Hepatitis A, B, C & HIV presentation (2011)

Hepatitis A, B, C and HIV

The Hepatitis Education Project

Seattle, Washington

Topics of Discussion

What is hepatitis?

How are the hepatitis viruses different?

How is HIV/AIDS similar to the hepatitis viruses?

Goals

Increase awareness and understanding Prevent transmission Educate patients about care and treatment

Ground Rules

Open and interactive Educational focus Respectful and attentive No medical diagnosis

Liver Function

“Hepa” means liver; “itis” means inflammation

2nd largest organ Performs over 500

different functions Lacks nerve

endings Able to regenerate

Hepatitis - caused by many different agents:

Viruses Alcohol Drugs/prescriptions Herbs Genetic disorders Obesity

Hepatitis Viruses

Hep A Fecal-oral transmission Contaminated food & water

Hep B Blood & bodily fluids

Hep C: Blood

Some Similarities:HIV and Hep B

Transmitted via contaminated blood & bodily fluids

Risk of sexual transmission is high More easily transmitted through sex than

hep C

There is no cure for HIV or hepatitis B

Hepatitis B

Vaccine preventable In the U.S. most adults get over this infection on

their own (90-95%) People infected for a long time have a higher risk

of getting liver cancer Liver cancer possible before cirrhosis (unlike HCV) Liver cancer screening is important

Protect Yourself

Get immunized against Hep A and Hep B

Practice good hygiene Wash your hands with soap

& water

Practice safer sex with any new partner Use condoms

Hepatitis C

Hepatitis C is a virus transmitted via contaminated blood

There is NO VACCINE It is very common U.S. and Worldwide

About 4-5 million Hep C+ people in the U.S. About 200 million Hep C+ people in the World

How do people get infected with hepatitis C?

Injection drug use Tattoos (especially in jail or

prison, street tattoos) Blood transfusions (pre-1992) Intranasal drug use

Lower Risks of Exposure

Sexual transmission Mother-to-child at birth (3-5%) Sharing personal hygiene tools

Toothbrushes, razors, nail clippers Occupational exposure

Firefighters, healthcare workers Fighting

Drug Use is #1

Sharing any drug equipment can pass Hep C and Hep B “works” – needles, syringes, cottons, cookers,

pipes, straws, rinse water, etc.

Cleaning with bleach is preferred, but isn’t reliable against hepatitis viruses

Tattoos

Tattoos done in prison or jail are the most risky

Best protection: get tattoos at licensed shops (autoclave, disposable inks and needles)

How will I know if I have Hep C?

Get tested First blood test looks for exposure. This is called

an Antibody test. Second blood test looks for virus. This is called a

PCR or confirmatory test.

100 People

25% Resolve 75% Chronic

Natural History of Hep C

100 People

Resolve (25) Chronic (75)

Stable (34) Cirrhosis (41)

Mortality (25)

Liver Cancer (10)

Natural History of Hep C

Long-term effects of viral hepatitis Healthy livers are

plump and smooth Cirrhotic livers are

nodular; bumpy and shrunken

HCV is the leading cause of liver transplant in the U.S.

Dangerous Combinations

Alcohol + Hep C

HIV + Hep C

Hep B + Hep C

These can cause much worse & much faster liver damage

Symptoms of Hep C

Most people have no symptoms.

Symptoms can include: Fatigue (frequently tired) Memory or concentration problems (brain fog) Joint pains Insomnia (can’t sleep) Depression

Liver Biopsy

Gives you a scar stage, a rating of the amount of scarring

Stages of scarring: Stage 0: No scarring Stage 1: Mild Stage 2: Moderate scarring, Treatment maybe Stage 3: Bridging fibrosis, Treatment yes! Stage 4: Cirrhosis, Treatment yes! (if liver can tolerate)

Types of Hep C

Hepatitis C is like a family with 6 different brothers or sisters.

These “siblings” represent the different genotypes of Hep C

In the U.S. we see mainly 3 different genotypes: Genotype 1: needs one year of treatment, by far

the most common type in the U.S. Genotype 2 or 3: needs six months of treatment

Is there a cure?

Yes, for many but not all.

Cure rates for Hep C

After 6-12 months of treatment about 70-80% of people will be cured

If HCV- after 4 weeks, cure rate is 90%+

Hep C Treatment

Combination of 3 drugs: interferon, ribavirin and a protease inhibitor

Treatment Goals Kill the virus Stop scarring of the liver Prevent cirrhosis Get rid of the fatigue and other symptoms

Interferon

Interferon is an injection given just under the skin 3 times per week Pegylated interferon is injected once a week.

Fever Headache Nausea

Diarrhea Hair Thinning Thyroid

Problems

Side Effects: Depression Irritability Fatigue

Ribavirin

Ribavirin is a pill taken twice a day

Anemia “low blood”, makes a person feel tired

Rash

Insomnia

Loss of appetite

Cough

Side Effects:

Protease Inhibitors Two new drugs:

Telaprevir Boceprevir

Both are oral medications taken every 8 hrs Both were added to IFN/riba treatment in 2011

Side Effects:

Telaprevir – main side effect: Rash

Boceprevir – main side effect: Anemia

Alternatives to TreatmentMay be useful for easing side effects

Complimentary/ alternative treatments Massage therapy Prayer & meditation Naturopathic medicine Herbal medicine*

Milk thistle Yoga Aroma therapy Acupuncture

Herbs that may be harmful to the liver* Heliotropium Skullcap Jin Bu Huan Germander Sassafras Comfrey Senna Valerian Pennyroyal

Sources: NIH, NCCAM, May 2000

Hepatitis C Support Project, www.hcvadvocate.org, August 2011

*Caution should be taken in the use of herbals

If you have Hep C, you should NOT…

Share needles or “works” Share tattoo equipment Share razors, nail clippers or

toothbrushes Donate blood

Hepatitis B & C are NOT spread by casual contact, i.e.

Hugging Kissing Sharing food or drinks Playing Sharing a house

Now that you know…

Get tested

And if you have Hep C… Limit alcohol Get vaccinated against

Hep A and B Talk with your doctor to

find out if you need treatment

For more information Books on Hep C are available in all Washington State

prison libraries

Go online to learn more at http://www.hcvadvocate.org

Visit your local Public Health Clinic

Contact the Hepatitis Education ProjectPhone: 1-800-218-6932Address: 911 Western Ave. #302, Seattle, WA 98104Websites: http://www.hepeducation.org

http://hcvinprison.org