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HEPATITIS
- 2. What is the Liver?What is the Liver? ⢠Makes chemicals that your body needs to stay healthy ⢠Removes waste products and other harmful substances from your blood ⢠Guards against infection
- 3. The Liver is a FactoryThe Liver is a Factory ⢠Builds and converts proteins and sugars ⢠Stores vitamins, sugars, fats and other nutrients ⢠Releases chemicals and nutrients into the body when needed
- 4. ⢠Stores vitamins A, D, K and B12 (also stores minerals) ⢠The production of biochemicals needed for digestion, such as bile ⢠Maintains proper levels of glucose in the blood ⢠Produces 80% of your body's cholesterol (cholesterol is vital) ⢠The storage glycogen (also converts glucose to glycogen) ⢠Decomposing red blood cells ⢠The production of hormones ⢠Produces urea (the main substance of urine).
- 5. What is Hepatitis?What is Hepatitis? ⢠âHepatitisâ means inflammation of the liver ⢠Can be caused by: â Genetic diseases â Medications (including over-the-counter) â Alcohol â Hepatitis viruses (A,B,C,D,E)
- 8. What Are Liver Enzymes?What Are Liver Enzymes? ⢠Enzymes are proteins found in your body that speed up certain chemical reactions. Liver enzymes perform these jobs within the liver. ⢠Healthy liver: â the level of enzymes in your blood is normal ⢠Unhealthy liver: â the level of enzymes can be higher than normal
- 9. Types of hepatitisTypes of hepatitis ⢠There are five main types of hepatitis that are caused by a virus, A, B, C, D, and E - plus types X and G.
- 12. Hepatitis AHepatitis A ⢠Virus HAV ⢠Spread through contaminated food and water ⢠Anal-oral sex ⢠Vaccine available to prevent hepatitis A ⢠full recovery - it does not lead to chronic disease.
- 13. Hepatitis BHepatitis B ⢠virus HBV ⢠Spread through blood- blood contact ⢠Also transmitted through sex, unsterilized needles, toothbrush or razor, ⢠mother's milk ⢠Vaccine available to prevent hepatitis B ⢠Being bitten by someone who is infected.
- 14. Hepatitis CHepatitis C ⢠Identified in 1989 ⢠Blood test became available in 1992 ⢠Used to be known as ânon- A, non-Bâ hepatitis ⢠Spread through blood-to- blood contact ⢠liver cancer risk is only increased in people with cirrhosis ⢠No vaccine available to prevent hepatitis C
- 15. ⢠Misuse of anesthesia can result in the transmission of h , -RESEARCH
- 16. Hepatitis CHepatitis C ⢠About 3 million Americans infected ⢠About 170 million infected worldwide ⢠Many do not experience symptoms
- 17. Hepatitis DHepatitis D ⢠virus HDV (Hepatitis D Virus). ⢠Only a person who is already infected with hepatitis B
- 18. Hepatitis EHepatitis E ⢠A person can become infected by drinking water that contains HEV (hepatitis E virus). ⢠Infection is also possible through anal-oral sex.
- 19. Hepatitis XHepatitis X ⢠If a hepatitis cannot be attributed to the viruses of hepatitis A, B, C, D, or E, it is called hepatitis X. In other words, hepatitis of an unknown virus.
- 20. Hepatitis GHepatitis G ⢠This is a type of hepatitis caused by the hepatitis G virus (HGV). Usually there are no symptoms. When there are symptoms, they are very mild.
- 21. PREVENTION OFPREVENTION OF HEPATITISHEPATITIS ⢠How to prevent hepatitis A? ⢠Wash your hands with soap after going to the toilet ⢠Only consume food that has just been cooked ⢠Only drink commercially bottled water, or boiled water if you're unsure of local sanitation ⢠Only eat fruits that you can peel if you are somewhere where sanitation is unreliable ⢠Only eat raw vegetables if you are sure they have been cleaned/disinfected thoroughly ⢠Get a vaccine for hepatitis A if you travel to places where hepatitis may be endemic.
