Hepatitis C let s face the facts LIVER Essential advice for drug users
Thanks to the following for their assistance: Dr Bobby Smyth, MRCPsych, HSE Addiction Services, Cherry Orchard Hospital, Dublin 10 Dr Shay Keating, MB, PhD Drug Treatment Centre Board, Trinity Court, Dublin Jean Flanagan, Hepatitis C Liaison Nurse HSE Northern Area Addiction Services and member of Blood Bourne Virus Forum Gail Hawthorne, HSE Hepatitis C Liaison Nurse South Western Area Addiction Services Eva Martin, formerly of Roche Ireland Roche Products (Ireland) Limited Hepatitis C - let s face the facts Essential advice for drug users 2007 produced by: Ballyfermot Advance Project, 3b Le Fanu Road, Ballyfermot, Dublin 10. t: (01) 623 8001 designed by: form www.form.ie This leaflet is for information and guidance only. It is not intended to replace professional or medical advice which should be sought before acting on anything contained within this leaflet.
What is Hepatitis C? If you are an injecting drug user or if you have snorted cocaine this Hepatitis C information booklet is for YOU. Facts to remember about Hepatitis C: Hepatitis C is a blood borne virus. To contract Hepatitis C infected blood must enter directly into your blood stream. It only take a tiny amount of infected blood to transmit Hepatitis C. Injecting even once with infected works can result in Hepatitis C. Hepatitis C can live outside the body for long periods. Hepatitis C can live in dried blood. There is NO Vaccine for Hepatitis C. Hepatitis C is NOT spread by normal social contact. You can Not contract or spread Hepatitis C by touching, kissing or hugging. LIVER
Protection from Hep C How do I protect myself from contracting Hepatitis C now? Never share works: filters, spoons and water for cleaning a works can all spread Hepatitis C. Always have your own works. Use a new sterile works from a wrapper every time. Use syringe markers to avoid getting works mixed up - stock up at your local needle exchange. Keep works away from each other. If you are sharing the same table top keep your works away from each other. Even if you can t see them, tiny drops of blood can carry Hepatitis C. If you are doing cocaine use a drinking straw and do not share it. Hepatitis C can be spread by sharing tooters and blood splattered notes.
Protection from Hep C Never share cocaine as a solution: cut it dry. Before getting a tattoo or piercing ASK if the equipment is sterilised. For tattoos make sure ink is poured into disposable containers for each customer. Never share razor blades, toothbrushes or nail clippers. Hepatitis C can live in dried blood on these items. Never share or use anyone else s personal hygiene items. Wear gloves if handling anything that potentially carries contaminated blood such as sanitary towels, bandages, syringe etc.. If you have to clean up blood spills use 1 measure bleach to 10 measures of hot water. Cover up cuts and sores with a clean dressing so that Hepatitis C can not get into your blood stream. If you already have Hepatitis C, covering up sores will help to protect others.
Re-infection Re-infection with Hepatitis C Hepatitis C is a very strong virus. You CANNOT DEVELOP IMMUNITY to Hepatitis C and YOU CAN BE RE-INFECTED with Hepatitis C. That is why it is so important to start and maintain safe practices. WELCOME BACK PARTY!
Symptoms of Hep C What are the symptoms of Hepatitis C? The common symptoms of Hepatitis C are: Flu-like symptoms: fever, sweating, nausea, tiredness, headaches and night sweats. Pain in the joints. Pain around the liver area. Diarrhoea or constipation. Mood swings, difficulty sleeping and depression. Loss of appetite, especially reacting to eating fatty foods. Bad reaction to alcohol and some medications. It s important to remember that these are common symptoms for many ailments and having one or a number of these does not necessarily mean that you have Hepatitis C. The only way to determine whether or not you have Hepatitis C is to get tested. If you have concerns please speak to your GP.
Testing & Genotypes Test Procedures Getting tested for Hepatitis C is done in stages. Your local GP or the Clinic Doctor will carry out the tests. 1) The first test is called an ANTIBODY TEST The Anti-body test tells if you have ever been exposed to Hepatitis C i.e. if you ever had the Hepatitis C virus in your body at some time. The results of this test can be: Antibody Positive: Yes, you have been exposed to Hepatitis C at some time. You will need to take a PCR test to see if you are Hepatitis C positive NOW. Antibody Negative: If you receive an Antibody Negative result you will be asked to retake the test to ensure that the result is accurate. It may take some time for the antibody level in your blood to show up on a test. About 20-30% of people who have been exposed to Hepatitis C clear the virus naturally from their body. These people show an Antibody Positive result but they do not have Hepatitis C NOW.
