Download Hepatitis C Overview 2014

Hepatitis C Overview
www.hcvadvocate.org
April 2014 - 1
Introduction
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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
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The Liver – A Chemical Factory
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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
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Liver Functions
Chemical Factory>500 chemical
functions
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Bile
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Immune System
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Detoxifies or Filters
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Clotting Factors
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Hormones
Regenerates Itself!
www.hcvadvocate.org
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Keep the Liver Healthy!
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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
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Keep the liver healthy!
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Get vaccinated!
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HAV and HBV vaccines
Avoid toxic substances / fumes
www.hcvadvocate.org
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Hepatitis C Statistics
U.S. Population
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More than 3.9 million Americans
chronically infected
HCV Populations
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~1.5 % to 2% Mexican Americans
~3 % African Americans
www.hcvadvocate.org
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HCV Antibody tests
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HCV Elisa II or III
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OraQuick
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Most common antibody test
whole blood and fingerprick approved
A positive antibody test indicates exposure
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It does not indicate current hepatitis C infection
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www.hcvadvocate.org
HCV viral load test performed to indicate active HCV
infection
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Viral Load Tests
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Viral Load tests
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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?
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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
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Genotype Test
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Genotype (1,2,3,4,5,6 and 7)
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U.S. population
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70% genotype 1
30% genotypes 2 & 3
Why Is a Genotype Test Important?
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Guide treatment, what drugs and
treatment duration
www.hcvadvocate.org
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Liver Biopsy
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Test for Determining the Health of the Liver
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Measure inflammation, extent of scarring (if
any), Rule out other diseases
Biopsy procedure
Non-invasive markers of liver
inflammation – not yet perfected
FibroScan
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Transmission- Prevention
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Direct blood-to-blood transmission route
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Can live on surfaces for up to 6 weeks
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Bleach and other disinfectants kill virus,
but probably not inside the needle
Not spread casually – need blood
www.hcvadvocate.org
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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
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products, procedures
razors & toothbrushes
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Prevention Tips
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Injection and Non-Injection Drugs
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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
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CDC – no need to change current sexual practices
– but there is a risk
www.hcvadvocate.org
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Prevention Tips
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Safer Sex
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For so called “high risk groups”
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www.hcvadvocate.org
Multiple sexual partners, people with sexually
transmitted diseases, infection with HIV or HBV
Any situation where blood is present
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Prevention Tips
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Mother-to-Child Transmission
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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
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Follow standard (universal) precautions
www.hcvadvocate.org
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Prevention Tips
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Tattoos & Piercing
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Considered a low/no risk in commercial
setting that practices safety
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Make sure disposable needles and separate ink
pots are used and that general safety
precautions are followed
Considered a higher risk in other settings
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www.hcvadvocate.org
Non-commercial settings such as in prison,
parties or on the streets
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Shared Personal Items
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Household
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Cover cuts or sores
Do not share personal hygiene items
(toothbrushes, razors, etc.)
Professional Personal Care Settings
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Standard precautions
Disposable equipment
Bring own equipment (best advice)
www.hcvadvocate.org
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HCV CAN NOT BE SPREAD BY:
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BREASTFEEDING
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SNEEZING
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HUGGING
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COUGHING
www.hcvadvocate.org
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FOOD OR WATER
SHARING EATING
UTENSILS OR
DRINKING GLASSES
CASUAL CONTACT
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Chronic Symptoms
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Fatigue – mild to
severe
Flu-like symptoms
(muscle/joint/fever)
‘Brain Fog’
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www.hcvadvocate.org
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Liver pain
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Loss of appetite
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Headaches
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Gastro problems
and more……
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Disease Progression
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10-25% of HCV positive people
progress on to serious disease usually
over 10-40 years
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Fibrosis
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Cirrhosis
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Light scarring
Compensated vs. decompensated
Steatosis
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www.hcvadvocate.org
Fatty deposits in the liver
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Treatment Decisions
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General Treatment
Guidelines
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Optimal Response
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Stable Health
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Active HCV Infection
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Compensated Liver
Disease
www.hcvadvocate.org
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CC genotype
Younger
Low BMI & Weight
Less Steatosis
Low Viral Load
Minimal Liver
Damage
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Clinical Data - Treatment
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Prospective – well designed clinical trial
with measurable outcomes
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Gold Standard
Retrospective – review of data from
previous clinical trials
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Important for looking for trends and for
designing future studies
www.hcvadvocate.org
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Treatment
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What is interferon?
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What is ribavirin?
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General antiviral – immune booster – injection
Antiviral - used only in combination with interferon - pill
or capsule
What is an HCV inhibitor
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Direct Acting Antiviral (DAA) – blocks viral replication
www.hcvadvocate.org
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Approved Medications
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Interferon – Pegylated (long-acting interferon)
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Ribavirin
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HCV Inhibitors
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Victrelis (boceprevir) – Merck
Incivek (telaprevir) – Vertex
Olysio (simeprevir) – Janssen
Solvadi (sofosbuvir) – Gilead
www.hcvadvocate.org
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Treatment - Genotype 2 & 3
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Standard of Care:
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Sofosbuvir plus ribavirin
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Genotype 2 – 12 weeks = 93% cure rate
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Genotype 3 – 24 weeks = 84% cure rate
www.hcvadvocate.org
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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
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Side-effects
Fatigue
 Anemia
 Muscle/Joint pain
 Nausea
 Headaches
 Anxiety
 Depression
 Dry Skin
 Rashes
 Anal itching
 Photosensitivity
and more.....
www.hcvadvocate.org
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Ribavirin can cause birth
defects– black box
warning:
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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
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Managing Side-Effects
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Inject before
bedtime
Drink lots of water
Low doses of
ibuprofen or
acetaminophen
Pain medications
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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
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Patient Assistance Programs
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Partnership for Prescription Assistance
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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
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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
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Complementary Medicine
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Herbs – milk thistle, licorice root, etc.
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Caution: St. Johns Wort should not be taken with an
HCV Protease Inhibitor; Milk Thistle should not be
taken with simeprevir/Olysio
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Acupuncture / Acupressure
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Traditional Chinese Medicine
www.hcvadvocate.org
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Lifestyle Changes That Help!
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Alcohol – Avoid or
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Exercise
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Stress Reduction
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Support Groups
reduce
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Get vaccinated –
Hep A & Hep B
Healthy balanced
diet
www.hcvadvocate.org
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Advocate for Yourself!
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Educate yourself
Establish a good
relationship with
your doctor
Bring an advocate
for doctor’s visits
www.hcvadvocate.org
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Ask questions
Keep copies of all
medical tests
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Keep a diary
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Keep an open mind
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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
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