- 22. How to prevent hepatitis B?How to prevent hepatitis B? ⢠Tell the partner if you are a carrier or try to find out whether he/she is a carrier ⢠Practice safe sex ⢠Only use clean syringes that have not been used by anyone else ⢠Do not share toothbrushes, razors, or manicure instruments ⢠Have a hepatitis B series of shots if you are at risk ⢠Only allow well sterilized skin perforating equipment (tattoo, acupuncture, etc.).
- 23. How to prevent hepatitis C?How to prevent hepatitis C? ⢠Is not preventables but ceratin measures are taken to get relief from it ⢠Later discussion detail
- 24. How to prevent hepatitis D?How to prevent hepatitis D? ⢠Use the same guidelines as for hepatitis B. Only a person who is infected with hepatitis B can become infected with hepatitis D.
- 25. How to prevent hepatitis E?How to prevent hepatitis E? ⢠Do the same as you would to protect yourself from hepatitis A infection.
- 26. How to prevent alcoholicHow to prevent alcoholic hepatitis?hepatitis? ⢠Go easy on the alcohol, or abstain from consuming alcohol.
- 27. How to prevent toxic/drugHow to prevent toxic/drug induced hepatitis?induced hepatitis? ⢠Make sure you know about the lethal contents of all chemicals ⢠e.g inj diclofenac sodium ,acitaminophen, or anal gesics for longer duration or ⢠Epidural analgesia
- 28. Who Should Be Tested forWho Should Be Tested for Hepatitis C?Hepatitis C? ⢠People with risk factors for hepatitis C ⢠Those who wish to be tested
- 29. How Do People BecomeHow Do People Become Infected With Hepatitis C?Infected With Hepatitis C? ⢠Blood products â Blood transfusions before 1992 â Other blood products before 1987 â Current transfusions no longer a major risk factor ⢠Injection (IV) drug use â 60% of all new infections High Risk:
- 30. How Do People BecomeHow Do People Become Infected With Hepatitis C?Infected With Hepatitis C? ⢠Snorting cocaine or other drugs ⢠Occupational exposure ⢠Body piercing & acupuncture with unsterilized needle ⢠Tattooing Lower Risk:
- 31. How Do People BecomeHow Do People Become Infected With Hepatitis C?Infected With Hepatitis C? ⢠From pregnant mother to child ⢠Non-sexual household contacts (rare) â Sharing razors and/or toothbrushes ⢠Sexual transmission ⢠Unknown Lower Risk:
- 32. What About Sex?What About Sex? ⢠Sexual transmission is not very likely, BUT it is still possible ⢠If you have more than one sex partner, use latex condoms ⢠If you have one long-term sex partner, you do not necessarily need to change your sex habits
- 33. Hepatitis C is NOTHepatitis C is NOT Spread By:Spread By: ⢠Sneezing ⢠Coughing ⢠Food or water ⢠Sharing drinking glasses or eating utensils ⢠Handshakes ⢠Holding hands ⢠Hugging ⢠Kissing on the cheek ⢠Playing with children ⢠Donating blood
- 34. How Can You Prevent theHow Can You Prevent the Spread of Hepatitis C?Spread of Hepatitis C? ⢠Cover open wounds ⢠Tell people not to touch your blood ⢠Clean blood spills yourself or inform others to use latex gloves ⢠Dispose of needles/materials properly ⢠Do not inject drugs
- 35. How Can You Prevent theHow Can You Prevent the Spread of Hepatitis C?Spread of Hepatitis C? ⢠Avoid sharing contaminated articles â Razors, toothbrushes, or other personal care items ⢠Inform healthcare professionals/others ⢠Do not donate blood, body organs, tissues or semen ⢠Practice safe sex
