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Hepatitis C Overview
www.hcvadvocate.org
April 2014 - 1
Introduction


Advocacy & Self-Advocacy through
Education
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
www.hcvadvocate.org
2
The Liver – A Chemical Factory




Largest internal organ
Size of a football
Approximately 3 lbs in the average
sized male
1.5 quarts of blood flow through it
every minute
www.hcvadvocate.org
3
Liver Functions
Chemical Factory>500 chemical
functions


Bile

Immune System

Detoxifies or Filters

Clotting Factors

Hormones
Regenerates Itself!
www.hcvadvocate.org
4
Keep the Liver Healthy!



If you have HCV – Avoid Alcohol
Avoid mixing drugs – prescription, overthe-counter, herbs/supplements and
street drugs
Eat a healthy, balanced diet based on
MyPlate (www.choosemyplate.gov)
www.hcvadvocate.org
5
Keep the liver healthy!

Get vaccinated!


HAV and HBV vaccines
Avoid toxic substances / fumes
www.hcvadvocate.org
6
Hepatitis C Statistics
U.S. Population


More than 3.9 million Americans
chronically infected
HCV Populations


~1.5 % to 2% Mexican Americans
~3 % African Americans
www.hcvadvocate.org
7
HCV Antibody tests

HCV Elisa II or III


OraQuick


Most common antibody test
whole blood and fingerprick approved
A positive antibody test indicates exposure

It does not indicate current hepatitis C infection

www.hcvadvocate.org
HCV viral load test performed to indicate active HCV
infection
8
Viral Load Tests

Viral Load tests




Hepatitis C RNA by PCR – > 5-10 IU/mL
HCV RNA by branched DNA Assay – > 615 IU/mL
TMA – > 5-10 IU/mL
Why Is a Viral Load Test Important?



To confirm active infection
Somewhat helps to predict treatment response & used to guide
treatment duration
Indication that treatment is working
** Viral load does not correlate with disease progression**
www.hcvadvocate.org
9
Genotype Test

Genotype (1,2,3,4,5,6 and 7)

U.S. population



70% genotype 1
30% genotypes 2 & 3
Why Is a Genotype Test Important?

Guide treatment, what drugs and
treatment duration
www.hcvadvocate.org
10
Liver Biopsy

Test for Determining the Health of the Liver




Measure inflammation, extent of scarring (if
any), Rule out other diseases
Biopsy procedure
Non-invasive markers of liver
inflammation – not yet perfected
FibroScan
www.hcvadvocate.org
11
Transmission- Prevention

Direct blood-to-blood transmission route

Can live on surfaces for up to 6 weeks


Bleach and other disinfectants kill virus,
but probably not inside the needle
Not spread casually – need blood
www.hcvadvocate.org
12
Transmission
Shared
Needles
All Drug
Paraphernalia
Blood Before
1992 - transfused,
Sexual
Transmission
(1-3%)
Mother to
Child 4-7%
Healthcare
Workers –
needle sticks
Shared Household items –
Tattoos /
Piercing
<10% of
routes can not
be identified
www.hcvadvocate.org
products, procedures
razors & toothbrushes
13
Prevention Tips

Injection and Non-Injection Drugs



Do not share needles, cookers, cottons, straws,
pipes, water or any items that might come into
contact with blood
Use bleach to clean – if no needle exchange is
available
People in Stable Long-Term Monogamous
Sexual Relationships

CDC – no need to change current sexual practices
– but there is a risk
www.hcvadvocate.org
14
Prevention Tips

Safer Sex

For so called “high risk groups”


www.hcvadvocate.org
Multiple sexual partners, people with sexually
transmitted diseases, infection with HIV or HBV
Any situation where blood is present
15
Prevention Tips

Mother-to-Child Transmission



Low risk – about 4-7% chance of hepatitis
being transmitted to infant
Given the low rate of transmission,
pregnancy should not be avoided.
Health-Care Settings

Follow standard (universal) precautions
www.hcvadvocate.org
16
Prevention Tips

Tattoos & Piercing

Considered a low/no risk in commercial
setting that practices safety


Make sure disposable needles and separate ink
pots are used and that general safety
precautions are followed
Considered a higher risk in other settings

www.hcvadvocate.org
Non-commercial settings such as in prison,
parties or on the streets
17
Shared Personal Items

Household



Cover cuts or sores
Do not share personal hygiene items
(toothbrushes, razors, etc.)
Professional Personal Care Settings



Standard precautions
Disposable equipment
Bring own equipment (best advice)
www.hcvadvocate.org
18
HCV CAN NOT BE SPREAD BY:

