april 2014 - 1 hepatitis c overview
TRANSCRIPT
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April 2014 - 1
Hepatitis C Overview
www.hcvadvocate.org
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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
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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
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Liver Functions Chemical Factory-
>500 chemical
functions
Bile
Immune System
Detoxifies or Filters
Clotting Factors
Hormones
Regenerates Itself!
www.hcvadvocate.org
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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
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Keep the liver healthy! Get vaccinated!
HAV and HBV vaccines
Avoid toxic substances / fumes
www.hcvadvocate.org
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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)
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HCV CAN NOT BE SPREAD BY:
BREASTFEEDING
SNEEZING
HUGGING
COUGHING
FOOD OR WATER
SHARING EATING UTENSILS OR DRINKING GLASSES
CASUAL CONTACT
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Chronic Symptoms Fatigue – mild to
severe
Flu-like symptoms (muscle/joint/fever)
‘Brain Fog’
Liver pain
Loss of appetite
Headaches
Gastro problems
and more……
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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
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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
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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
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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
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Approved Medications
Interferon – Pegylated (long-acting interferon)
Ribavirin
HCV Inhibitors Victrelis (boceprevir) – Merck Incivek (telaprevir) – Vertex Olysio (simeprevir) – Janssen Solvadi (sofosbuvir) – Gilead
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Treatment - Genotype 2 & 3
Standard of Care:
Sofosbuvir plus ribavirin
Genotype 2 – 12 weeks = 93% cure rate
Genotype 3 – 24 weeks = 84% cure rate
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Genotype 1 -
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• 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
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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
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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
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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
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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
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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
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Lifestyle Changes That Help!
Alcohol – Avoid or reduce
Get vaccinated – Hep A & Hep B
Healthy balanced diet
Exercise
Stress Reduction
Support Groups
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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
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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