- 36. How Will You Know if YouHow Will You Know if You Have Hepatitis C?Have Hepatitis C? ⢠Many people have no symptoms of the virus ⢠If you do have symptoms: ⢠The only way to know if you have hepatitis c is to have a blood test ⢠Fatigue ⢠Discomfort in the liver area ⢠Loss of appetite ⢠Aching joints ⢠Trouble sleeping ⢠Depression
- 37. How is Hepatitis CHow is Hepatitis C Diagnosed?Diagnosed? ⢠Blood testing 1. Hepatitis C antibody test 2. Hepatitis C PCR test to find virus in blood ⢠Liver function tests
- 38. What is Your Hepatitis CWhat is Your Hepatitis C Genotype?Genotype? ⢠Like different breeds of dog ⢠Genotype 1: â Most common in U.S. ⢠Genotypes 2 & 3: â Less common 6 different genotypes of hepatitis C
- 39. Why Should You Be ConcernedWhy Should You Be Concerned About Hepatitis C?About Hepatitis C? ⢠Hepatitis C causes serious problems in some patients ⢠Fibrosis ⢠Cirrhosis ⢠Advanced liver disease ⢠Hepatocellular carcinoma (liver cancer)
- 40. FibrosisFibrosis ⢠The beginning of scarring ⢠Caused by infection, inflammation, or injury ⢠Can prevent the liver from working well ⢠Can lead to permanent scarring (cirrhosis)
- 41. CirrhosisCirrhosis ⢠Pronounced âsir-o-sisâ ⢠Means âscarring of the liverâ ⢠At risk for liver failure and liver cancer ⢠Requires close medical follow-up Healthy Liver Liver with Cirrhosis
- 42. Advanced Liver DiseaseAdvanced Liver Disease ⢠Fatigue ⢠Difficulty thinking clearly or concentrating ⢠Yellow jaundice ⢠Swelling ⢠Fluid in the abdomen ⢠Gastrointestinal bleeding ⢠Poor blood clotting
- 43. Hepatocellular CarcinomaHepatocellular Carcinoma ⢠Most common type of liver cancer ⢠Chronic hepatitis C increases the risk ⢠Treated with surgery, medications or liver transplant
- 44. Liver TransplantLiver Transplant ⢠May be needed for patients who develop liver failure or liver cancer ⢠About 50% of all U.S. liver transplants result from liver damage caused by hepatitis C ⢠Most patients with hepatitis C will never need a liver transplant
- 45. What Happens to People WithWhat Happens to People With Hepatitis C Virus?Hepatitis C Virus? â˘â˘â˘â˘â˘â˘â˘â˘â˘â˘â˘â˘â˘â˘â˘â˘â˘â˘â˘â˘ â˘â˘â˘â˘â˘â˘â˘â˘â˘â˘â˘â˘â˘â˘â˘â˘â˘â˘â˘â˘ â˘â˘â˘â˘â˘â˘â˘â˘â˘â˘â˘â˘â˘â˘â˘â˘â˘â˘â˘â˘ â˘â˘â˘â˘â˘â˘â˘â˘â˘â˘â˘â˘â˘â˘â˘â˘â˘â˘â˘â˘ â˘â˘â˘â˘â˘â˘â˘â˘â˘â˘â˘â˘â˘â˘â˘â˘â˘â˘â˘â˘ â˘â˘â˘â˘â˘â˘â˘â˘â˘â˘â˘â˘â˘â˘â˘â˘â˘â˘â˘â˘ â˘â˘â˘â˘â˘â˘â˘â˘â˘â˘â˘â˘â˘â˘â˘â˘â˘â˘â˘â˘ â˘â˘â˘â˘â˘â˘â˘â˘â˘â˘â˘â˘â˘â˘â˘â˘â˘â˘â˘â˘ â˘â˘â˘â˘â˘â˘â˘â˘â˘â˘â˘â˘â˘â˘â˘â˘â˘â˘â˘â˘ â˘â˘â˘â˘â˘â˘â˘â˘â˘â˘â˘â˘â˘â˘â˘â˘â˘â˘â˘â˘ Infected With Hepatitis C 100 â˘â˘â˘â˘â˘â˘â˘â˘â˘â˘ â˘â˘â˘â˘â˘ 15 No Chronic Disease â˘â˘â˘â˘â˘â˘â˘â˘â˘â˘ â˘â˘â˘â˘â˘â˘â˘â˘â˘â˘ â˘â˘â˘â˘â˘â˘â˘â˘â˘â˘ â˘â˘â˘â˘â˘â˘â˘â˘â˘â˘ â˘â˘â˘â˘â˘â˘â˘â˘â˘â˘ â˘â˘â˘â˘â˘â˘â˘â˘â˘â˘ â˘â˘â˘â˘â˘â˘â˘â˘â˘â˘ â˘â˘â˘â˘â˘â˘â˘â˘â˘â˘ â˘â˘â˘â˘â˘ Chronic Disease 85 â˘â˘â˘â˘â˘â˘â˘â˘â˘â˘ â˘â˘â˘â˘â˘â˘â˘ Cirrhosis 17 â˘â˘ 2 Liver Cancer
- 46. How Will You Know if YouHow Will You Know if You Have Problems fromHave Problems from Hepatitis C?Hepatitis C? ⢠Blood tests â Can be normal even with liver damage ⢠Liver biopsy â Only way to determine the amount of scarring â Small risk of complications and very few side effects â Should be free of alcohol and street drugs
- 47. What About Alcohol?What About Alcohol? Drinker Without Hepatitis C Drinker With Hepatitis C Hepatitis C Non-Drinker Chance Of Getting Cirrhosis Non-Drinker
- 48. Effect of Alcohol onEffect of Alcohol on Liver ScarringLiver Scarring 0 1 2 3 4 <10 15 25 35+ Cirrhosis No Scarring Years of Hepatitis C Infection Heavy Drinker Light or Non-Drinker
