Hepatitis C Overview 2011 - HCV Advocate

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					Hepatitis C Overview




                       1
    Introduction


n   Self-Advocacy through Education

n   The information in this presentation is designed to help
    you understand and manage HCV and is not intended as
    medical advice. HCV medical care is a partnership
    between patients and their medical providers


                                                          2
The Liver – A Chemical Factory
n   Largest internal organ
n   Size of a football
n   Approximately 3 lbs in the average
    sized male
n   1.5 quarts of blood flow through it
    every minute


                                          3
Liver Functions
nChemical Factory-      n   Detoxifies or Filters
>500 chemical
 functions              n   Clotting Factors

n   Bile                n   Hormones

n   Immune System
            Regenerates Itself!
                                                4
Keep the Liver Healthy!

n   If you have HCV – Avoid Alcohol

n   Avoid mixing drugs – prescription, over-
    the-counter, herbs/supplements and
    street drugs

n   Eat a healthy, balanced diet based on
    MyPlate (www.myplate.gov)

                                            5
Keep the liver healthy!
n   Get vaccinated!
    n   HAV and HBV vaccines


n   Avoid toxic substances / fumes




                                     6
Hepatitis C Statistics
               U.S. Population

n   1.8% overall
    n   Up to 3.9 million chronically infected


n   HCV Populations
    n   2.1% Mexican Americans
    n   3.4% African Americans



                                                 7
HCV Antibody tests
n   HCV Elisa II or III
    n   Most common antibody test
n   HCV RIBA
    n   Usually only performed on people with no history
        of risk factors or if results are indeterminate
n   OraQuick
    n   whole blood and fingerprick approved – waiting
        for oral swab approval
n   A positive antibody test indicates exposure
    n   It does not indicate current hepatitis C infection
         n   HCV viral load test performed to indicate active HCV
             infection                                              8
        Viral Load Tests
n   Viral Load tests
    n   Hepatitis C RNA by PCR – > 5-10 IU/mL
    n   HCV RNA by branched DNA Assay – > 615 IU/mL
    n   TMA – > 5-10 IU/mL

n   Why Is a Viral Load Test Important?
    n   To confirm active infection
    n   Helps to predict treatment response & used to guide treatment
        duration
    n   Indication that treatment is working

    ** Viral load does not correlate with disease progression**
                                                                        9
Genotype Test
n   Genotype (1,2,3,4,5,6)
    n   U.S. population
         n   70% genotype 1
         n   30% genotypes 2 & 3


n   Why Is a Genotype Test Important?
    n   Guide treatment, what drugs and
        treatment duration

                                          10
        Liver Biopsy
n   Gold Standard for Determining the Health of
    the Liver
    n   Measure inflammation
    n   Extent of scarring (if any)
    n   Rule out other diseases
    n   Biopsy procedure
n   Non-invasive markers of liver
    inflammation – not yet perfected
                                                  11
Transmission- Prevention

n   Direct blood-to-blood transmission route

n   Not spread casually




                                         12
  Transmission
Shared            All Drug        Blood Before
Needles           Paraphernalia   1992 - transfused,
                                  products, procedures

Sexual            Healthcare      Shared House-
Transmission      Workers –       hold items –
(1-3%)            needle sticks   razors & toothbrushes

Mother to Child   Tattoos /       <10% of
<5%               Piercing        routes can not
                                  be identified
                                                          13
Prevention Tips
n   Injection and Non-Injection Drugs
    n   Do not share needles, cookers, cottons,
        straws, pipes, water or any items that might
        come into contact with blood
    n   Use bleach to clean –if no needle exchange is
        available
n   People in Stable Long-Term
    Monogamous Sexual Relationships
    n   CDC – no need to change current sexual
        practices – but there is a risk
                                                   14
Prevention Tips
n   Safer Sex
    n   For so called “high risk groups”
         n   Multiple sexual partners, people with sexually
             transmitted diseases, infection with HIV or HBV
         n   Any situation where blood is present




                                                         15
Prevention Tips
n   Mother-to-Child Transmission
    n   Low risk – about 4-7% chance of hepatitis
        being transmitted to infant
    n   Given the low rate of transmission,
        pregnancy should not be avoided.
n   Health-Care Settings
    n   Follow standard precautions


                                               16
Prevention Tips
n   Tattoos & Piercing
    n   Considered a low risk in commercial setting
         n   Make sure disposable needles and separate ink
             pots are used and that general safety
             precautions are followed
    n   Considered a higher risk in other settings
         n   Non-commercial settings such as in prison,
             parties or on the streets


                                                          17
Shared Personal Items
n   Household
    n   Cover cuts or sores
    n   Do not share personal hygiene items
        (toothbrushes, razors, etc.)
n   Professional Personal Care Settings
    n   Standard precautions
    n   Disposable equipment
    n   Bring own equipment (best advice)

