1. Hepatitis C and You www.hepcfund.org info@hepcfund.org  2014 Greenview Hepatitis C Fund All Rights Reserved.

2. What You May Not Know About Hepatitis C (HCV)

3. Differences Between Hepatitis A, B and C Transmission Vaccine Available? HAV Contaminated Food / Water (e.g., when traveling) HBV Blood and Bodily Fluids (e.g., sexually transmitted) HCV Blood (e.g., transfusions, health care workers) 

4. What You May Not Know Hepatitis C (HCV) now kills more people than HIV/AIDS in the U.S. (16,600 in 2010) 1 in 30 baby boomers is infected About 75% of people who die from HCV were born between 1945 and 1965 45% of people infected with HCV report no known risk ALT screening (routine liver test) misses > 50% of chronic cases

5. HCV in the U.S. Deaths from HCV vs. HIV Source: Centers for Disease Control

6. HCV in the U.S. Affects 3-5 times more people than HIV/AIDS Most common chronic blood borne infection 40-60% of adult liver transplants in the U.S. U.S.: 4 million (1.6%) people infected

7. HCV World-Wide Western Countries: Most common cause of chronic liver disease About 170 million (3%) are chronically infected world- wide

8. Modes of Transmission HCV Transfusion Before 1992 Sexual Contact Piercing / Tattoo Intranasal Drugs Injected Drugs Mother to Infant Occupational Exposure (Needle) Hospital Stay Organ/Tissue Transplant Source: NIH Consensus Development Conference Statement 2002

9. Natural History after Acute HCV Infection After 12 Months

10. Hepatitis C Symptoms Acute patients: Most have few or no symptoms Chronic patients: Many have no symptoms until they develop complications of cirrhosis Common symptoms (e.g., fatigue, anorexia, other flu- like symptoms) correlate poorly with severity of liver disease Quality of Life: Frequently impaired, even before cirrhosis (complications from liver disease)

11. Some Possible HCV Symptoms Vagueness Depression Anxiety Dry Eyes Dry Mouth Fatigue Malaise Aches and Pains in Muscles Joints Poor Appetite Indigestion Nausea Feeling Sick Liver Pain or Discomfort Itching Rashes Symptoms usually take more than 10 years to develop. Some people never have any symptoms

12. Your Risk of Having HCV is Higher if You: Were born between 1945 and 1965 Have every injected illicit drugs, even once Have HIV Have received hemodialysis treatments Have received a blood transfusion or organ transplant before 1992 Are (or were) a health care worker and had been exposed to infected blood

13. Factors in Disease Progression Heavy alcohol consumption Heavy Approx. 2 drinks/day 30 g/day in men, 20 g/day in women 40+ years old at the time of infection Male gender Coinfection: HIV / HBV Immunosuppression Obesity Source: NIH Consensus Development Conference Statement. 2002. Poynard et al. Lancet. 1997;349:825-832.

14. Untreated HCV Possible Long Term Complications Increased cirrhosis, liver cancer, liver failure Increased skin, joint and muscle problems Increased incidence of vascular disease: Circulation problems, heart attack, stroke 3x higher rate of type 2 diabetes after age 40 Increased incidence of kidney disease / possible failure Increased incidence of autoimmune thyroid disease

15. Untreated HCV Possible Long-Term Complications

16. Current Treatment Standard: Injected Pegylated Interferon + oral Ribavirin Additional (for genotype 1): Oral Boceprevir or Telaprevir Duration: Typically 24-48 weeks; depends on response and genotype Side Effects 1 As with any chemotherapy, side effects can be expected Dosage adjustment and other methods can reduce side effects 1 If you are currently undergoing treatment or are considering starting treatment, please discuss possible side effects with your physician.

17. Improved Treatment Simeprevir: approved by the FDA in November 2013. Same class as telaprevir and boceprevir (protease inhibitor) Approved for genotype 1 infection in combination with peginterferon and ribavirin Sofosbuvir: approved in Dec. 2013 New class of antiviral therapy (nucleotide analog) For genotype 1 in combination with peginterferon/ribavirin For genotypes 2/3 with ribavirin and without interferon Advanced clinical trials Testing interferon-free and ribavirin-free treatment regimens, including genotype 1

18. Who Should Get Tested for HCV? What group is 5x more likely than other adults to have HCV? People born between 1945 and 1965 How many deaths could be prevented if all baby boomers got tested for HCV? 120,000

19. Why All Baby Boomers Should Get Tested The CDC recommends testing of all baby boomers High rates of experimental drug use in the ‘60’s and ’70’s No widespread blood-supply screening before 1992

20. Getting Tested for HCV Contact your physician, your health department or local clinic to find out how to get tested Results can take between a few days and a few weeks Rapid tests are available at some clinics The first blood test, a Hepatitis C Antibody Test, determines if you have ever been exposed to HCV If you have been exposed, then an RNA test is needed to determine if you are currently infected with HCV

21. Cost of Testing Under the Affordable Care Act, most private health insurance must now pay the full costs of screening. State Medicaid programs receive extra funding for this. If your insurance doesn’t pay for testing, the antibody test will cost between $50-75. Some free testing is also available.

22. Why Get Tested? A simple blood test could save your life and prevent you from infecting others HCV is the leading cause of liver cancer and liver transplants Symptoms are so vague, most people don’t know they have HCV until serious problems develop New treatments can eliminate the virus in most cases Even if you don’t get treated: You can adjust your lifestyle to reduce chances of progression You can be careful about spreading your HCV to others

23. Greenview Hepatitis C Fund www.hepcfund.org Supports HCV research to find a cure Supports educational efforts to increase awareness All donations large or small are accepted and appreciated Contributes over 85% of total revenue (more than 95% of cash donations) directly to Hepatitis C research Recent Success: Provided seed money for research at the University of Michigan to cut off HCV's lifeline Led to a $1.08 million NIH grant