Hep 202

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Hep 202

• Just when you thought you knew everything.

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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

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Case Study Jane and Julia
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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?

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Hep 101 Overview
Liver inflammation

• Hepatitis

Virus that causes liver inflammation

• Viral Hepatitis

• Name 5 identified types of viral hepatitis

• Hepatitis C
• Name signs/symptoms, risk factors and prevention

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How Does Hep C Damage The Liver?
BC Hepatitis Services, 2003
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Hepatocellular Carcinoma
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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
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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

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Hepatitis C
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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
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More Info (cont)

• 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

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Health Canada, Hepatitis C Prevention, Support
and Research Program, 2002
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Health Canada, Hepatitis C Prevention, Support
and Research Program, 2002
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Health Canada, Hepatitis C Prevention, Support
and Research Program, 2002
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Health Canada, Hepatitis C Prevention, Support
and Research Program, 2002
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Health Canada, Hepatitis C Prevention, Support
and Research Program, 2002
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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

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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.

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Tests

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

Corneil, 2003
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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
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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
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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
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Milk Thistle Example
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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
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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

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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

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Treatment

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

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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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Questions?