BREASTFEEDING


SNEEZING


HUGGING

COUGHING
www.hcvadvocate.org

FOOD OR WATER
SHARING EATING
UTENSILS OR
DRINKING GLASSES
CASUAL CONTACT
19
Chronic Symptoms



Fatigue – mild to
severe
Flu-like symptoms
(muscle/joint/fever)
‘Brain Fog’

www.hcvadvocate.org

Liver pain

Loss of appetite

Headaches

Gastro problems
and more……
20
Disease Progression

10-25% of HCV positive people
progress on to serious disease usually
over 10-40 years

Fibrosis


Cirrhosis


Light scarring
Compensated vs. decompensated
Steatosis

www.hcvadvocate.org
Fatty deposits in the liver
21
Treatment Decisions

General Treatment
Guidelines



Optimal Response

Stable Health

Active HCV Infection




Compensated Liver
Disease
www.hcvadvocate.org

CC genotype
Younger
Low BMI & Weight
Less Steatosis
Low Viral Load
Minimal Liver
Damage
22
Clinical Data - Treatment

Prospective – well designed clinical trial
with measurable outcomes


Gold Standard
Retrospective – review of data from
previous clinical trials

Important for looking for trends and for
designing future studies
www.hcvadvocate.org
23
Treatment

What is interferon?


What is ribavirin?


General antiviral – immune booster – injection
Antiviral - used only in combination with interferon - pill
or capsule
What is an HCV inhibitor

Direct Acting Antiviral (DAA) – blocks viral replication
www.hcvadvocate.org
24
Approved Medications

Interferon – Pegylated (long-acting interferon)

Ribavirin

HCV Inhibitors




Victrelis (boceprevir) – Merck
Incivek (telaprevir) – Vertex
Olysio (simeprevir) – Janssen
Solvadi (sofosbuvir) – Gilead
www.hcvadvocate.org
25
Treatment - Genotype 2 & 3

Standard of Care:

Sofosbuvir plus ribavirin

Genotype 2 – 12 weeks = 93% cure rate

Genotype 3 – 24 weeks = 84% cure rate
www.hcvadvocate.org
26
Genotype 1 • Standard of care:
• Cure rates up to 90%
• Treatment duration 12 to 48 weeks
• Simeprevir, pegylated interferon plus
ribavirin
• Sofosbuvir, ribavirin with and without
pegylated interferon
www.hcvadvocate.org
27
Side-effects
Fatigue
 Anemia
 Muscle/Joint pain
 Nausea
 Headaches
 Anxiety
 Depression
 Dry Skin
 Rashes
 Anal itching
 Photosensitivity
and more.....
www.hcvadvocate.org


Ribavirin can cause birth
defects– black box
warning:

Women of childbearing age, their
partners and female partners of
male patients taking ribavirin must
practice two forms of effective
contraception during to 6 months
post-treatment
Note: the majority of side effects
are from interferon and ribavirin
28
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
Key: support from medical providers, family, friends, work –
all areas of life & side effect management
www.hcvadvocate.org
29
Patient Assistance Programs

Partnership for Prescription Assistance



www.pparx.org
Needy Meds: www.needymeds.org
HCSP Fact Sheet lists all the pharmaceutical
patient assistance programs
Version 12.2
www.hcvadvocate.org
Experimental Therapies




Sofosbuvir plus ledipasvir submitted to FDA for
approval (genotype 1) >90% cure rate
AbbVie interferon-free therapy phase 3 trials are
completed and AbbVie is expected to apply for FDA
approval soon. Approval expected 2014
HCV Advocate’s Drug Pipeline
www.clinicaltrials.gov – search button, type in:
HCV
www.hcvadvocate.org
31
Complementary Medicine

Herbs – milk thistle, licorice root, etc.

Caution: St. Johns Wort should not be taken with an
HCV Protease Inhibitor; Milk Thistle should not be
taken with simeprevir/Olysio

Acupuncture / Acupressure

Traditional Chinese Medicine
www.hcvadvocate.org
32
Lifestyle Changes That Help!

Alcohol – Avoid or

Exercise

Stress Reduction

Support Groups
reduce


Get vaccinated –
Hep A & Hep B
Healthy balanced
diet
www.hcvadvocate.org
33
Advocate for Yourself!



Educate yourself
Establish a good
relationship with
your doctor
Bring an advocate
for doctor’s visits
www.hcvadvocate.org


Ask questions
Keep copies of all
medical tests

Keep a diary

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, and
HIV/HCV Coinfection
www.hcvadvocate.org
35