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Hepatitis C Overview - PowerPoint PPT Presentation


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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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Presentation Transcript
the liver
The Liver
  • Largest internal organ
  • Approximately 3 lbs (men)
  • Size of a football
  • 1.5 quarts of blood flow through it every minute
liver functions
Bile

Immune System

Chemical Factory-

>500 chemical functions

Detoxifies

Clotting Factors

Hormones

Liver Functions

Regenerates Itself!

keep your liver healthy healthy people
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
some statistics
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

more statistics
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
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
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
Harm Reduction
  • Prevention –
    • Needle exchange – clean needles and drug preparation tools – cookers & cottons
    • Bleach – Does it work?
    • Safer Sex
    • Cover wounds
hcv can not be spread by
BREAST FEEDING

SNEEZING

HUGGING

COUGHING

FOOD OR WATER

SHARING EATING UTENSILS OR DRINKING GLASSES

CASUAL CONTACT

HCV CAN NOT BE SPREAD BY:
symptoms
Acute vs. Chronic

Fatigue – mild to severe

Flu-like symptoms (muscle/joint/fever)

‘Brain Fog’

Liver Pain

Loss of appetite

Headaches

Gastro Problems

Symptoms
treatment medications
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
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
pegylated interferon
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
pegylated ifn and ribavirin
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
treatment decisions
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
side effects
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
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
experimental therapies
Experimental Therapies
  • Amantadine - pill
  • Maxamine – by injection (phase II studies)
  • Ribozymes
  • Helicase Inhibitors
  • Protease Inhibitors
  • Interleukin-10
complementary medicine
Complementary Medicine
  • Herbs – milk thistle
    • Always check with your doctor and herbalist – some herbs are TOXIC
  • Acupuncture / Acupressure
  • Traditional Chinese Medicine
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!
advocate for yourself
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