- 49. With Hepatitis C, YouWith Hepatitis C, You Should:Should: ⢠Avoid all alcohol ⢠Be careful with all medications, including over the counter and herbal medications ⢠Tell all health care providers that you have hepatitis C
- 50. Hepatitis C & HIV Co-InfectionHepatitis C & HIV Co-Infection HIV ⢠Spread through blood and sexual contact ⢠Over time makes it hard for your body to fight off dangerous infections ⢠Can be treated BUT there is no cure Hepatitis C ⢠Spread through blood only ⢠Over time can cause cirrhosis and liver cancer ⢠There is a cure BUT itâs not effective in all patients These viruses are spread in similar ways but are very different diseases All patients with hepatitis C should be tested for HIVAll patients with hepatitis C should be tested for HIV
- 51. Those With Hepatitis CThose With Hepatitis C ShouldShould ⢠Take care not to spread hepatitis C to others ⢠Be vaccinated for hepatitis A and hepatitis B ⢠Discuss treatment options with a knowledgeable medical professional
- 52. What Medications to Avoid?What Medications to Avoid? ⢠acetaminophen (TylenolÂŽ and others): no more than four extra strength or six regular strength tablets per day ⢠ibuprofen and other anti-inflammatory medications (MotrinÂŽ , AdvilÂŽ , AleveÂŽ , and others) â Hepatitis C patients without cirrhosis may take the recommended dose on bottle â Hepatitis C patients with cirrhosis should NOT take any
- 53. What About Vitamins andWhat About Vitamins and Herbs?Herbs? ⢠Iron supplements not recommended â They may increase the rate of liver scarring ⢠Milk thistle is safe, BUT not shown to improve liver disease ⢠Talk with your medical care provider before starting any new medication or supplement
- 54. Treatment of ChronicTreatment of Chronic Hepatitis CHepatitis C
- 55. Goals of TreatmentGoals of Treatment ⢠Clear all the hepatitis C virus from the body (âsustained responseâ) ⢠Slow or stop damage to the liver ⢠Help decrease symptoms
- 56. What Treatment isWhat Treatment is Available?Available? ⢠Interferon â Given by shot, usually 3 times a week ⢠Pegylated interferon â Long-acting, taken once a week ⢠Combination therapy â Interferon (standard or pegylated) taken with ribavirin â Ribavirin is a pill taken twice daily
- 57. During TreatmentDuring Treatment ⢠Medications taken for either 6 or 12 months ⢠Blood testing required 2 to 3 times the first month, then every 4 weeks ⢠Clinic visits every 1 month ⢠Interferon must be refrigerated
- 58. Side Effects ofSide Effects of Interferon & RibavirinInterferon & Ribavirin ⢠Flu-like symptoms â Headache â Fatigue â Muscle & joint aches â Fever, chills ⢠Psychiatric symptoms â Depression â Difficulty sleeping â Difficulty concentrating â Irritability Common Side Effects:
- 59. Side Effects ofSide Effects of Interferon & RibavirinInterferon & Ribavirin ⢠May occur from the beginning: â Upset stomach, diarrhea â Decreased blood counts â Skin irritation from shots ⢠May occur later in treatment: â Hair loss â Weight loss â Thyroid problems Less Common Side Effects:
- 60. Disadvantages of TreatmentDisadvantages of Treatment ⢠Side effects ⢠Other medical conditions can be made worse ⢠Patients with severe mental health problems cannot be safely treated ⢠Ribavirin can cause severe birth defects if either parent is taking the medication ⢠Two forms of reliable birth control required
- 61. Complementary TherapiesComplementary Therapies ⢠Aromatherapy ⢠Massage therapy ⢠Meditation and visualization ⢠Yoga
- 62. Living With Hepatitis CLiving With Hepatitis C Maintain a healthy life outlook. Live your life!
