Hepatitis C Overview. The Liver. Largest internal organ Approximately 3 lbs (men) Size of a football 1.5 quarts of blood flow through it every minute. Bile Immune System Chemical Factory- >500 chemical functions. Detoxifies Clotting Factors Hormones. Liver Functions.
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The Liver • Largest internal organ • Approximately 3 lbs (men) • Size of a football • 1.5 quarts of blood flow through it every minute
Bile Immune System Chemical Factory- >500 chemical functions Detoxifies Clotting Factors Hormones Liver Functions Regenerates Itself!
Keep Your Liver Healthy (Healthy People) • No more than: • 2 alcoholic drinks daily for men • 1 alcoholic drink daily for women • Be cautious about mixing drugs – especially with alcohol • Healthy, balanced diet • Get HAV & HBV vaccinations • Avoid toxic substances / fumes
3% of world has HCV (150-200 million) 3.9 Million in U.S. infected with HCV * Chronic – 2.7 Million in U.S. 8,000 to 10,000 in U.S. die of complications from HCV – in 10 years this # will triple HCV is the leading cause for liver transplants 50-80% of HCV infected become chronic Some Statistics * Does not include prisoners, homeless
U.S. Population 1.8% overall 2.1% Mexican-Americans 3.4 African Americans California 500,000 infected with HCV 85-95% - IDU’s Prison’s – 63,500 inmates infected or (41%) More Statistics
What Does It Mean? • Only 10-25% progress on to serious liver disease • Treatment choices do work for some • Hopefully better treatment options will be available within 5 years • Lifestyle changes can make a big difference
Diagnostic Tools • Elisa II / Riba – Test for anti-body • Hepatitis C RNA by PCR - >50 particles • Hep C RNA by branched DNA Assay – >2,000 particles • TMA – more sensitive, less expensive • Genotype (six major subtypes – 72% of U.S. population have genotype 1) • Liver Biopsy
Harm Reduction • Prevention – • Needle exchange – clean needles and drug preparation tools – cookers & cottons • Bleach – Does it work? • Safer Sex • Cover wounds
BREAST FEEDING SNEEZING HUGGING COUGHING FOOD OR WATER SHARING EATING UTENSILS OR DRINKING GLASSES CASUAL CONTACT HCV CAN NOT BE SPREAD BY:
Acute vs. Chronic Fatigue – mild to severe Flu-like symptoms (muscle/joint/fever) ‘Brain Fog’ Liver Pain Loss of appetite Headaches Gastro Problems Symptoms
Interferon – by injection - first FDA approved treatment (3 MU, thrice weekly for 48 weeks) Genotype 1 - 9% SVR Genotype other than 1 –30% SVR Treatment Medications
Interferon and Ribavirin • Intron A plus Rebetol • INF – 3 mu units, thrice weekly - Ribavirin 800-1200 mg daily • Genotype 1 – 12 mos – 29% SVR • Genotype 2 & 3 – 6 mos - 62% SVR
Schering- PEG-Intron Genotype 1 – 14% SVR Genotype 2 & 3 – 47% SVR Dosed by body weight - Needs reconstitution ROCHE – Pegasys Genotype – 1 – 23% SVR Genotype – 2 & 3 – 56% SVR Patients with Cirrhosis– 30% SVR Standard dose – does not need to be reconstituted Pegylated Interferon
Schering – PEG-Intron plus Rebetol Genotype 1 - 42% SVR high viral load - 30% SVR Genotype 2 & 3 - 82% SVR Roche – Pegasys plus Copegus Genotype 1 - 46-51% SVR high viral load - 41-45% SVR Genotype 2 & 3 - 76-78% SVR Pegylated IFN and Ribavirin
General Treatment Guidelines Healthy Active HCV Elevated ALT’s Compensated liver disease Optimal Response Younger Female Low visceral fat Low viral load Minimal liver damage Genotype 2 or 3 Treatment Decisions
Interferon Fatigue Muscle/Joint pain Nausea Headaches Anxiety Depression Dry Skin/rashes Ribavirin seems to make interferon side effects worse – especially fatigue-Anemia (both men & women must use birth control) 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
Experimental Therapies • Amantadine - pill • Maxamine – by injection (phase II studies) • Ribozymes • Helicase Inhibitors • Protease Inhibitors • Interleukin-10
Complementary Medicine • Herbs – milk thistle • Always check with your doctor and herbalist – some herbs are TOXIC • Acupuncture / Acupressure • Traditional Chinese Medicine
Alcohol – Avoid or reduce Get vaccinated – Hep A & Hep B Healthy balanced diet Exercise Stress Reduction Support Groups Lifestyle Changes That Help!
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
Do You want to take Proficiency Test Now ? • Yes • No