The Basics of Hepatitis C. Presented by: Barb Panter, Regional Health Education Coordinator, CATIE Date: Monday December 2nd, 2013, 1 2pm EST

Transcription

1 The Basics of Hepatitis C Presented by: Barb Panter, Regional Health Education Coordinator, CATIE Date: Monday December 2nd, 2013, 1 2pm EST

2 Outline Transmission Prevention Disease progression Testing Treatment 2

3 What is it? Before 1989 it was called non-a non-b hepatitis A virus that attacks the liver There are 6 genotypes Spread through blood-to-blood contact, especially shared drug-use equipment There is no vaccine 3

4 Epidemiology 170 million people worldwide ~ 250,000 Canadians ~ 140,000 are previous or current injection drug users (IDU) 20% of people with the virus don t know they are infected 4

5 The liver Largest internal organ Can re-grow Filter of the body Filters & Cleanses Manufactures Regulates And more! 5

6 Liver damage Fibrosis = scar tissue that forms on the liver in reaction to an infection or toxin Cirrhosis = severe widespread scarring that destroys the liver 6

7 TRANSMISSION 7

8 Transmission Sharing drug-use equipment Transfusions (pre-1992) Tattooing/piercing equipment Hygiene and grooming equipment Re-used or unsterilized medical equipment 8

9 But what about sex? Sexual transmission is rare Risk can increase when blood is present or if either partner has an STI More common in people co-infected with HIV, particularly MSM 9

10 PREVENTION 10

11 Prevention tools Harm Reduction NEP, MMT, SCS, Peer involved, non-judgment, practical Blood Screening Safer Sex Routine practices/infection control Education/counselling/information Determinants of health 11

12 Safer Injection Kit filters cooker water tourniquet syringe 12

13 Safer Crack Smoking Kit 13

14 DISEASE PROGRESSION 14

15 6 months If 100 people are infected ~20 people ~80 people people years Untreated HCV Disease Progression Cirrhosis: 20 people Cancer: 1-4 people

16 Signs and symptoms 70-80% of people will have no symptoms % may have: depression fatigue nausea low appetite dark-coloured urine flu-like symptoms jaundice abdominal pain 16

17 TESTING 17

18 Diagnosing Hep C Hep C testing and diagnosis is complex Two separate tests are needed to determine current active infection The first is an antibody test The second is a diagnostic test called a Hep C RNA test 18

19 Antibody test Looks for Hep C antibodies in blood Indicates exposure (blood to blood contact) Have antibodies for life, but they don t protect against getting Hep C again Window period 6-8 weeks, but can be up to 6 months Sometimes called: EIA, ELISA, RIBA, Siemens anti-hcv assay 19

20 RNA-PCR test Looks for the Hep C virus measures viral load and genotype Window period: 1-3 weeks shows active infection Sometimes called: PCR, NAT, viral load, qualitative/quantitative RNA, Taqman Real Time HCV RNA PCR assay 20

21 Other tests for treatment Liver enzyme tests High enzyme levels mean some sort of liver damage is happening Liver function tests Can show if the liver is working properly Ultrasound Uses sound waves to take a picture of the liver Shows the difference between a healthy liver and one with a lot of damage Also screens for liver cancer 21

22 Other tests, cont. Biopsy A small piece of the liver is removed with a needle and examined under a microscope Measures level of cirrhosis and/or fibrosis METAVIR is most common scale (F0 to F4, with F4 = cirrhosis) Fibro Test, FibroScan 22

23 METAVIR scale 23

24 TREATMENT 24

25 What is treatment? Goal is to clear the virus from the body called SVR (sustained virological response) 50-80% effective Four medications: peg-interferon ribavirin bocepravir (Victrelis) telaprevir (Incivik) 25

26 Standard of care Pegylated interferon boosts the immune system Ribavirin may interfere with the replication of the hepatitis C virus Boceprevir and telaprevir are protease inhibitors (PIs), also interfere with viral replication 26

27 Dose and administration Weekly peg-interferon injection Daily ribavirin pill Boceprevir or telaprevir pill taken 3X daily, every eight hours Both should be taken with food PIs cannot be adjusted once started (adherence) Dosage depends on factors such as weight Treatment response is monitored to make sure it s working 27

28 New Hep C Treatment, cont. Best practice includes a multidisciplinary team with lots of support 28

29 How long is treatment? What is your genotype? Genotype 1 = 24 or 28 weeks on triple therapy or 48 weeks (one year) on dual therapy Genotype 2, 3 = 24 weeks (six months) Genotype 4, 5, 6 = 48 weeks (one year) 29

30 Treatment Efficacy Data does not always reflect real world conditions Data on triple therapy still new Triple therapy with boceprevir 66-75% SVR Triple therapy with telaprevir 60-73% SVR Dual therapy all genotypes 38-62% SVR Dual therapy G2 and G3* 67-78% SVR *G3 is harder to treat 30

31 Contraindications or Reasons why your doctor might not offer you treatment Absolute: Pregnancy Strong: Alcohol abuse Coronary artery disease Organ transplantation (except liver) None: IDU, alcohol, methadone no longer contraindications 31

32 Side Effects Side effects make treatment tough, esp. depression and fatigue Most disappear after treatment is completed but some can linger Most minor side effects can fade after a few weeks Many side effects can be managed 32

33 Managing side effects Plan around your interferon injections Do household chores when your energy is highest (window of energy) Drink lots of water Avoid dehydrating drinks like alcohol or caffeine Pain management (meditation, massage, etc.) Gentle exercise when possible 33

34 Thank you ~ Next Webinar ~ Barb Panter Regional Health Education Coordinator, CATIE bpanter@catie.ca Please evaluate this webinar! 34