Testing & Genotypes 2) The second test is a PCR TEST To see if you still have the Hepatitis C virus in your system, you need to take a PCR test. The results of this test mean: PCR Positive: Yes, you have Hepatitis C. PCR Negative: You do NOT have Hepatitis C. Your GP may advise you to re-test for Hepatitis C in the future to ensure the test results are accurate. Biopsy: You may need to get a biopsy done at some point. A biopsy involves a small piece of liver being taken out through the skin by a needle, using a local anaesthetic. The procedure takes about 15-20 minutes altogether. Afterwards, you will need to rest and take it easy for a few days. You may have some pain around the site of the biopsy and possibly into your right shoulder for a few hours but it may last longer. Remember, just because somebody you know has had a bad experience of a medical procedure, doesn t necessarily mean that you will too. If you don t understand your test results ASK your GP or the Clinic Doctor to explain the results to you fully and to discuss your options.
10 Dormant Hep C Dormant Hepatitis C There is no such thing as Dormant Hepatitis C. Some people may have been tested for Hepatitis C in the past and were told they have Dormant Hepatitis C. If you have tested positive for Hepatitis C you need to keep in contact with your GP to monitor the progress of the virus. If you are unsure or confused about your Hepatitis C status talk to your GP.
Genotypes 11 Genotypes WE ARE FAMILY The Hepatitis C virus comes in 6 different types. They are called Genotypes. The most common Hepatitis C Genotypes in Ireland are: Genotype 1 and Genotype 3 Find out which Genotype you are and what are the best options for YOU. What Can I Do Now? If you have Hepatitis C there are treatment options and lifestyle changes that can significantly improve your health.
12 Treatment Treatment Treatment has improved greatly in the last number of years. Treatment time for Hepatitis C depends on the Genotype that you have. January 1 2 6 7 8 2 9 3 4 10 11 5 12 Genotype 3 is treated over 24 weeks. 13 14 15 20 21 22 27 28 29 16 17 18 23 24 25 30 31 19 26 Genotype 1 is treated over 48 weeks. If you are co-infected with HIV or have liver cirrhosis you may also be treated over 48 weeks. Success rates for treatment are high: October 1 2 2 3 4 5 6 7 8 9 10 11 People with Genotype 3 who undergo the full treatment have up to an 80% chance of clearing Hepatitis C fully from their body. 12 13 14 15 19 20 21 22 26 27 28 29 16 17 18 23 24 25 30 31 1 People with Genotype 1 undergoing the current treatment have a 50% chance of clearing Hepatitis C from their body. Ongoing research is being done to improve treatment for people with this Hepatitis C Genotype.
Treatment 13 Before you can get treatment you may need to make changes in your lifestyle: If you want treatment for Hepatitis C you will have to STOP DRINKING ALCOHOL before you will be able to begin treatment. If you have problems reducing your alcohol intake ask your GP or local drug and alcohol services for support. You will need to be DRUG FREE. Most hospitals will request that you are no longer using intravenous drugs or that you are stable on methadone for between 6 and 12 months before starting treatment. Treatment is not always an option for people at particular times in their lives: Women and their male partners if they are planning to start a family as the medication can cause birth defects. If you are going through particular stresses or problems in your own life or you do not have support systems in place. If this applies to you, talk to your GP, drug, counselling or support services in your area who can offer help. People who have a history of mental illness should talk to their GP as treatment can make some symptoms worse.
14 Side Effects Side Effects to Treatment While the Treatment for Hepatitis C has improved a lot, many people still experience negative side effects. It s important to talk through the possible side effects with your doctor before treatment and to prepare yourself and those close to you. Some side effects of treatment are: Flu like symptoms Exhaustion Depression Nausea Irritability Mood changes Dry or itchy skin Keeping in contact with your doctor and Hepatology Department by attending all appointments and letting them know of any changes in your mood and physical health is very important when going through treatment.