Hinweis der Redaktion
- One of the largest and most important organs in the body. Right side of the body behind the lower right part of the rib cage Size of a âfootballâ Acts as a filter to clean blood The liver is a toxic waste station. It breaks down what we take in. Most of the substances in our bodies have been through the liver at some point
- You can also think of the liver as a factory. It builds and converts proteins and sugars into most of the things that our bodies need. The liver converts and stores vitamins, hormones, cholesterol, and minerals. Stores vitamins, sugars, fats, and other nutrients Your liver then releases these chemicals and nutrients into your bloodstream when needed. Helps regulate hormones Helps make clotting factors Image taken from website, http://www.coelima.co.uk/factory.htm. Image not copyrighted.
- Many things can cause hepatitis. With hepatitis C you need to be careful not to do anything that will irritate your liver With hepatitis the liver enzymes are usually elevated and the liver can become enlarged
- AST (SGOT) and ALT (SGPT) are sensitive indicators of liver damage.But it must be emphasized that higher-than-normal levels of these liver enzymes should not be automatically equated with liver disease. They may mean liver problems or they may not. A patient may have normal liver enzymes levels but have liver damage. Liver enzyme levels do not tell us what is going on in the liver.
- Most people infected with the hepatitis A virus get well within six months. Does not result in long-term (chronic) infection Can be very serious for older people and people who already have liver disease. If someone is hepatitis C positive and gets hepatitis A there is a larger chance of making their hepatitis C worse. Those with hepatitis C should be vaccinated against hepatitis A. The vaccine is given in two shots. The first shot should be followed by a second shot 6 months to a year later. The vaccine is good for 20 years. A common question is, &quot;If I&apos;ve got hepatitis C, can I get either hepatitis A or B?&quot; The answer is, &quot;yes&quot;. That is because they are spread in different ways and affect your liver in different ways. But all types of hepatitis can harm your liver.
- Most people who get hepatitis B can get rid of the virus on their own, but others can develop chronic hepatitis B. Usually does not result in long-term (chronic) infection. May not have any symptoms. Those at risk for getting hepatitis B should get vaccinated. The vaccine is given in 3 shots. A single shot followed by a second shot one month later, and then a third shot six months later. The vaccine will protect you for about 13 years.
- Important to stress the fact that HCV does not always have symptoms. Can feel healthy for 10-20 or more years before developing symptoms. Patient can be asymptomatic but have hepatitis C. Symptoms are often very mild, but liver damage can occur without symptoms No vaccine is available for hepatitis C, but researchers are working hard. The virus mutates quickly making it difficult to make a vaccine.
