1. Foundation for Faith Based Organizations www.NYCHepBC.org
Hepatitis C
Presenters: Please feel free to include your personal program contact info on this title slide
Foundation for Faith Based Organizations

2. Goals To understand the liver and it’s role in the body
To understand liver health & disease
To understand Hepatitis C:
How it is Transmitted
The Testing Process
Treatment Options
Prevention
Be able to find Hep C Services in NYC

3. The Liver Largest internal organ Central to the body’s functioning
Performs many functions
Filters out and eliminates toxins
Converts nutrients into substances that can be used by the body
Stores vitamins & minerals
Regulates blood clotting, fat & sugar storage
Has the ability to heal or regenerate itself
Depending on how bad the damage is
We can not live without our liver
Script:
The liver is the largest internal organ, right here under the lower right rib (point to rib).
The liver is central to the body’s functioning, like the center of a wheel with the spokes going out to all the systems of the body.
The liver performs hundreds of functions, but is best known for acting as the body’s filter and warehouse.
The liver is the only organ that can regenerate it self.
A live donor can give up to ¾ of their liver to a person who needs a liver transplant and the liver will grow back to a full size functioning liver in both the donor and the recipient.
We can not live without our liver. You can remove the gall bladder for example, but can not remove the liver. We need the liver to live.

4. Hepatitis means Inflammation of the Liver
Major causes of hepatitis
Infections
Viruses (A, B & C)
Or other infections (Amoebas)
Toxic Exposure
Alcohol
Poisons & Chemicals
Some Prescribed, Over the Counter Medications or Vitamins/Supplements
Fatty Liver
Poor Diet & Obesity
Genetics/ Family History
More than one type of hepatitis at a time
= more stress to the liver
Fatty Liver (Liver Steatosis)

5. Hepatitis C Transmission
Hep C is a virus
Transmitted through infected Blood → Blood stream of another person
Percutaneous (i.e., puncture through the skin)
Can live outside of body for 4 days or longer
How do you get it?
Sharing Any Injection Equipment (IDU)
Poor Infection Control
Blood Transfusions or organ donation before 1992, Dialysis
Medical procedures in countries with poor infection control
Other Blood exposure: Shared tattoo or piercing equipment, fighting, sex, sharing razors, inter-nasal drug use equipment or pipes, blood brothers/sisters
Hepatitis C is an RNA virus
Hepatitis A, B & C are each different viruses, one does not turn into another. They are not stages of one another.

6. Signs & Symptoms of Hepatitis
Liver is known as the “Uncomplaining Organ”
Much of the liver can be damaged without any symptoms
Possible Symptoms are easy to miss
Flu-like symptoms
Fever, chills, fatigue, loss of appetite, nausea, vomiting, diarrhea, muscle aches, dehydration
Pain or tenderness under lower right rib
Weight loss, lack of appetite
Extreme Fatigue
Classic signs of liver problems
Jaundice: Yellowing of the skin pigment & whites of eyes
Dark urine, light stools
Distended abdomen – fluid build up in the stomach area
What is Jaundice?
The liver processes a pigment called bilirubin.
When the liver is inflamed, the liver can not process bilirubin properly and it builds up in the blood stream.
The body tries to get bilirubin out of the blood stream by depositing it in skin and eyes.
Wedro, B. (2012).

7. Hepatitis can lead to Liver Damage
Steps of Damage & Disease
Inflammation
Scarring
Fibrosis
Nodules
Cirrhosis
Liver Failure
* Liver Cancer
* There is an increased risk for liver cancer when someone has Hep C. It does not always occur.
Detailed explanation of the damage:
Liver fibrosis refers to the accumulation of tough, fibrous scar tissue in the liver. Formation of scar tissue is a normal bodily response to injury, but in fibrosis this healing process goes awry. When hepatocytes (functional liver cells) are injured due to viral infection, heavy alcohol consumption, toxins, trauma, or other factors, the immune system is activated and the repair process swings into gear. The injury or death (necrosis) of hepatocytes stimulates inflammatory immune cells to release cytokines, growth factors, and other chemicals. These chemical messengers direct support cells in the liver called hepatic stellate cells to activate and produce collagen, glycoproteins (such as fibronectin), proteoglycans, and other substances. These substances are deposited in the liver, causing the build-up of extracellular matrix (nonfunctional connective tissue). At the same time, the process of breaking down or degrading collagen is impaired. In a healthy liver, the synthesis (fibrogenesis) and breakdown (fibrolysis) of matrix tissue are in balance. Fibrosis occurs when excessive scar tissue builds up faster than it can be broken down and removed from the liver/ (
Liver damage usually occurs slowly over 20 – 30 years Damage can occur faster if there are stresses to the liver

8. Liver damage can cause…
Diabetes
Liver Cancer
Hepatic Encephalopathy
Build up of toxins in the brain
Can cause confusion, memory fog, mental health issues & coma
Extreme Fatigue
Itching, bruising & bleeding
Fluid retention
(Ascites & Edema)
Cardiovascular Problems

