1 Hepatitis C Overview Patricia Perkins, MS, MPH Tri City Institute: Los Angeles, CA

1 The Liver Largest internal organ Approximately 3 lbs (men) Size of a football 1.5 quarts of blood flow through it every minute

1 Liver Functions Bile Immune System Chemical Factory- >500 chemical functions Detoxifies Clotting Factors Hormones Regenerates Itself!

1 Keep Your Liver Healthy (Healthy People) No more than: 2 alcoholic drinks daily for men 1 alcoholic drink daily for women Be cautious about mixing drugs – especially with alcohol Healthy, balanced diet Get HAV & HBV vaccinations Avoid toxic substances / fumes

1 Some Statistics 3% of world has HCV ( million) 3.9 Million in U.S. infected with HCV * Chronic – 2.7 Million in U.S. 8,000 to 10,000 in U.S. die of complications from HCV – in 10 years this # will triple HCV is the leading cause for liver transplants 50-80% of HCV infected become chronic * Does not include prisoners, homeless

1 More Statistics U.S. Population 1.8% overall 2.1% Mexican- Americans 3.4 African Americans California 500,000 infected with HCV 85-95% - IDU’s Prisons – 63,500 inmates infected or (41%)

1 What Does It Mean? Only 10-25% progress on to serious liver disease Treatment choices do work for some Hopefully better treatment options will be available within 5 years Lifestyle changes can make a big difference

1 Diagnostic Tools Elisa II / Riba – Test for anti-body Hepatitis C RNA by PCR - >50 particles Hep C RNA by branched DNA Assay – >200,000 particles TMA – more sensitive, less expensive Genotype (six major subtypes – 72% of U.S. population have genotype 1) Liver Biopsy

1 Transmission / Prevention <10% of routes can not be identified Tattoos / Piercing Neonatal – <5% Shared House- hold items – razors & toothbrushes Healthcare workers – needle sticks Sexual Transmission (1-3%) Blood before transfused, products, procedures All Drug Paraphernalia Shared Needles

1 Harm Reduction Prevention – Needle exchange – clean needles and drug preparation tools – cookers & cottons Bleach – Does it work? 10 minutes! Safer Sex Cover wounds

1 HCV CAN NOT BE SPREAD BY: BREAST FEEDING SNEEZING HUGGING COUGHING FOOD OR WATER SHARING EATING UTENSILS OR DRINKING GLASSES CASUAL CONTACT

1 Symptoms Acute vs. Chronic Fatigue – mild to severe Flu-like symptoms (muscle/joint/fever) ‘Brain Fog’ Liver Pain Loss of appetite Headaches Gastro Problems

1 Treatment Medications Interferon – by injection - first FDA approved treatment (3 MU, thrice weekly for 48 weeks) Genotype 1 - 9% SVR Genotype other than 1 –30% SVR

1 Interferon and Ribavirin Interferon and ribavirin(capsule)- ‘combo therapy’ INF – 3 mu units, thrice weekly - Ribavirin mg daily Overall SVR up to 45% Genotype 1 – 12 mos – 29% SVR Genotype Non 1 – 6 mos - 62% SVR

1 Pegylated Interferon Schering- PEG-Intron Approved by FDA – % sustained response rate Genotype 1 – 14% Genotype 2 & 3 – 47% ROCHE – Pegasys – FDA approval pending 39% sustained response rate Genotype – 1 – 28% Genotype – 2 & 3 – 56%

1 Pegylated and Ribavirin Schering – PEG-Intron plus ribavirin Phase III clinical data – 54% sustained response rates One group improved SVR - Genotype 1 low viral load FDA Approved Roche – Pegasys plus ribavirin Phase III clinical data – 56% sustained response rate – Genotype 1 – 46% - Genotype 2-3, 76% Pending FDA Approval

1 Treatment Decisions General Treatment Guidelines Healthy Active HCV Elevated ALT’s Compensated liver disease Optimal Response Younger Female Low visceral fat Low viral load Minimal liver damage Genotype 2 or 3

1 Side-effects Interferon Fatigue Muscle/Joint pain Nausea Headaches Anxiety Depression Dry Skin/rashes Ribavirin seems to make interferon side effects worse – especially fatigue-Anemia (both men & women must use birth control)

1 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

1 Experimental Therapies Amantadine - pill Maxamine – by injection (phase II studies) Ribozymes Helicase Inhibitors Protease Inhibitors Interleukin-10

1 Complementary Medicine Herbs – milk thistle Always check with your doctor and herbalist – some herbs are TOXIC Acupuncture / Acupressure Traditional Chinese Medicine

1 Lifestyle Changes That Help! Alcohol - Avoid Get vaccinated – Hep A & Hep B Healthy balanced diet Exercise Stress Reduction Support Groups

1 Advocate for Yourself and Your Client! Educate yourself Establish a good relationship with your doctor Bring an advocate for doctor’s visits Ask questions Keep copies of all medical tests Keep a diary Keep an open mind

1 Conclusions