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Hepatitis C Overview

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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Hepatitis C Overview

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  1. Hepatitis C Overview

  2. The Liver • Largest internal organ • Approximately 3 lbs (men) • Size of a football • 1.5 quarts of blood flow through it every minute

  3. Bile Immune System Chemical Factory- >500 chemical functions Detoxifies Clotting Factors Hormones Liver Functions Regenerates Itself!

  4. 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

  5. 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

  6. 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

  7. 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

  8. 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

  9. Transmission / Prevention

  10. Harm Reduction • Prevention – • Needle exchange – clean needles and drug preparation tools – cookers & cottons • Bleach – Does it work? • Safer Sex • Cover wounds

  11. BREAST FEEDING SNEEZING HUGGING COUGHING FOOD OR WATER SHARING EATING UTENSILS OR DRINKING GLASSES CASUAL CONTACT HCV CAN NOT BE SPREAD BY:

  12. Acute vs. Chronic Fatigue – mild to severe Flu-like symptoms (muscle/joint/fever) ‘Brain Fog’ Liver Pain Loss of appetite Headaches Gastro Problems Symptoms

  13. 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

  14. 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

  15. 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

  16. 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

  17. 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

  18. 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

  19. 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

  20. Experimental Therapies • Amantadine - pill • Maxamine – by injection (phase II studies) • Ribozymes • Helicase Inhibitors • Protease Inhibitors • Interleukin-10

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

  22. Alcohol – Avoid or reduce Get vaccinated – Hep A & Hep B Healthy balanced diet Exercise Stress Reduction Support Groups Lifestyle Changes That Help!

  23. 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

  24. Do You want to take Proficiency Test Now ? • Yes • No

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