Hepatitis C

What is Hepatitis?

Hepatitis: A general term meaning inflammation of the liver

Hepatitis can be caused by: Alcohol Drugs Chemicals Toxins Autoimmunity (your immune system attacks your

own body) Viral infections

Overview of the Liver

Largest internal organ

Has over 500 vital functions

Involved in many digestive, vascular, and metabolic activities

What does the Liver do?

Functions as the body's chemical processing plant Stores iron, vitamins, minerals, sugars Produces bile, cholesterol, lymph Regulates blood clotting, glucose, hormone levels Cleans the blood of bacteria and toxins Processes food, alcohol, drugs Converts food and drink into forms the body can

use Oxidizes triglycerides to produce energy

What does the Liver do?

Basically, the liver processes everything we eat, drink, swallow, breathe, and/or absorb!

Hepatitis C

Caused by the hepatitis C virus (HCV) Incubation period 6-7 weeks Often no signs or symptoms About 4.1 million in U.S have been infected Estimated 115,000 infected in WA About 55-85% of adults have chronic infection

HCV Transmission

Primarily transmitted via direct blood-to-blood contact

highly infectious Stable in environment

for at least 16 hours but no longer than 4 days

Most common transmission through the sharing of drug paraphernalia

HCV Transmission cont.

Also blood transfusions & products before 1992 Perinatal transmission Needle stick/healthcare

exposure Other blood risks

low/unknown risk tattooing/piercing intranasal cocaine use shared personal items

Prevention of HCV Transmission

Avoid blood exposure: New syringe, cooker, cotton etc. every time for

injection Use universal precautions Don't share personal items that may contain

blood (toothbrush/razor) Use barriers and lubricants Cover open cuts and wounds Ensure instruments used for tattooing, piercing,

and accupuncture are new or sterilized

HCV Transmission: Sharing Injection Equipment

Studies have found high rates of HCV in IDUs who didn't share syringe, but shared cooker, cotton, water or other paraphernalia

People who inject other things (steroids, vitamins, hormones) may also be at risk

IDUs should use new, sterile equipment every time clean hands, injection site and surface too

Unknown if bleach kills HCV

HCV Transmission: Mother-to-Infant

5-6% risk with pregnancy post exposure prophylaxis not available co-infection with HIV risk increases up to 17%

Test infants born to HCV-positive women consider testing any children born since women

became infected evaluate infected children for chronic disease

Breastfeeding ok unless nipples are cracked and/or bleeding

HCV Transmission: Low/Unknown Risks

Intranasal cocaine/meth use Some studies have found link to HCV transmission by

blood getting into nasal membrane from shared snorting items

Crack use At least one study (Schaefer) found higher rate of HCV

in non-injecting crack users who indicated cracked, bleeding or burned lips

Personal items with blood on them Anything that cuts/breaks the skin or membreane Razors, clippers, toothbrush

Hepatitis C and Your Liver

What does it do to the liver? Causes inflammation Becomes sensitive to

alcohol Causes blood sugars to rise Linked to high cholesterol

Want to avoid Scarring Cirrhosis

About 20% of cases Hepatocarcinoma

Chronic Hepatitis C

Factors promoting progression Alcohol intake Age >40 at the time of infection HIV or HBV co-infection Male gender

Vaccinate for HAV/HBV when appropriate! HCV leads to about 10,000 deaths per year from

chronic liver disease

Symptoms of Chronic Hepatitis

Fatigue Depression Loss of appetite Nausea/indegestion Muscle/joint pain Mood swings "Brain fog" Abdominal pain Fever

Symptoms of Late Stage Hepatitis with Cirrhosis

All of the symptoms of Hepatitis C with addition of: Vomiting Jaundice Cognitive dysfunction Fluid retention Frequent urination Lack of concentration Confusion Dizziness

Co-infection: HCV/HIV Up to 1/3 of those living with HIV also have HCV

1/10 of those with HCV have HIV HIV positive persons with IDU risk who have

tested negative for anti-HCV may want to have viral test

HCV considered OI in people living with HIV HIV infection may promote HCV disease

progression Anti-HIV medications may cause hepatitis

Especially in those with viral hepatitis

Supporting a Healthy Liver

Drink water Do not drink alcohol Get vaccinated against hepatitis A & B Eat a healthy diet Exercise Reduce stress Minimize contact with other toxins Check with your health provider before starting

new medications

Alcohol & the liver

Avoid alcohol! Will accelerate liver injury May kill cells & cause oxidative damage Decreases effectiveness of interferon

Keep Your Liver Healthy!

Eat low-fat, low-cholesterol < 30% of calories from

fat, ~ 65g a day < 10% of calories from

saturated fat Fat can be malabsorbed High fat intake can lead

to infections High saturated fat

intake can lead to increased heart disease risk

Keep Your Liver Healthy! Eat carbs in moderation

50-55% of calories, ~ 300g a day Eat whole grains Check the label for fiber! Wheat bread, brown rice, whole wheat pasta,

whole grain cereals

Keep Your Liver Healthy!

Eat protein 15-20% of calories, ~ 75-

100g a day less with acute

liver failure Eat enough calories daily

Target ~ 3,000 cal/day Prevent breaking down

body tissues for energy Try omega-3 fats

Decreases inflammation Wild tuna, wild salmon,

walnuts, flaxseed

Keep Your Liver Healthy!

Try Antioxidants Bright colored fruits and vegetables Red grapes, pomegranate, melons, apples, broccoli,

cabbage, cauliflower, onion, bell peppers Eat small, frequent meals

Relieves burden of the liver to store extra carbohydrate calories

Maintain a healthy weight High Body Mass Index (BMI) Linked to poor recovery Increases diabetes risk

Patient Support Programs

Hepatitis C Case Management Program Free Assistance with medical resourced in

Washington State Aid in locating places that provide care,

treatment, services Aid in finding financial aid for treatment & testing

Patient assistance programs via Pharmaceutical companies

DSHS Charity Care

Patient Support Programs

Pharmaceutical companies offer assistance programs Genentech Access Solutions

Ships medications free of charge to those who qualify based on household income

Pegasys Access to Care Possible medication free of charge to those who

qualify Many hospitals provide charity assistance programs to

uninsured KVCH Harborview Virginia Mason

Psychosocial Support

Friends and family Support groups Hotlines Internet Most providers who

treat will ask for psych assessment and refer to counseling

Local Support Groups Yakima

Wellness House210 S. 11th Ave

Wenatchee Wellness Place

208 N. Chelan

Seattle HEP Resource Center

911 Western Ave #302

Chronic Hepatitis & Transmission Prevention

Do not donate blood, body organs, other tissue, or semen

Do not share personal items that might have blood on them razor, toothbrush, clippers

Cover cuts and sores on the skin Never reuse or share syringes, needlesm cottons,

cookers and water Use barriers for sexual intercourse.

For those with HCV and one long-term partner, should discuss with partner to make decision about condom use

Chronic Hepatitis & Transmission Prevention

HCV is not spread by sneezing, hugging, coughing, sharing eating

utensils or drinking glasses, or casual contact HCV positive persons should not be excluded from

work, school, play, child-care or other settings on the basis of their HCV status