Hepatitis HIV/AIDS Program Public Health Seattle & King County 206/205-STDS (7837)

Hepatitis inflammation of the liver Can have many causes –drugs –toxins –alcohol –viral infections (A, B, C, D, E) –other infections (parasites, bacteria) –physical damage

Liver Functions –Stores sugar needed for energy –Absorbs good nutrients –Breaks down poisons (toxins) and drugs –Makes important proteins that help build new tissue and repair broken tissue –Produces bile, which helps remove waste from the body

Healthy LiverCirrhosis Liver

Hepatitis Terms Acute Hepatitis: Short-term hepatitis. –Body’s immune system clears the virus from the body within 6 months Chronic Hepatitis: Long-term hepatitis. –Infection lasts longer than 6 months because the body’s immune system cannot clear the virus from the body

Hepatitis A What is it? –Infection of the liver caused by Hepatitis A virus

Geographic Distribution of HAV Infection Anti-HAV Prevalence High Intermediate Low Very Low

Hepatitis A Incubation period –30 days on average (range days) –infectious latter half of incubation period while asymptomatic through 1 week after having jaundice.

–Nausea –Loss of appetite –Vomiting –Fatigue –Fever –Dark urine –Pale stool –Jaundice –Stomach pain –Side pain A person may have all, some or none of these Hepatitis A Symptoms

Hepatitis A How do you get it? –Feces (stool) on hands that gets on food or in water –Contaminated shellfish –Sex A person is most contagious 2 weeks before they feel sick Not spread by kissing, sneezing, saliva

Hepatitis A Diagnosis and Treatment –Blood test –No medicine or treatment to make it go away –Rest, fluids, treatment of symptoms –Most people recover completely and become immune to reinfection

Hepatitis A Prevention –Shot of immune globulin up to 2 weeks after exposure –Good hand washing –Cook food well –Good diaper hygiene –Only drink clean water –VACCINE!!!

Hepatitis A Who needs immune globulin? –Living with someone with Hep A –Eaten food handled by someone with Hep A –Sexual contact with person with Hep A –Traveling to an area where Hep A is common –Child or employee at a child care program where someone else has Hep A

Hepatitis B What is it? –Hep B is a serious disease caused by a virus that infects the liver –Can cause lifelong infection, cirrhosis (liver scarring), liver cancer, liver failure and death

Geographic Distribution of Chronic HBV Infection HBsAg Prevalence  8% - High 2-7% - Intermediate <2% - Low

Hepatitis B Incubation period –60-90 days on average (range days) –infectious weeks before getting ill and for variable period after acute infection –chronic carriers remain infectious

–Nausea –Loss of appetite –Vomiting –Fatigue –Fever –Dark urine –Pale stool –Jaundice –Stomach pain –Side pain A person may have all, some or none of these Hepatitis B Symptoms

Hepatitis B Who is at risk? –Anyone can get it –In the USA, 200,000 people get Hep B every year –5,000 people die every year of Hep B –If you have had other kinds of Hepatitis, you can still get Hep B

Hepatitis B Infections 200,000 per year Asymptomatic Cases 100,000 (50%) Symptomatic Cases 100,000 (50%) Death 100 (0.05%) Chronic Liver Disease Death from Cirrhosis 3400 (1.7%) Death-Primary Liver Cancer 800 (0.4%) Hepatitis B Chronic Carriers 12-20,000 (6-10%) Clear Virus; Healthy ,000 (90-94%)

Hepatitis B Who is at highest risk? –Injection drug users –Sex partners of those with Hep B –Sex with more than one partner –Men who have sex with men –Living with someone with chronic Hep B –Contact with blood –Transfusions, travel, dialysis

Hepatitis B How do you get it? –Direct contact with blood or body fluids of an infected person sharing injection equipment sex baby from infected mother during childbirth Hepatitis B is not spread by food, water or casual contact

Hepatitis B Who is a carrier of Hep B virus? –Some people with Hep B never fully recover from the infection (chronic infection) –They still carry the virus and can infect others for the rest of their lives –There are about 1 million carriers of Hep B in the USA

