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 www.NYCHepBC.org

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

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.

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)

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.

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).

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/ (http://www.hcvadvocate.org/hepatitis/factsheets_pdf/Fibrosis.pdf) Liver damage usually occurs slowly over 20 – 30 years Damage can occur faster if there are stresses to the liver

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

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

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

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

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

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: www.nychepbc.org

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.

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

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

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

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