Hepatitis C Disease & Treatment

Hepatitis C Hepatitis C virus (HCV) is an RNA virus discovered in 1988 Hepatitis C is now thought to be the most common cause of chronic hepatitis (long-lasting inflammation in the liver) and probably affects about 1% of the Australian community. Causes liver inflammation and liver disease Spread through blood-to-blood contact A slow-acting virus, and for most people does not result in serious disease or death Approximately 284,000 Australians have been exposed to hepatitis C virus and 212,000 are living with chronic hepatitis C There is no vaccination currently available for hepatitis C

Hepatitis C The virus reproduces by making many copies of itself in liver cells. The hepatitis C virus does not kill liver cells directly, but the immune response initiated by the presence of the virus in the liver can cause liver inflammation and cell death Chronic hepatitis C is a risk factor for hepatocellular carcinoma 175 people per year develop HCV-associated liver failure requiring transplantation.

Natural history of hepatitis C If 100 people are infected with HCV, about 25 of those will clear the virus within 2 to 6 months, but will continue to have hepatitis C antibodies About 75 of the 100 people who do not clear the virus will develop chronic infection. About 20 of the 75 people will not experience any noticeable symptoms. After an average of 15 years, between 40 and 60 of the 75 people with chronic hepatitis C will experience some symptoms and develop some liver damage After 20 years, between 5 and 10 people will develop cirrhosis. Between 2 and 5 of these people will experience liver failure or develop a form of liver cancer known as hepatocellular carcinoma Other factors which affect the progression of liver disease include: age when first infected; male gender; alcohol use; co-infection with hepatitis B virus and/or HIV; obesity

Genotypes There are six main genotypes (strains) of hepatitis C numbered from 1-6 Each genotype contains numerous subtypes, labelled a, b, or c. Genotypes 1a and 1b (55% prevalence) and 3a (36% prevalence) are the most common genotypes in Australia There is no evidence to confirm whether genotype influences disease progression

Transmission

Diagnosis The diagnosis of hepatitis C is rarely made during the acute phase. Majority of people infected experience no symptoms during this phase of the disease. Those who do, are rarely ill enough to seek medical attention. The diagnosis of chronic phase hepatitis C is also challenging due to the absence or lack of symptoms until advanced liver disease develops, which may not occur until decades into the disease Chronic hepatitis C may be suspected on the basis of the medical history (particularly if there is any history of IV drug abuse, a history of piercings or tattoos, unexplained symptoms, or abnormal liver enzymes or liver function tests found during routine blood testing Occasionally, hepatitis C is diagnosed as a result of targeted screening such as blood donation

Blood Tests HCV antibody test identifies people who have been exposed to HCV HCV-RNA quantitative test identifies whether the virus is in your blood, indicating that you have an active infection with HCV. A qualitative HCV test is reported as “positive” or “detected” if any HCV viral RNA is found; Otherwise it will be reported as “negative” or “not detected”. The HCV RNA quantitative test will also be used after treatment to see if the virus has been eliminated from the body Viral Load or Quantitative HCV tests measure the number of viral RNA particles in your blood Viral genotyping is used to determine the kind, or genotype, of the virus present

Treatment Current treatment is a combination of Pegylated interferon-alpha-2a or Pegylated interferon-alpha-2b (brand names Pegasys or PEG-Intron) and the antiviral drug ribavirin Interferon is given once a week subcutaneously on the same day Ribavirin is taken orally twice a day Genotype 1: combination therapy for 48 weeks Genotype 2 and 3: combination therapy for 24 weeks

Response Rates Genotype Description 1 Sustained Virological response is about 50% in patients with HCV genotype 1 after 48 weeks of treatment. People who become negative after 4 weeks of HCV treatment (Rapid Virological Response) will have >70% chance of clearing the virus. 2 and 3 Sustained cure rates (sustained viral response) of 80% are seen in people with HCV genotypes 2 and 3 with 24 weeks of treatment.

Treatment Side Effects “Flu like symptoms” Lethargy Headaches Insomnia Loss of Appetite Nausea Weight Loss Dry Itchy Skin Mood Changes- Depression & Anger Hair Loss Brain Fog

Treatment Eligibility Subsidised by the Government on S100 Scheme Patient’s undergo medical and psychological work up Injecting Drug Use whilst on treatment is not recommended but does not exclude any one from treatment if they are stable Stable Social/Family/Work environment Abstinence from alcohol

Referral Process HCV Antibody test – If positive, patient’s should then have a HCV RNA or Quantitative (HCV Viral Load) test performed to establish current infection. If the patient has a positive HCV RNA or Viral Load then referrals should be sent to the Townsville Hospital Hepatitis Clinic. GP Nurses - How you can help!

Hepatitis B Hepatitis B is one of the most common infectious diseases in the world. World wide there is approximately 350-400 million people with chronic (lifelong) Hepatitis B. In Australia it is estimated that 165,000 have chronic Hepatitis B infection with approx 6,000 new cases each year. Majority of people infected were born overseas, predominantly in the Asia-Pacific region. Other groups at higher risk of Hep B infection include Indigenous Australians, people participating in high risk sexual activity and people who inject drugs.

Hepatitis B Causes inflammation of the liver Cirrhosis and liver failure with higher risk of developing liver cancer Is found in blood and body fluids including: Breast milk, saliva, vaginal secretions and semen. Is a chronic (long-term) infection in the majority of people infected early in life

Natural history Hep B The disease course of Hepatitis B is very complex: main predictor is age of infection. Infants infected with Hep B rarely experience symptoms of acute infection, but 90% will develop chronic or lifelong infection. Children infected with Hep B also rarely experience symptoms of acute infection, but 30% will develop chronic or lifelong disease. Adults or adolescents infected with Hep B commonly experience symptoms of acute infection, however less than 5 % develop lifelong infection.

Symptoms of Hepatitis B Loss of Appetite Nausea and Vomiting Tiredness, (Depression and Anxiety occur in chronic infection) Abdominal pain Muscle and Joint Pain Jaundice ( Acute Infection)

Transmission Risks of Hep B Sexual Contact- blood and body fluids including saliva, semen, vaginal secretions and breast milk Mother to child at birth Sharing of injecting equipment Needlestick injuries in the health care setting Reuse of unsterilised or inadequately sterilised equipment Child to child transmission through household contact such as biting Sharing personal items such as razors, toothbrushes or nail clippers

Phases of Hepatitis B Immune Tolerance Immune Clearance Immune Control Immune Escape

Hep B Prevention & Treatment Vaccination is the best prevention of Hepatitis B infection Available to all Treatment is available, all people require a liver biopsy before undergoing treatment for Hep B Once treatment is required it is often lifelong All people infected with Hepatitis B whether on treatment or not require ongoing monitoring of bloods and abdominal ultrasound

Thank You for Listening Any Questions? Presented by Lyn Burke Hepatitis C Clinical Nurse Consultant Ph: 47962536 Email: lyn_burke@health.qld.gov.au