1.How did I get Hepatitis C?

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2 1.How did I get Hepatitis C? Sharing needles and syringes ( iv drug use ) or using contaminated straws to snort cocaine Reused needles or medications in a health care setting- (LV endoscopy outbreak, glucometers shared in a nursing home, mass vaccinations in basic training)

3 Contaminated needles or medications in a foreign country (ex: Egypt and mass vaccination programs) Sexual transmission rarely seen in a long term heterosexual, single partner relationship Blood or blood products before 1992 Mother to baby 1 to 3% chance during pregnancy, not reduced by C-section ( in contrast to HIV). Breast feeding safe unless mastitis is present Household- only thru sharing razors or tooth brushes contaminated by blood. Can live for hours to days on surfaces Unregulated tattooing and piercing

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6 Is Hepatitis C transmitted sexually? Heterosexual risk very low in a single partner relationship- condoms are optional except when genital sores present, active menstrual bleeding or traumatic anal intercourse Risk is increased with multiple partners there have been some well documented HCV infections among gay men, but much less risk than HIV

7 Transmission of HCV in the United States (CDC estimate)

8 How is Hepatitis C NOT spread? Sharing eating utensils Hugging Kissing Holding hands Coughing Sneezing Through food or water Licensed, commercial tattooing facilities

9 Does hepatitis C affect just my liver or my whole body? Often causes no symptoms for decades many people can t believe they have had it so long. If you wait till you have symptoms it can be too late- often the first awareness of it is when you turn yellow or have liver cancer is diagnosed Other patients may have systemic symptoms such as fatigue, depression, itchy skin or rashes, muscle loss or kidney problems Some evidence that type 2 diabetes is associated with HCV infection

10 Will I end up dying from cirrhosis or liver cancer? Rule of 20 s. Natural History of Hepatitis C over 20 Years Condition #of individuals I. Acute infection 100 II. Chronic infection 80 (20% clear spontaneously) III. chronic progressive disease 60 IV. Cirrhosis 20 (40% after 30 yrs) V. Death/ yr. from cirrhosis or liver cancer 1-3

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12 Often a Silent Disease until its too late Over the last 20 to 30 years, liver disease in many undiagnosed or untreated hepatitis C patients has silently progressed: -In the 1990s, the most common finding on liver biopsy was stage 0 (no liver damage). -Now 20 years later the most common finding will soon be Stage 4 (cirrhosis). 1990s 2015

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14 Vertex Pharmaceuticals Incorporated, March 2010

15 I have cirrhosis now. is it too late to help me, how much time do I have left? Can I still benefit from these new therapies you are telling me about? Improvements seen in patients cured of Hepatitis C I. Actual regression (improvement) of the liver scars II. Decreased incidence of liver failure III. Decreased incidence of liver cancer IV. Reduced all-cause mortality V. Prolonged life expectancy- the life expectancy of a cured patient even with cirrhosis approaches a age matched patient without hepatitis C! VI. Prevent viral transmission to others

16 I hear the treatment is very difficult and anyways you are not actually cured of Hepatitis Nope Interferon is no longer used at all. That is what made treatment so gruelling in the past (up till 2 months ago) The treatment is simple, using well tolerated pills 90 to 100% of patients are actually cured. Once you stop viral replication the virus has no where to hide, and it is eliminated from the body

17 Why didn t my other doctors diagnose this before- I have had a lot of blood tests. This makes me angry! This is not part of routine blood testing- must be ordered for you to be screened for this infection Maybe your doctor didn t think of you as having any risk factors for hepatitis- but now we know that baby boomers may not be aware themselves of having a risk for Hepatitis C Many times the enzyme tests results are reported by the lab as normal even when you have this infection. ALT/AST range set too high on labs Maybe your doctor attributed the test results to other factors that can effect the liver- like medication alcohol, diabetes etc.

18 How should blood spills be cleaned from surfaces Household bleach diluted 10x with water, wear gloves even for dried blood

19 What can I do now to help keep myself heathy? Is there a special diet? A no alcohol balanced diet is critical. Alcohol use is the greatest risk factor for progression to cirrhosis and liver cancer. Even if you are cured of Hepatitis C but continue to drink, you can end up with liver failure Obesity and diabetes can put great stress on your liver in addition to the Hepatitis C, so managing them appropriately is very helpful to your liver Get vaccinated for Hepatitis A and Hepatitis B. There is currently no vaccination for Hepatitis C

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