9. Acute & Chronic Infection
Infection lasting longer than 6 months
Acute
1st Six Months
of Infection
Often no symptoms
About 15% of people clear Hep C during the acute Phase
Treatment during acute phase is highly effective
25% of people who have chronic infection develop liver damage
Often no symptoms for 20 – 30 years until liver damage is severe
Hep C can be treated and cured
First 6 months of infection
Often no symptoms
May experience flu like symptoms, jaundice or abdominal pain
Approximately 15% of Adults with a healthy immune system clear HCV during the acute phase (CDC)
People with a weak immune system may have a harder time fighting off infection
Treatment during the acute phase is highly effective

10. Map shows were new + tests were reported in a 2 year period.
People Newly Reported with Chronic Hepatitis C in New York City, by ZIP Code, 2008 and 2009
Map shows were new + tests were reported in a 2 year period.
NYC Health Department
Estimated up to 150,000 infected with Hep C in NYC

11. High Risk: Should be Tested
People who have ever injected ANY drugs
Blood transfusion before 1992
Veterans, especially Vietnam
History of Homelessness
History of Incarceration
HIV+
Sex with HCV+ partner (blood exchange)
Born in Egypt, Russia, Eastern Europe, China or Pakistan
Other Blood exposure:
Medical procedure in developing country
Tattoo or piercing with shared equipment
Fighting

12. Hepatitis C Testing: 2 Step Process
HCV Anti-body Test
Test to see if the virus was ever in the body
Window period: 10 weeks – 6 months
If anti-body positive = was infected at some time
85% chance of being Infected Now
Confirmatory Test (HCV PCR)
Tests for the actual presence of virus in the body now
Window period: 3 weeks
If positive = Infected Now
Incubation period or “Window Period” for HCV is usually 6-7 weeks
Antibodies (Anti HCV) develop in 70-80% by week 12, and 95% by week 24
Virus (HCV RNA) is sometimes detected in the blood in as little as 1-3 weeks
Liver Enzyme Level Tests
If enzymes are elevated = “red flag” liver is having problems
If liver enzyme levels are normal: still might be HCV+
HCV Anti-body Test: Test for the immune system’s response to the virus ever having been in the body
HCV infection can be detected by anti-HCV screening tests (enzyme immunoassay) 4–10 weeks after infection. Anti-HCV can be detected in >97% of persons by 6 months after exposure. (CDC)
Confirmatory Test (HCV PCR): Determines if the virus is currently in the body
HCV RNA appears in blood and can be detected as early as 2–3 weeks after infection.
Genotype Test: Determines which virus a person has
Viral Load Test: Determines how much virus is in the blood
Liver Biopsy: Determines amount of liver damage
Remove a piece of the liver tissue for examination under a microscope
Determines Stage of Liver Disease 0 – 4

13. Hep C can be Treated and Cured!
There is medical treatment available for Hep C
Up to 80% of people can now be cured
Current Treatment:
Weekly Interferon injections with pills taken daily
Challenging side effects
Treatment preparation and support are very important
Future Treatment:
Treatments are rapidly advancing and pill only regimens are likely to be available in the next few years
Find Care & Treatment:

14. Hepatitis C & HIV Co-infection
25% HIV+ people are co-infected with hepatitis C
Hepatitis C is one of the leading causes of death for people with HIV
When someone has both HIV and hepatitis C
Progression to liver disease is more likely and about 3-4 times faster
Having both conditions makes treatment more complex
HIV/HCV co-infected patients do not respond as well to HCV treatment
Advanced liver disease can make HIV treatment more difficult
Hepatitis C is more easily transmitted sexually when someone has HIV+
Treatment Action Group ~ Viral Hepatitis Project. Guide to Hepatitis C for people living with HIV - Available in English, Spanish and Russian
Guide to Hepatitis C for people living with HIV:  testing, coinfection, treatment, and support.

15. Hepatitis C Prevention
You are Never Immune to Hepatitis C
Always possible to get again!
There is No Vaccine to Prevent Hepatitis C
Prevention: Behavioral Only
Harm Reduction & Recovery
Safer Sex
Universal Precautions and Infection Control in Health Care

16. Basic Liver Health Counseling Messages
Get tested! Early detection can save your life!
Get into care with an experienced and caring liver medical specialist
Inform All medical providers of hepatitis status
Avoid alcohol, smoking & toxins
Be Healthy!
Eat a nutritious diet, low in fat, salt & sugar
Drink water
Exercise
Sleep
Reduce stress

17. There Is Hope! Getting tested is easy!
Now finger-prick rapid test – results in 20 mins
Free testing is available
Free testing can be arranged at your organization.
Care & treatment is available and Hep C can be cured!
Up to 80% of people can be cured
Care & treatment save lives

18. Get Involved www.NYCHepBC.org Find Hep C Testing & Medical Care sites
Educate your community
See latest Policy & Advocacy Alerts
Join a Patient Support Group
Join the NYC Hep C Task Force
‘Like’ NYC Liver Health on Facebook