1. Greenview Hepatitis C Fund Deborah Green www.hepcfund.org Home:734- 665-3395 Cell: 734-223-8400 Debbie@vedit.com 5/31/2008

2. Differences Between Hepatitis A, B and C Hepatitis A (HAV) Transmitted through drinking water or eating food contaminated by fecal matter Usually runs its course in 6 months without treatment Vaccine available Hepatitis B (HBV) Transmitted through bodily fluids About 5% of adult cases result in chronic condition which can lead to serious liver problems and death (approx. 5,000/year in U.S.) Vaccine available Hepatitis C (HCV) Transmitted through blood About 80% result in chronic condition which can lead to serious liver problems and death (about 10,000 -12,000/year in the U.S.) No vaccine available ( about 50 subtypes of the virus)

3. Hepatitis C (HCV) Magnitude of the Problem Worldwide: 170 million (3%) U.S.: 4 million (1.6%) Most common chronic blood borne infection in the U.S., affecting 3-5 times as many people as HIV/AIDS. Most common cause of chronic liver disease in western countries and accounts for 40-60% of adult liver transplants in the U.S.

4. Death Rate from HCV vs. AIDS Annual deaths in the U.S related to HCV as estimated by the National Institute (NIH) : 10,000 - 12,000 CDC figures for HIV/AIDS deaths have not been updated since 2005 when they were 16,000, but a poll of the Departments of Health in all 50 states conducted by www.fairfoundation.org, yielded 10,962 deaths in 2007.)

6. At Risk Populations IV drug abusers Veterans, especially Vietnam veterans Homeless Minorities Prison inmates Recipients of blood products prior to 1992

7. Hepatitis C Symptoms Most patients with acute hepatitis C have few or no symptoms. Many patients with chronic hepatitis C have no symptoms until they develop complications of cirrhosis. Common symptoms including fatigue, anorexia, and other flu-like symptoms correlate poorly with severity of liver disease. Quality of life frequently becomes impaired, even in pre-cirrhotic patients

8. Diagnosis of Hepatitis C Clinical evaluation Lab tests Liver biopsy

9. Factors Associated With Disease Progression Alcohol consumption –30 g/day in men –20 g/day in women Disease acquisition at >40 years Male gender HIV coinfection Hepatitis B virus coinfection Immunosuppression Obesity NIH Consensus Development Conference Statement. 2002. Poynard et al. Lancet. 1997;349:825-832. ~ 2 drinks per day

10. Current Treatment 48 weeks of injected Pegylated Interferon and Ribavirin pills

11. Possible Side Effects of Treatment Flu-like symptoms - fever, chills, headache, muscle ache Anemia, fatigue and/or sleep disturbance Anxiety, irritability, depression Hair loss, dry cough, skin rash Decrease in white cells and platelets Retinal hemorrhage/loss of vision in rare cases Birth defects and miscarriages Unmasking or exacerbation of autoimmune disease

12. Possible Long Term Complications of Untreated HCV Increased cirrhosis, liver cancer, liver failure Increased skin, joint and muscle problems Increased incidence of vascular disease (  circulation problems, heart attack, stroke) 3 times higher rate of type 2 diabetes after age 40 Increased incidence of kidney disease and possible kidney failure Increased incidence of autoimmune thyroid disease.

13. Goals of Treatment of Individual Primary goal -Eradicate HCV infection Secondary goals -Slow or prevent disease progression and scarring of the liver (fibrosis) which otherwise might lead to extensive scarring, (cirrhosis). -Reduce risk of liver cancer -Improve health-related quality of life

14. 2005 NIH Research Budget per Death Source: Fair Foundation ( http://www.fairfoundation.org/news_letter/2004/hepatitis_magazine.htm)

15. 2007 NIH Spending per Patient $3052 $25

16. Can Awareness and Spending Impact Future of Disease? AIDS Case Study Data from NIH Office of Budget and the FAIR Foundation Pre 1990 1990- 1999 2000- 2007 NIH Spending (in Billions) 4.19.9719.6