission: Mother-to-Infant • 5-6% risk with pregnancy • post exposure prophylaxis not available • co-infection with HIV risk increases up to 17% • Test infants born to HCV-positive women • consider testing any children born since women became infected • evaluate infected children for chronic disease • Breastfeeding ok unless nipples are cracked and/or bleeding

12. HCV Transmission: Low/Unknown Risks • Intranasal cocaine/meth use • Some studies have found link to HCV transmission by blood getting into nasal membrane from shared snorting items • Crack use • At least one study (Schaefer) found higher rate of HCV in non-injecting crack users who indicated cracked, bleeding or burned lips • Personal items with blood on them • Anything that cuts/breaks the skin or membreane • Razors, clippers, toothbrush

13. Hepatitis C and Your Liver • What does it do to the liver? • Causes inflammation • Becomes sensitive to alcohol • Causes blood sugars to rise • Linked to high cholesterol • Want to avoid • Scarring • Cirrhosis • About 20% of cases • Hepatocarcinoma

14. Chronic Hepatitis C • Factors promoting progression • Alcohol intake • Age >40 at the time of infection • HIV or HBV co-infection • Male gender • Vaccinate for HAV/HBV when appropriate! • HCV leads to about 10,000 deaths per year from chronic liver disease

15. Symptoms of Chronic Hepatitis • Fatigue • Depression • Loss of appetite • Nausea/indegestion • Muscle/joint pain • Mood swings • "Brain fog" • Abdominal pain • Fever

16. Symptoms of Late Stage Hepatitis with Cirrhosis • All of the symptoms of Hepatitis C with addition of: • Vomiting • Jaundice • Cognitive dysfunction • Fluid retention • Frequent urination • Lack of concentration • Confusion • Dizziness

17. Co-infection: HCV/HIV • Up to 1/3 of those living with HIV also have HCV • 1/10 of those with HCV have HIV • HIV positive persons with IDU risk who have tested negative for anti-HCV may want to have viral test • HCV considered OI in people living with HIV • HIV infection may promote HCV disease progression • Anti-HIV medications may cause hepatitis • Especially in those with viral hepatitis

18. Supporting a Healthy Liver • Drink water • Do not drink alcohol • Get vaccinated against hepatitis A & B • Eat a healthy diet • Exercise • Reduce stress • Minimize contact with other toxins • Check with your health provider before starting new medications

19. Alcohol & the liver • Avoid alcohol! • Will accelerate liver injury • May kill cells & cause oxidative damage • Decreases effectiveness of interferon

20. Keep Your Liver Healthy! • Eat low-fat, low-cholesterol • < 30% of calories from fat, ~ 65g a day • < 10% of calories from saturated fat • Fat can be malabsorbed • High fat intake can lead to infections • High saturated fat intake can lead to increased heart disease risk

21. Keep Your Liver Healthy! • Eat carbs in moderation • 50-55% of calories, ~ 300g a day • Eat whole grains • Check the label for fiber! • Wheat bread, brown rice, whole wheat pasta, whole grain cereals

22. Keep Your Liver Healthy! • Eat protein • 15-20% of calories, ~ 75-100g a day • less with acute liver failure • Eat enough calories daily • Target ~ 3,000 cal/day • Prevent breaking down body tissues for energy • Try omega-3 fats • Decreases inflammation • Wild tuna, wild salmon, walnuts, flaxseed

23. Keep Your Liver Healthy! • Try Antioxidants • Bright colored fruits and vegetables • Red grapes, pomegranate, melons, apples, broccoli, cabbage, cauliflower, onion, bell peppers • Eat small, frequent meals • Relieves burden of the liver to store extra carbohydrate calories • Maintain a healthy weight • High Body Mass Index (BMI) • Linked to poor recovery • Increases diabetes risk

24. Patient Support Programs • Hepatitis C Case Management Program • Free Assistance with medical resourced in Washington State • Aid in locating places that provide care, treatment, services • Aid in finding financial aid for treatment & testing • Patient assistance programs via Pharmaceutical companies • DSHS • Charity Care

25. Patient Support Programs • Pharmaceutical companies offer assistance programs • Genentech Access Solutions • Ships medications free of charge to those who qualify • based on household income • Pegasys Access to Care • Possible medication free of charge to those who qualify • Many hospitals provide charity assistance programs to uninsured • KVCH • Harborview • Virginia Mason

26. Psychosocial Support • Friends and family • Support groups • Hotlines • Internet • Most providers who treat will ask for psych assessment and refer to counseling

27. Local Support Groups • Yakima • Wellness House210 S. 11th Ave • Wenatchee • Wellness Place 208 N. Chelan • Seattle • HEP Resource Center 911 Western Ave #302

28. Chronic Hepatitis & Transmission Prevention • Do not donate blood, body organs, other tissue, or semen • Do not share personal items that might have blood on them • razor, toothbrush, clippers • Cover cuts and sores on the skin • Never reuse or share syringes, needlesm cottons, cookers and water • Use barriers for sexual intercourse. • For those with HCV and one long-term partner, should discuss with partner to make decision about condom use

29. Chronic Hepatitis & Transmission Prevention • HCV is not spread by • sneezing, hugging, coughing, sharing eating utensils or drinking glasses, or casual contact • HCV positive persons should not be excluded from work, school, play, child-care or other settings on the basis of their HCV status