                                              18
HCV CAN NOT BE SPREAD BY:

n   BREASTFEEDING   n   FOOD OR WATER

n   SNEEZING        n   SHARING EATING
                        UTENSILS OR
n   HUGGING             DRINKING GLASSES


n   COUGHING        n   CASUAL CONTACT


                                        19
Chronic Symptoms
n   Fatigue – mild to        n   Liver pain
    severe
                             n   Loss of appetite
n   Flu-like symptoms
    (muscle/joint/fever)     n   Headaches


n   ‘Brain Fog’              n   Gastro problems

            n   and more……
                                                    20
Disease Progression
n   10-25% of HCV positive people
    progress on to serious disease usually
    over 10-40 years
    n   Fibrosis
         n   Light scarring
    n   Cirrhosis
         n   Compensated vs. decompensated
    n   Steatosis
         n   Fatty deposits in the liver

                                             21
Treatment Decisions
n   General Treatment          n   Optimal Response
    Guidelines                     n   CC genotype
                                   n   Younger
    n   Stable Health              n   Female
                                   n   Low BMI & Weight
    n   Active HCV Infection
                                   n   Less Steatosis
    n   Compensated Liver          n   Low Viral Load
        Disease                    n   Minimal Liver
                                       Damage

                                                      22
Clinical Data - Treatment
n   Prospective – well designed clinical trial
    with measurable outcomes
    n   Gold Standard

n   Retrospective – review of data from
    previous clinical trials
    n   Important for looking for trends and for
        designing future studies

                                                   23
        Treatment
n   What is interferon?
    n   General antiviral – immune booster – injection

n   What is ribavirin?
    n   Antiviral - used only in combination with interferon - Pill
        or capsule

n   What is an HCV protease inhibitor
    n   Direct Acting Antiviral (DAA) – only used in combination
        with interferon and ribavirin – blocks viral replication

                                                                 24
        Approved Medications
n   Interferon
n   Pegylated interferon –
    n   Pegasys (pegylated interferon alpha 2a) – Genentech
    n   PegIntron (pegylated interferon alpha 2b) – Merck

n   Ribavirin
n   HCV Protease Inhibitors
    n   Victrelis (boceprevir) – Merck
    n   Incivek (telaprevir) – Vertex
                                                              25
        Treatment -
n   Genotype 2, 3:

    n   Merck – PegIntron + ribavirin (800mg)

    n   Genentech – Pegasys + ribavirin (800 mg)

    n   Cure rates up to 82%


                                                   26
   Genotype 1 -

• Triple combination of an HCV protease inhibitor
  (PI), pegylated interferon and ribavirin

• Victrelis (boceprevir)

• Incivek (telaprevir)

• Cure rates up to ~79%

• Caution: HCV PI’s should never be used as a
  mono-therapy
                                                    27
Side-effects
  n   Fatigue             n   Ribavirin can cause
  n   Anemia                  birth defects– black
  n   Muscle/Joint pain       box warning:
  n   Nausea
  n   Headaches               n   Women of childbearing age,
  n   Anxiety                     their partners and female
  n   Depression                  partners of male patients
                                  taking ribavirin must practice
  n   Dry Skin                    two forms of effective
  n   Rashes                      contraception during to 6
  n   Anal itching                months post-treatment
  n   And more.....
                                                            28
      Managing Side-Effects
      n   Inject before            n   Light exercise
          bedtime                  n   Daily moisturizing
      n   Drink lots of water      n   Vary injection sites
      n   Low doses of             n   Anti-Depressants
          ibuprofen or             n   Plenty of rest
          acetaminophen
                                   n   Frequent small
      n   Pain medications             meals
Key: support from medical providers, family, friends, work –
all areas of life & side effect management
                                                          29
                     Patient Assistance Programs


n   Partnership for Prescription Assistance
        n   www.pparx.org

n   Needy Meds: www.needymeds.org
n   Genentech: www.genentechaccesssolutions.com
n   Merck: www.merck-cares.com
n   Vertex: www.vrtx.com

      Version 12.2
       Experimental Therapies
n   Combinations of HCV Protease Inhibitors, HCV
    Polymerase Inhibitors, NS5a Inhibitors, with and
    without interferon
n   Newer forms of interferon (PEG lambda), and
    studies are being conducted without interferon
n   HCV Advocate’s Drug Pipeline
n   www.clinicaltrials.gov – search button, type in:
    HCV
                                                       31
Complementary Medicine
n   Herbs – milk thistle, licorice root, etc.
    n   Always check with your doctor and
        herbalist – some herbs are unsafe
n   Caution: St. Johns Wort should not be
    taken with an HCV Protease Inhibitor
n   Acupuncture / Acupressure
n   Traditional Chinese Medicine

                                                32
    Lifestyle Changes That Help!
n   Alcohol – Avoid or   n   Exercise
    reduce
                         n   Stress Reduction
n   Get vaccinated –
    Hep A & Hep B
                         n   Support Groups

n   Healthy balanced
    diet

                                                33
Advocate for Yourself!
n   Educate yourself      n   Ask questions

n   Establish a good      n   Keep copies of all
    relationship with         medical tests
    your doctor
                          n   Keep a diary
n   Bring an advocate
    for doctor’s visits   n   Keep an open mind

                                                   34
 Resources –
• HCV Advocate Newsletter
• Education Materials in various languages
• Over 200 fact sheets & guides
• National Support Group Listing
• Recommended links
• Information on hepatitis C, hepatitis B,
  HIV/HCV Coinfection



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