1. Just when you thought you knew everything.
Hep 202
Just when you thought you knew everything.

2. Today We Will Review Hepatitis 101
Take a more in-depth look at Hepatitis C
Look at hepatitis C tests, nutrition, HIV co-infection, extra hepatic effects and treatment

3. Case Study Jane and Julia

4. What Would You Tell Jane and Julia if You Were Bob?
Discuss in your groups:
What does hepatitis and viral hepatitis mean and what do you know about the five major types of viral hepatitis?
What are the signs and symptoms of hepatitis C?
What are the risk factors for hepatitis C and how can one prevent getting it?

5. Hep 101 Overview Liver inflammation Hepatitis = Virus that causes
Viral Hepatitis =
Name 5 identified types of viral hepatitis
Hepatitis C
Name signs/symptoms, risk factors and prevention

6. How Does Hep C Damage The Liver?
BC Hepatitis Services, 2003

7. Hepatocellular Carcinoma

8. 5 Major Identified Types: A: oral-fecal transmission
Viral Hepatitis
5 Major Identified Types:
A: oral-fecal transmission
B: sexual fluids & blood to blood
C: blood to blood
D: travels with B
E: oral-fecal transmission
Vaccine
Preventable
There are also other less common strains
Adapted from Corneil, 2003

9. Other Types are Being Discovered!
Hepatitis G (HGV or HGBV-C)
Similar transmission to Hep C
Appears to cause chronic infection
Long term effects of virus on the liver still to be determined

10. Hepatitis C

11. More on Hepatitis C RNA Virus (Flaviviridae Family)
6 major variations maybe up to 11 +
50 to 90 subtypes
(e.g. Hepatitis C genotype 1 subtype B)
Type 1 is most common type found in North America
Unfortunately it is also the most difficult to treat

12. More Info (con’t) Other routes of transmission
–Mother-to-child, breastfeeding, dialysis
Certain locations also increase risk
E.g. prisons because more individuals already have the virus than in general population
Highly Debatable

13. Health Canada, Hepatitis C Prevention, Support and Research Program, 2002

14. Health Canada, Hepatitis C Prevention, Support and Research Program, 2002

15. Health Canada, Hepatitis C Prevention, Support and Research Program, 2002

16. Health Canada, Hepatitis C Prevention, Support and Research Program, 2002

17. Health Canada, Hepatitis C Prevention, Support and Research Program, 2002

18. Tests
Screening:
Detects if the body has produce antibodies to Hepatitis C (anti-HCV)
1st test that is done when someone gets tested
Usually need a minimum of six weeks to detect antibodies. After 6 months 95% will have detectable antibodies

19. Tests
Other tests are required to confirm the screening test and whether someone still has the virus
They look for the specific genotype and the amount of virus in the blood stream.
Looks for virus RNA

20. Tests Other tests are used to monitor liver function and damage
They include:
Liver Enzymes
(ALT, AST, GGT, LDH)
Checks for amount of liver cell inflammation
Liver Function
(Bilirubin, Albumin, INR)
Checks to see if liver is clearing toxins and producing proteins
Liver Biopsy
Microscopic look at how badly the liver is scarred
Liver Ultrasound
Liver cancer screen
Corneil, 2003

21. Hepatitis C Nutrition/Health Tips
Eat frequent smaller meals
Avoid Alcohol
May need to decrease iron intake
Protein intake may need to increase
1-1.5g/kg/Day is generally recommended
Dieticians of Canada, Hepatitis C Nutrition Care, 2003

22. More Tips
Salt restrictions may need to be implemented depending on fluid retention
Consult with dietician or health care professional to best tailor needs
Dieticians of Canada, Hepatitis C Nutrition Care, 2003

23. Complimentary & Alternative Therapies
For the most part, are considered experimental due to lack of research
Some herbs have shown to have some benefit
E.g. Milk Thistle (Silymarin)
Just because herbs are natural does not mean they are all safe some can harm the liver!
Dieticians of Canada, Hepatitis C Nutrition Care, 2003

24. Milk Thistle Example

25. Other HCV-related conditions
These may occur when the immune system tries to fight off the virus
Dead antibodies deposit in the body causing
Blood & Kidney Disorders
Toxins in the blood may
deposit in the body
causing:
Skin Disorders
Mental Disorders

26. HIV Co-infection
Appears to increase rate of liver scarring and long-term
complications such as cirrhosis
Seems to
speed up
the rate of
viral
replication

27. Treatment Goal is to achieve a sustained virological response (SVR)
Means that virus RNA is no longer detectable after treatment over a sustained period of time (will still have antibodies)
More likely to achieve a SVR if:
Treating genotype other than genotype 1
Low viral levels and liver damage at treatment onset
Low body weight or surface area

28. + Pegylated Interferon Ribavirin Treatment
Best treatment currently available is a combination of two antiviral drugs:
Pegylated
Interferon +
Ribavirin

29. Treatment Side effects can include:
Depression
Flu-like symptoms
Some cannot complete treatment due to side effects
Others may not qualify because
Liver is too damaged
Addicted to drugs and/or alcohol

30. Questions?