1. Hep 202 Just when you thought you knew everything.

2. Today We Will Review Hepatitis 101 Take a more in-depth look at Hepatitis C Look at hepatitis C tests, nutrition, HIV co-infection, extra hepatic effects and treatment

3. Case Study Jane and Julia

4. What Would You Tell Jane and Julia if You Were Bob? Discuss in your groups: 1.What does hepatitis and viral hepatitis mean and what do you know about the five major types of viral hepatitis? 2.What are the signs and symptoms of hepatitis C? 3.What are the risk factors for hepatitis C and how can one prevent getting it?

5. Hep 101 Overview Hepatitis C –Name signs/symptoms, risk factors and prevention Hepatitis = Viral Hepatitis = Name 5 identified types of viral hepatitis Liver inflammation Virus that causes liver inflammation

6. How Does Hep C Damage The Liver? BC Hepatitis Services, 2003

7. Hepatocellular Carcinoma

8. Viral Hepatitis 5 Major Identified Types: A : oral-fecal transmission B : sexual fluids & blood to blood C : blood to blood D : travels with B E : oral-fecal transmission Vaccine Preventable Adapted from Corneil, 2003 There are also other less common strains

9. Other Types are Being Discovered! Hepatitis G (HGV or HGBV-C) –Similar transmission to Hep C –Appears to cause chronic infection –Long term effects of virus on the liver still to be determined

10. Hepatitis C

11. More on Hepatitis C RNA Virus (Flaviviridae Family) 6 major variations maybe up to 11 + 50 to 90 subtypes (e.g. Hepatitis C genotype 1 subtype B) Type 1 is most common type found in North America Unfortunately it is also the most difficult to treat

12. More Info (con’t) Other routes of transmission –Mother-to-child, breastfeeding, dialysis Certain locations also increase risk –E.g. prisons because more individuals already have the virus than in general population Highly Debatable

13. Health Canada, Hepatitis C Prevention, Support and Research Program, 2002

18. Tests Screening: Detects if the body has produce antibodies to Hepatitis C (anti-HCV) Usually need a minimum of six weeks to detect antibodies. After 6 months 95% will have detectable antibodies 1 st test that is done when someone gets tested

19. Tests Other tests are required to confirm the screening test and whether someone still has the virus They look for the specific genotype and the amount of virus in the blood stream. Looks for virus RNA

20. Tests Other tests are used to monitor liver function and damage They include: Liver Enzymes (ALT, AST, GGT, LDH) Checks for amount of liver cell inflammation Liver Function (Bilirubin, Albumin, INR) Checks to see if liver is clearing toxins and producing proteins Liver Biopsy Microscopic look at how badly the liver is scarred Liver Ultrasound Liver cancer screen Corneil, 2003

21. Hepatitis C Nutrition/Health Tips Eat frequent smaller meals Avoid Alcohol May need to decrease iron intake Protein intake may need to increase – 1-1.5g/kg/Day is generally recommended Dieticians of Canada, Hepatitis C Nutrition Care, 2003

22. More Tips Salt restrictions may need to be implemented depending on fluid retention Consult with dietician or health care professional to best tailor needs Dieticians of Canada, Hepatitis C Nutrition Care, 2003

23. Complimentary & Alternative Therapies For the most part, are considered experimental due to lack of research Some herbs have shown to have some benefit –E.g. Milk Thistle (Silymarin) Just because herbs are natural does not mean they are all safe some can harm the liver! Dieticians of Canada, Hepatitis C Nutrition Care, 2003

24. Milk Thistle Example

25. Other HCV-related conditions These may occur when the immune system tries to fight off the virus Dead antibodies deposit in the body causing Blood & Kidney Disorders Toxins in the blood may deposit in the body causing: Skin Disorders Mental Disorders

26. HIV Co-infection Seems to speed up the rate of viral replication Appears to increase rate of liver scarring and long-term complications such as cirrhosis

27. Treatment Goal is to achieve a sustained virological response (SVR) Means that virus RNA is no longer detectable after treatment over a sustained period of time (will still have antibodies) More likely to achieve a SVR if: Treating genotype other than genotype 1 Low viral levels and liver damage at treatment onset Low body weight or surface area

28. Treatment Best treatment currently available is a combination of two antiviral drugs: Pegylated Interferon + Ribavirin

29. Treatment Side effects can include: –Depression –Flu-like symptoms Some cannot complete treatment due to side effects Others may not qualify because –Liver is too damaged –Addicted to drugs and/or alcohol

30. Questions?