april 2014 - 1 hepatitis c overview
TRANSCRIPT
April 2014 - 1
Hepatitis C Overview
www.hcvadvocate.org
2
Introduction
Advocacy & Self-Advocacy through Education
The information in this presentation is designed to help you understand and manage HCV and is not intended as medical advice. HCV medical care is a partnership between patients and their medical providers
www.hcvadvocate.org
3
The Liver – A Chemical Factory
Largest internal organ Size of a football Approximately 3 lbs in the average
sized male 1.5 quarts of blood flow through it
every minute
www.hcvadvocate.org
4
Liver Functions Chemical Factory-
>500 chemical
functions
Bile
Immune System
Detoxifies or Filters
Clotting Factors
Hormones
Regenerates Itself!
www.hcvadvocate.org
5
Keep the Liver Healthy!
If you have HCV – Avoid Alcohol
Avoid mixing drugs – prescription, over- the-counter, herbs/supplements and street drugs
Eat a healthy, balanced diet based on MyPlate (www.choosemyplate.gov)
www.hcvadvocate.org
6
Keep the liver healthy! Get vaccinated!
HAV and HBV vaccines
Avoid toxic substances / fumes
www.hcvadvocate.org
7
Hepatitis C Statistics
U.S. Population
More than 3.9 million Americans chronically infected
HCV Populations ~1.5 % to 2% Mexican
Americans ~3 % African Americans
www.hcvadvocate.org
8
HCV Antibody tests HCV Elisa II or III
Most common antibody test
OraQuick whole blood and fingerprick approved
A positive antibody test indicates exposure It does not indicate current hepatitis C
infection HCV viral load test performed to indicate active
HCV infection
www.hcvadvocate.org
9
Viral Load Tests
Viral Load tests Hepatitis C RNA by PCR – > 5-10 IU/mL HCV RNA by branched DNA Assay – > 615 IU/mL TMA – > 5-10 IU/mL
Why Is a Viral Load Test Important? To confirm active infection Somewhat helps to predict treatment response & used to guide
treatment duration Indication that treatment is working
** Viral load does not correlate with disease progression**
www.hcvadvocate.org
10
Genotype Test Genotype (1,2,3,4,5,6 and 7)
U.S. population 70% genotype 1 30% genotypes 2 & 3
Why Is a Genotype Test Important? Guide treatment, what drugs and
treatment duration
www.hcvadvocate.org
11
Liver Biopsy
Test for Determining the Health of the Liver Measure inflammation, extent of scarring
(if any), Rule out other diseases Biopsy procedure
Non-invasive markers of liver inflammation – not yet perfected
FibroScan www.hcvadvocate.org
12
Transmission- Prevention Direct blood-to-blood transmission
route
Can live on surfaces for up to 6 weeks
Bleach and other disinfectants kill virus, but probably not inside the needle
Not spread casually – need blood
www.hcvadvocate.org
13
Transmission
Shared Needles
All Drug Paraphernalia
Blood Before 1992 - transfused, products, procedures
Sexual Transmission(1-3%)
Healthcare Workers – needle sticks
Shared House-hold items – razors & toothbrushes
Mother to Child 4-7%
Tattoos / Piercing
<10% of routes can not be identified
www.hcvadvocate.org
14
Prevention Tips Injection and Non-Injection Drugs
Do not share needles, cookers, cottons, straws, pipes, water or any items that might come into contact with blood
Use bleach to clean – if no needle exchange is available
People in Stable Long-Term Monogamous Sexual Relationships CDC – no need to change current sexual
practices – but there is a risk
www.hcvadvocate.org
15
Prevention Tips Safer Sex
For so called “high risk groups”
Multiple sexual partners, people with sexually transmitted diseases, infection with HIV or HBV
Any situation where blood is present
www.hcvadvocate.org
16
Prevention Tips Mother-to-Child Transmission
Low risk – about 4-7% chance of hepatitis being transmitted to infant
Given the low rate of transmission, pregnancy should not be avoided.
Health-Care Settings Follow standard (universal)
precautions
www.hcvadvocate.org
17
Prevention Tips Tattoos & Piercing
Considered a low/no risk in commercial setting that practices safety
Make sure disposable needles and separate ink pots are used and that general safety precautions are followed
Considered a higher risk in other settings
Non-commercial settings such as in prison, parties or on the streets
www.hcvadvocate.org
18
Shared Personal Items Household
Cover cuts or sores Do not share personal hygiene items
(toothbrushes, razors, etc.)
