Hepatitis C Overview

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Hepatitis C Overview
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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

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Liver Functions

• Bile
• Immune System
• Chemical Factory-
• gt500 chemical functions

• Detoxifies
• Clotting Factors
• Hormones

Regenerates Itself!
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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

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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

Does not include prisoners, homeless
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More Statistics

• U.S. Population
• 1.8 overall
• 2.1 Mexican-Americans
• 3.4 African Americans

• California
• 500,000 infected with HCV
• 85-95 - IDUs
• Prisons 63,500 inmates infected or (41)

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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

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Diagnostic Tools

• Elisa II / Riba Test for anti-body
• Hepatitis C RNA by PCR - gt50 particles
• Hep C RNA by branched DNA Assay gt2,000
  particles
• TMA more sensitive, less expensive
• Genotype (six major subtypes 72 of U.S.
  population have genotype 1)
• Liver Biopsy

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Transmission / Prevention
Shared Needles All Drug Paraphernalia Blood before 1992 - transfused, products, procedures
Sexual Transmission (1-3) Healthcare workers needle sticks Shared House-hold items razors toothbrushes
Neonatal lt5 Tattoos / Piercing lt10 of routes can not be identified
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Harm Reduction

• Prevention
• Needle exchange clean needles and
  drug preparation tools cookers cottons
• Bleach Does it work?
• Safer Sex
• Cover wounds

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HCV CAN NOT BE SPREAD BY

• BREAST FEEDING
• SNEEZING
• HUGGING
• COUGHING

• FOOD OR WATER
• SHARING EATING UTENSILS OR DRINKING GLASSES
• CASUAL CONTACT

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Symptoms

• Acute vs. Chronic
• Fatigue mild to severe
• Flu-like symptoms (muscle/joint/fever)
• Brain Fog

• Liver Pain
• Loss of appetite
• Headaches
• Gastro Problems

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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

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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

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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

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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

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Treatment Decisions

• General Treatment Guidelines
• Healthy
• Active HCV
• Elevated ALTs
• Compensated liver disease

• Optimal Response
• Younger
• Female
• Low visceral fat
• Low viral load
• Minimal liver damage
• Genotype 2 or 3

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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)

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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

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Experimental Therapies

• Amantadine - pill
• Maxamine by injection (phase II studies)
• Ribozymes
• Helicase Inhibitors
• Protease Inhibitors
• Interleukin-10

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Complementary Medicine

• Herbs milk thistle
• Always check with your doctor and herbalist
  some herbs are TOXIC
• Acupuncture / Acupressure
• Traditional Chinese Medicine

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Lifestyle Changes That Help!

• Alcohol Avoid or reduce
• Get vaccinated Hep A Hep B
• Healthy balanced diet

• Exercise
• Stress Reduction
• Support Groups

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Advocate for Yourself!

• Educate yourself
• Establish a good relationship with your doctor
• Bring an advocate for doctors visits
• Ask questions
• Keep copies of all medical tests
• Keep a diary
• Keep an open mind

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Do You want to take Proficiency Test Now ?

• Yes
• No