Hepatitis C

What is Hepatitis? Hepatitis: A general term meaning inflammation of the liver Hepatitis can be caused by: Alcohol Drugs Chemicals Toxins Autoimmunity (your immune system attacks your own body) Viral infections

Overview of the Liver Largest internal organ Has over 500 vital functions Involved in many digestive, vascular, and metabolic activities

What does the Liver do? Functions as the body's chemical processing plant Stores iron, vitamins, minerals, sugars Produces bile, cholesterol, lymph Regulates blood clotting, glucose, hormone levels Cleans the blood of bacteria and toxins Processes food, alcohol, drugs Converts food and drink into forms the body can use Oxidizes triglycerides to produce energy

What does the Liver do? Basically, the liver processes everything we eat, drink, swallow, breathe, and/or absorb!

Hepatitis C Caused by the hepatitis C virus (HCV) Incubation period 6-7 weeks Often no signs or symptoms About 4.1 million in U.S have been infected Estimated 115,000 infected in WA About 55-85% of adults have chronic infection

HCV Transmission Primarily transmitted via direct blood-to-blood contact highly infectious Stable in environment for at least 16 hours but no longer than 4 days Most common transmission through the sharing of drug paraphernalia

HCV Transmission cont. Also blood transfusions & products before 1992 Perinatal transmission Needle stick/healthcare exposure Other blood risks low/unknown risk tattooing/piercing intranasal cocaine use shared personal items

Prevention of HCV Transmission Avoid blood exposure: New syringe, cooker, cotton etc. every time for injection Use universal precautions Don't share personal items that may contain blood (toothbrush/razor) Use barriers and lubricants Cover open cuts and wounds Ensure instruments used for tattooing, piercing, and accupuncture are new or sterilized

HCV Transmission: Sharing Injection Equipment Studies have found high rates of HCV in IDUs who didn't share syringe, but shared cooker, cotton, water or other paraphernalia People who inject other things (steroids, vitamins, hormones) may also be at risk IDUs should use new, sterile equipment every time clean hands, injection site and surface too Unknown if bleach kills HCV

HCV Transmission: Mother-to-Infant 5-6% risk with pregnancy post exposure prophylaxis not available co-infection with HIV risk increases up to 17% Test infants born to HCV-positive women consider testing any children born since women became infected evaluate infected children for chronic disease Breastfeeding ok unless nipples are cracked and/or bleeding

HCV Transmission: Low/Unknown Risks Intranasal cocaine/meth use Some studies have found link to HCV transmission by blood getting into nasal membrane from shared snorting items Crack use At least one study (Schaefer) found higher rate of HCV in non-injecting crack users who indicated cracked, bleeding or burned lips Personal items with blood on them Anything that cuts/breaks the skin or membreane Razors, clippers, toothbrush

Hepatitis C and Your Liver What does it do to the liver? Causes inflammation Becomes sensitive to alcohol Causes blood sugars to rise Linked to high cholesterol Want to avoid Scarring Cirrhosis About 20% of cases Hepatocarcinoma

Chronic Hepatitis C Factors promoting progression Alcohol intake Age >40 at the time of infection HIV or HBV co-infection Male gender Vaccinate for HAV/HBV when appropriate! HCV leads to about 10,000 deaths per year from chronic liver disease

Symptoms of Chronic Hepatitis Fatigue Depression Loss of appetite Nausea/indegestion Muscle/joint pain Mood swings "Brain fog" Abdominal pain Fever

Symptoms of Late Stage Hepatitis with Cirrhosis All of the symptoms of Hepatitis C with addition of: Vomiting Jaundice Cognitive dysfunction Fluid retention Frequent urination Lack of concentration Confusion Dizziness

Co-infection: HCV/HIV Up to 1/3 of those living with HIV also have HCV 1/10 of those with HCV have HIV HIV positive persons with IDU risk who have tested negative for anti-HCV may want to have viral test HCV considered OI in people living with HIV HIV infection may promote HCV disease progression Anti-HIV medications may cause hepatitis Especially in those with viral hepatitis

Supporting a Healthy Liver Drink water Do not drink alcohol Get vaccinated against hepatitis A & B Eat a healthy diet Exercise Reduce stress Minimize contact with other toxins Check with your health provider before starting new medications

Alcohol & the liver Avoid alcohol! Will accelerate liver injury May kill cells & cause oxidative damage Decreases effectiveness of interferon

Keep Your Liver Healthy! Eat low-fat, low-cholesterol < 30% of calories from fat, ~ 65g a day < 10% of calories from saturated fat Fat can be malabsorbed High fat intake can lead to infections High saturated fat intake can lead to increased heart disease risk

Keep Your Liver Healthy! Eat carbs in moderation 50-55% of calories, ~ 300g a day Eat whole grains Check the label for fiber! Wheat bread, brown rice, whole wheat pasta, whole grain cereals

Keep Your Liver Healthy! Eat protein 15-20% of calories, ~ 75-100g a day less with acute liver failure Eat enough calories daily Target ~ 3,000 cal/day Prevent breaking down body tissues for energy Try omega-3 fats Decreases inflammation Wild tuna, wild salmon, walnuts, flaxseed

Keep Your Liver Healthy! Try Antioxidants Bright colored fruits and vegetables Red grapes, pomegranate, melons, apples, broccoli, cabbage, cauliflower, onion, bell peppers Eat small, frequent meals Relieves burden of the liver to store extra carbohydrate calories Maintain a healthy weight High Body Mass Index (BMI) Linked to poor recovery Increases diabetes risk

Patient Support Programs Hepatitis C Case Management Program Free Assistance with medical resourced in Washington State Aid in locating places that provide care, treatment, services Aid in finding financial aid for treatment & testing Patient assistance programs via Pharmaceutical companies DSHS Charity Care

Patient Support Programs Pharmaceutical companies offer assistance programs Genentech Access Solutions Ships medications free of charge to those who qualify based on household income Pegasys Access to Care Possible medication free of charge to those who qualify Many hospitals provide charity assistance programs to uninsured KVCH Harborview Virginia Mason

Psychosocial Support Friends and family Support groups Hotlines Internet Most providers who treat will ask for psych assessment and refer to counseling

Local Support Groups Yakima Wenatchee Seattle Wellness House 210 S. 11th Ave Wenatchee Wellness Place 208 N. Chelan Seattle HEP Resource Center 911 Western Ave #302

Chronic Hepatitis & Transmission Prevention Do not donate blood, body organs, other tissue, or semen Do not share personal items that might have blood on them razor, toothbrush, clippers Cover cuts and sores on the skin Never reuse or share syringes, needlesm cottons, cookers and water Use barriers for sexual intercourse. For those with HCV and one long-term partner, should discuss with partner to make decision about condom use

Chronic Hepatitis & Transmission Prevention HCV is not spread by sneezing, hugging, coughing, sharing eating utensils or drinking glasses, or casual contact HCV positive persons should not be excluded from work, school, play, child-care or other settings on the basis of their HCV status