Professional Personal Care Settings Standard precautions Disposable equipment Bring own equipment (best advice)
www.hcvadvocate.org
19
HCV CAN NOT BE SPREAD BY:
BREASTFEEDING
SNEEZING
HUGGING
COUGHING
FOOD OR WATER
SHARING EATING UTENSILS OR DRINKING GLASSES
CASUAL CONTACT
www.hcvadvocate.org
20
Chronic Symptoms Fatigue – mild to
severe
Flu-like symptoms (muscle/joint/fever)
‘Brain Fog’
Liver pain
Loss of appetite
Headaches
Gastro problems
and more……
www.hcvadvocate.org
21
Disease Progression 10-25% of HCV positive people
progress on to serious disease usually over 10-40 years Fibrosis
Light scarring Cirrhosis
Compensated vs. decompensated Steatosis
Fatty deposits in the liver
www.hcvadvocate.org
22
Treatment Decisions General Treatment
Guidelines
Stable Health
Active HCV Infection
Compensated Liver
Disease
Optimal Response CC genotype Younger Low BMI & Weight Less Steatosis Low Viral Load Minimal Liver
Damage
www.hcvadvocate.org
23
Clinical Data - Treatment
Prospective – well designed clinical trial with measurable outcomes Gold Standard
Retrospective – review of data from previous clinical trials Important for looking for trends and
for designing future studies
www.hcvadvocate.org
24
Treatment What is interferon?
General antiviral – immune booster – injection
What is ribavirin? Antiviral - used only in combination with
interferon - pill or capsule
What is an HCV inhibitor Direct Acting Antiviral (DAA) – blocks viral
replication
www.hcvadvocate.org
25
Approved Medications
Interferon – Pegylated (long-acting interferon)
Ribavirin
HCV Inhibitors Victrelis (boceprevir) – Merck Incivek (telaprevir) – Vertex Olysio (simeprevir) – Janssen Solvadi (sofosbuvir) – Gilead
www.hcvadvocate.org
26
Treatment - Genotype 2 & 3
Standard of Care:
Sofosbuvir plus ribavirin
Genotype 2 – 12 weeks = 93% cure rate
Genotype 3 – 24 weeks = 84% cure rate
www.hcvadvocate.org
Genotype 1 -
27
• Standard of care:
• Cure rates up to 90%
• Treatment duration 12 to 48 weeks
• Simeprevir, pegylated interferon plus ribavirin
• Sofosbuvir, ribavirin with and without pegylated interferon
www.hcvadvocate.org
28
Side-effects Fatigue Anemia Muscle/Joint pain Nausea Headaches Anxiety Depression Dry Skin Rashes Anal itching Photosensitivity
and more.....
Ribavirin can cause birth defects– black box warning:
Women of childbearing age, their partners and female partners of male patients taking ribavirin must practice two forms of effective contraception during to 6 months post-treatment
Note: the majority of side effects are from interferon and ribavirin
www.hcvadvocate.org
29
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
Key: support from medical providers, family, friends, work – all areas of life & side effect management
www.hcvadvocate.org
Patient Assistance Programs
Partnership for Prescription Assistance www.pparx.org
Needy Meds: www.needymeds.org
HCSP Fact Sheet lists all the pharmaceutical patient assistance programs
Version 12.2www.hcvadvocate.org
31
Experimental Therapies Sofosbuvir plus ledipasvir submitted to FDA for
approval (genotype 1) >90% cure rate AbbVie interferon-free therapy phase 3 trials
are completed and AbbVie is expected to apply for FDA approval soon. Approval expected 2014
HCV Advocate’s Drug Pipeline
www.clinicaltrials.gov – search button, type in: HCV
www.hcvadvocate.org
32
Complementary Medicine Herbs – milk thistle, licorice root, etc.
Caution: St. Johns Wort should not be taken
with an HCV Protease Inhibitor; Milk Thistle
should not be taken with simeprevir/Olysio
Acupuncture / Acupressure
Traditional Chinese Medicine
www.hcvadvocate.org
33
Lifestyle Changes That Help!
Alcohol – Avoid or reduce
Get vaccinated – Hep A & Hep B
Healthy balanced diet
Exercise
Stress Reduction
Support Groups
www.hcvadvocate.org
34
Advocate for Yourself! 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
www.hcvadvocate.org
35
Resources –
• HCV Advocate Newsletter
• Education Materials in various languages
• Over 200 fact sheets & guides
• National Support Group Listing
• Recommended links
• Information on hepatitis C, hepatitis B, and HIV/HCV Coinfection
www.hcvadvocate.org