Alcohol and Hep C 15 Alcohol and Hepatitis C Too much alcohol damages the liver. Stopping your alcohol intake will have a positive effect on your liver and enable you to get treatment for Hepatitis C. Many hospitals will request that you have stopped drinking alcohol before they will consider you for Hepatitis C treatment. If you are having problems with reducing your alcohol intake talk to your doctor or alcohol services about possible options (see list of services on page 19). PARTY TIME!!
16 Hep ABC/Sexual health Hepatitis A, B & C If you have Hepatitis C it is important that you get vaccinated against Hepatitis A & Hepatitis B to protect your liver. Remember there is NO Vaccine against Hepatitis C. Getting vaccinated against Hepatitis A and B does NOT prevent you from getting Hepatitis C. Sexual Health Many people worry about the effect having Hepatitis C will have on their sex life and if they will infect somebody close to them. Hepatitis C is rarely transmitted through sex: except where blood to blood contact happens eg. during the woman s period. Use a condom/femidom at all times to minimise risks. Mother to baby transmission: There are some cases of mother to baby transmission of Hepatitis C during pregnancy or childbirth, but these are very rare. If you have Hepatitis C or think you may have it let your maternity hospital know as early as possible.
Healthy Diet 17 Healthy Diet Increasing the amount of healthy food you eat increases your liver s ability to get stronger and to fight the Hepatitis C virus. A good diet CAN improve liver health in someone with Hepatitis C. It can also keep the immune system healthy which in turn fights the Hepatitis C virus. Many people with Hep C or who are getting treatment can find eating a problem. A good tip is to eat small healthy snacks regularly (every 3-4 hours) instead of eating big meals a few times a day. Eat plenty of carbohydrates: cereals, bread (especially whole grain bread) and potatoes. Eat lots of fruit and vegetables. Reduce fatty, salty and sugary foods. Drink enough fluids, 6-8 glasses/cups a day. This doesn t just have to be water but can also be juices, herbal teas, milk etc..
18 Healthy Diet Supplements (multi vitamins etc.) Consult your GP or nurse before taking dietary supplements. Supplements containing high iron content are not suitable for people with Hepatitis C. Avoid large doses of Vitamin C and Vitamin A. Exercise Reaching and maintaining a healthy weight is important if you have Hepatitis C. If you weigh too little or too much it can affect the speed at which the virus progresses through your body. If you are over-weight treatment can be more difficult. Exercising gently can help you reach your goal weight and improve your mood. A 30 minute walk 3 times a week can make a big difference to your body and your outlook. Rest Getting a good rest combined with a healthy diet can help you deal with Hepatitis C. Energy levels can be affected by the virus so it is important to let your body rest when it needs to. For further information on Hepatitis C speak to your GP.
Contact Information 19 Hepatitis C Information Websites: Hepatitis Information Point: www.hepinfo.ie Consultative Committee on Hepatitis C: www.cchepc.ie/publications British Liver Trust: www.britishlivertrust.org.uk Centre for Disease Control and Prevention: www.cdc.gov Alcohol Support Services: Alcoholics Anonymous Alcohol support group. Helpline: 1890 412 412 t: (01) 842 0700 ANEW Alcohol support group for women. t: (046) 902 1279 Ballyfermot Advance Low threshold service responding to the needs of street drinkers. Services include: outreach, drop in, crisis contact, careplanning, counselling, holistic therapies & group work. Referral point for residential and treatment options. 3b Le Fanu House, Le Fanu Road t: (01) 623 8001 Alcohol Support Group Methadone maintenance support. Bridge House, Cherry Orchard Hospital Tuesdays 11am 12pm t: (01) 620 6010 Tallaght Community Alcohol Alcohol support, educational group, 1-1, family support & aftercare. Glenabbey Centre, Belgard Rd. t: (01) 451 6589 / 451 6754 Simon Community Alcohol Detox Residential Detox programme for homeless or newly resettled people. t: (01) 675 9950 Baggot Street Community Non-residential alcohol treatment service. t: (01) 660 7838 The Hanly Centre Confidential alcohol support and counselling. t: (01) 280 9795 / 280 7269 Stanhope Street Residential and outpatient alcohol treatment service. t: (01) 677 3965 Cuan Mhuire Residential rehabilitation alcohol treatment centre. t: (091) 797 102 - Athenry Teach Mhuire Assessment & Aftercare centre, transitional house for those who have completed residential. t: (01) 878 8877
The longer we ignore Hepatitis C the bigger the problem will get. Get Informed and Get Sorted.