HEPATITIS B

Hepatitis B Diagnosis and Treatment –Blood test –There is no cure –Interferon/Ribaviron

Hepatitis B What about Hep B and pregnancy? –A woman with Hep B can give it to her baby at birth –Babies with Hep B can get very sick, can develop chronic infection and spread Hep B, can get cirrhosis or liver cancer –Pregnant women should be tested for Hep B –Babies should get Hep B vaccine at birth

Hepatitis B Who should get Hepatitis B vaccine? –All babies, at birth –All children who have not had vaccine –People at risk MSM Multiple sex partners Injection drug users People with jobs where exposure to blood might happen

Hepatitis C What is it? –Hep C is a liver infection caused by a virus –Also known as non A, non B hepatitis

Hepatitis C Incubation period –6-7 weeks on average (range 2-6months) –infectious one or more weeks before getting ill –chronic carriers remain infectious

–Nausea –Loss of appetite –Vomiting –Fatigue –Fever –Dark urine –Pale stool –Jaundice –Stomach pain –Side pain Hepatitis C Symptoms 3 out of 4 persons have no symptoms and can infect others without knowing it

Hepatitis C Who is at risk? –About 35,000 people get Hep C every year down from 180,000 in the 1980s –About 3.9 million people in the USA are infected with Hep C. –It can cause liver failure, cirrhosis, liver cancer –Responsible for 8,000 to 10,000 deaths/year.

Hepatitis C Who is at highest risk? –Injection drug users –Estimated that over 75% of injectors nationwide have Hep C –In Seattle/King County, 86%

Hepatitis C –Shared injection equipment (60% of new infections) –Blood transfusion before May, 1992 (now only 1 in 100,000 chance of transmission) –Blood transfer (HCW, tattoo, piercing …) –Sex? (HCV in semen and vf but only 1.5% rate of transmission for long-term partners) –Mother to child (<5%) –10-20% of infections have no identifiable risk factors How do you get it?

Hepatitis C Diagnosis –There is a blood test that screens for Hep C antibodies (ELISA or RIBA) –Antibodies usually develop within 3 months –HIV+ persons may not develop detectable antibodies –There is a PCR test (detects parts of actual virus) for Hep C but it is not yet FDA approved –If infected, liver enzyme tests or a liver biopsy can check liver function

What happens when you have Hepatitis C ? –85% of people develop chronic infection (infected for the rest of their life) –Rapid progression, slow progression, no progression HCV subtype Alcohol consumption (alcoholics 3 times more likely to develop cirrhosis after 20 years) age (older at time of infection more rapid) gender (men faster progression than women) Hepatitis C

HEPATITIS C

Hepatitis C Long term pathogenesis –Over time progressive liver damage may occur – % of those infected will develop cirrhosis over years –Of those with cirrhosis 25-30% (5% of overall) will develop end-stage liver disease or liver cancer –Many live without symptoms for decades –Others experience mild symptoms --intermittent fatigue, nausea, and muscle aches

Hepatitis C Treatment –Interferon/Ribaviron (suggest 40% “cure” rate) –Peginterferon Alfa-2a (still in studies - not yet FDA approved)

Hepatitis C What should a person do who has Hep C? –Get regular medical care--tell doctor about ALL drugs (including herbs)!!! –Have a healthy diet (no iron supplements, reduce salt intake, no large doses of vitamin A) –Get needed rest –No alcohol or Tylenol, cut back on other drug use –Avoid chemical fumes and other environmental toxins –Get vaccinated for A and B!!!

Hepatitis C What should a person do who has Hep C? –Do not share injection equipment. –Do not donate blood or plasma, organs or sperm –Do not share toothbrushes, razors –Cover areas of open skin –Use safer sex?

Hepatitis C and HIV % of HIV+ people in US also infected with Hep C More rapid progression of Hep C (twice as fast) Little to no affect on HIV progression (still inconclusive) Complications of medication regimens Increases risk of perinatal transmission

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