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Hepatitis C Overview

• Patricia Perkins, MS, MPH• Tri City Institute: Los Angeles, CA• www.pperkins.org

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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-

>500 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% - IDU’s

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 - >50 particles Hep C RNA by branched DNA Assay –

>200,000 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

<10% of routes can not be identified

Tattoos / Piercing

Neonatal – <5%

Shared House-hold items – razors & toothbrushes

Healthcare workers – needle sticks

Sexual Transmission(1-3%)

Blood before 1992 - transfused, products, procedures

All Drug Paraphernalia

Shared Needles

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Harm Reduction Prevention –

Needle exchange – clean needles and drug preparation tools – cookers & cottons

Bleach – Does it work? 10 minutes!

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 Interferon and ribavirin(capsule)-

‘combo therapy’ INF – 3 mu units, thrice weekly -

Ribavirin 800-1200 mg daily Overall SVR up to 45% Genotype 1 – 12 mos – 29% SVR Genotype Non 1 – 6 mos - 62% SVR

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Pegylated Interferon Schering- PEG-Intron

Approved by FDA – 1-2001 25% sustained response rate

Genotype 1 – 14% Genotype 2 & 3 – 47%

ROCHE – Pegasys – FDA approval pending 39% sustained response rate

Genotype – 1 – 28% Genotype – 2 & 3 – 56%

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Pegylated and Ribavirin Schering – PEG-Intron plus ribavirin

Phase III clinical data – 54% sustained response rates

One group improved SVR - Genotype 1 low viral load FDA Approved

Roche – Pegasys plus ribavirin Phase III clinical data – 56% sustained response

rate – Genotype 1 – 46% - Genotype 2-3, 76% Pending FDA Approval

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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

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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

Get vaccinated – Hep A & Hep B

Healthy balanced diet

Exercise

Stress Reduction

Support Groups

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Advocate for Yourself and Your Client! 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

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Conclusions