Hepatitis C in Retrospect

David Gladders Portsmouth City Council

Tackling Hepatitis C

• Preventing infection• Raising awareness of infection• Increasing access to treatment• Ensuring infected individuals access treatment

Source: Hepatitis C in the UK. Public Health England 2013

Hepatitis C Transmission

• Hepatitis C is a blood borne virus• High risk for HCV transmission

– IV /snorting drug use- sharing any equipment– Tattoos and Piercings– Medical and dental treatment abroad– Blood transfusion pre 1992

• Low transmission risk for HCV transmission– Sexual transmission approximately 1.5%.– 3% risk in gay sex– Mother to baby in presence of HIV coinfection <3%

What does Hepatitis C do?

• Hepatitis C causes damage to the liver.• Hepatitis C clearance can reverse associated

mild/moderate liver damage• If left untreated Hepatitis C can cause cirrhosis-

irreversible damage to the liver and increases the risk of liver cancer.

• Hepatitis C has been linked to symptoms of night sweats, brain fog and depression.

• Infection does not cause specific symptoms

Hepatitis C testing

• Hepatitis C Antibody• Should be offered to anyone who has been put

at risk • Is not useful for anyone who knows they either

have or have had the virus• Tells us if the person has ever been infected

with Hepatitis C• Can be performed on oral swab, blood spot or

blood test

Oral swab testing:-Hepatitis C Antibody-Result in 20-40 minutes

Oral Swab Testing

Hepatitis C RNA

• Positive result indicates that the patient still has the virus.

• Negative result with positive antibody suggests that the virus has been cleared with treatment or that the person has cleared the virus themselves (15-20% of cases)

Genotypes

• There are several strains of hepatitis C called Genotype.

• Genotype 1-6. • Genotype 1 and 3 most common in UK• Affects the type of treatment offered to

people• Effects response to treatment• Genotype is determined by blood test

Assessment Of Liver Damage And Preparation For Treatment

• Ultrasound scan of liver • Fibroscan of liver• Blood tests• Medical history• Assessment of psychosocial history past and

present • Assessment of current psychosocial support

What is the treatment?

• Pegylated Interferon- self administered injection in pen form

• Ribavirin- tablets twice daily• Protease inhibitor- tablets either four times

daily or twice daily for Genotype 1 only. Must be taken on time and with high fat snack.

• 6 month treatment for most patients- 75% chance of clearance if treatment naive

Treatment

• Hepatitis C is cleared with treatment in 60-80% of people

• Treatment usually lasts 6 months• Treatment may be extended due to viral

response or extent of liver damage at start of treatment

• Drug and alcohol use does not mean you cant have treatment

Main Side Effects of Treatment

• Fatigue• Shortness of breath• Muscle and Joint aches• Feeling flu like for 24-48 hours after injection• Lowered mood, irritability• Difficulty sleeping• Ano rectal itch, diarrhoea, nausea

Pathways For People Who Test Positive For Hepatitis C Antibody

Antibody positive

Refer to nurses for confirmatory Hepatitis C

RNA test.Advise of Hepatitis C

support group

Assessment for liver damage and discussion

re treatment options in nurse led clinic

Consultant appointment Treatment

Avalon centre

Gosport War memorial

QA Hospital

St Marys Hospital

Orion Centre

HCV Outreach ClinicsOutreach clinics have improved access to specialist HCV services for vulnerable groups.

Hepatology Nurse led outreach clinics 2013

0

20

40

60

80

100

120

Numbers of patientstested

Positive HCV RNA

Negative HCV RNA

Portsmouth City HCV Screening Day Sept 2013

• Organized by Peer educator lead –Dave Gladders & Portsmouth City Council

• Attend 1hr education session • 113 PWID tested• 37 oral mouth swab Ab positive• 11 have returned for HCV RNA testing over past 4 months

– ( 10 positive 1 negative)• 76 negatives were advised to have repeat testing 3 months –

letters sent out 3 months after event • How many have addressed substance misuse??

Dispelling the myths

• Treatment is available• Everyone testing positive for hepatitis C will be

considered for treatment• Drug use and Alcohol use is not a reason to

not offer treatment if person is stable• Liver biopsy is rarely needed before treatment• Treatment can be accessed locally

Support group

• Aim: to provide emotional support to people contemplating testing and on treatment.

• Universality is why people respond well to support groups

• Advantageous to run groups alongside nurse treatment clinics where possible

• A team approach is imperative.

Recovery and Treatment

• Hepatitis C Diagnosis is an anxious time• Potential for return to learned behaviours is

high• Talking therapies can compliment medical

treatment

Confidentiality And The Installation Of Hope

• People need to feel safe and listened to without judgement

• Patients learn from others to believe in the process

• Hope has a positive impact on a patients journey through treatment

Catharsis

• Expressing suppressed thoughts and feelings is healing.

• Sharing feelings in a group leads to feelings of belonging and self worth

• Positive thinking can help people believe that they can cope with treatment and improves compliance to medication.

Thank you for your time