- 4 times more common than HIV Fewer people are transmitting HCV now compared to 20-30 years ago. About 30,000 more become infected each year
- The largest two predictors are IV drug use and use of blood products. Just one contaminated needle, regardless of it that person was sure the needle was new, can infect someone with hepatitis C. It only takes one drop of blood to become infected. The blood supply is thoroughly tested for hepatitis C and recent blood products are no longer a risk factor. Less than 1 chance per million units transfused. 1. CDC, Viral Hepatitis C, Frequently Asked Questions, http://www.cdc.gov/ncidod/diseases/hepatitis/c/faq.htm#7a
- Above are possible ways to transmit the disease. No one really knows the exact risk. Hemodialysis is another risk factor not listed above ~ 20 â 30% HCV + Occupational: Needle sticks or exposure to blood products Cocaine Use: Not from the cocaine itself, from intranasal drug use. Broken blood vessel in the nose â blood on the straw Body Piercing and Acupuncture: By way of the needles used (may or may not be sterilized) Tattooing: By way of the needles used (may or may not be sterilized) and/or reuse of ink in tattoo parlors. Use of rubber tubing to carry the ink to the needle (The ink and/or the rubber tubing may not be sterilized between customers.) âNo data exist in the U.S. indicating that persons with exposures to tattooing and body piercing alone are at increased risk of HCV infection. Further studies are needed to determine if these types of exposures and settings in which they occur (e.g., correctional institutions, unregulated commercial establishments), are risk factors for HCV infection in the United States.â 2. CDC, http://www.cdc.gov/ncidod/diseases/hepatitis/c_training/edu/1/epidem-trans-5.htm For more information on tattooing refer to references 3, 4, & 5
- My wife is pregnant. Will our baby have hepatitis C? No, HCV is not transmitted from the father to the baby. An HCV + father poses no risk to the baby at all. Remember blood to blood transmission. Can breastfeeding transfer hepatitis C? No, breastfeeding is fine, however HCV-positive mothers should consider refraining from breast-feeding if their nipples are cracked or bleeding. Remember to think blood-to-blood transmission. 1. CDC, Viral Hepatitis C, Frequently Asked Questions, http://www.cdc.gov/ncidod/diseases/hepatitis/c/faq.htm#7a 6. NDDIC, Chronic Hepatitis C: Current Disease Management, http://digestive.niddk.nih.gov/ddiseases/pubs/chronichepc/index.htm Non-sexual: Anything used in the bathroom or anything that you put in your mouth Razors: use your own Nail clippers: make sure sterilized properly, or bring your own Use your own tooth brush Clean blood spills: use bleach 1:10
- In single partner relationships you should discuss the risk of transmission with your partner. The risk is very low but not absent: discuss the need for partner testing. Discuss this with your partner. Your partner may consider being tested To be 100% sure of not infecting your partner you should consider safe sex. There is a &lt;7% chance that it can be spread by sexual contact. Can HCV be spread by oral sex? There is no evidence that HCV has been spread by oral sex. 1. CDC, Viral Hepatitis C, Frequently Asked Questions, http://www.cdc.gov/ncidod/diseases/hepatitis/c/faq.htm#7a The risk of sexual transmission increases if the person has been treated for an STD, or has had sex with a prostitute, or has had a large number of sexual partners. Large is considered 10-20 in a lifetime. For more information refer to reference 7 & 8
- Emphasize: Saliva, sweat and tears cannot spread the virus. Remember blood-to-blood. Do not need to sterilize household items such as kitchenware and utensils. HCV + person should not be restricted in work or home, or in social activities or settings. Donating blood: Cannot get HCV from donating blood, but can get it from receiving blood that someone else donated.
- Around the house, cover cuts and sores; clean up blood spills with bleach solution; properly dispose of needles Good idea to have latex gloves at home or in the car. How long can hepatitis C live outside of the body? We donât know. We do know that hepatitis C can leave outside of the body longer than HIV. Will bleach, hot water, or alcohol kill the HCV on my needle or razor? No, bleach, hot water, or alcohol cannot kill the HCV on a needle or razor. How do I sterilize my needle or razor? A medical autoclave can sterilize a needle or razor. If I have HCV and I share my equipment or works with someone else who has HCV can my HCV be made worse? We do not know, however, we have no reason to think that it would.
- Do not share razors, toothbrushes, scissors, nail clippers Do not donate blood or blood products, semen, or body fluids In multiple partner relationships practice safe sex In single partner relationships discuss the risk of transmission Inform health care providers, such as dentists or others who may come into contact with your blood. What is the risk of transmitting HCV through medical or dental work? Medical and dental procedures done in most settings in the United States do not pose a risk for the spread of HCV. There have, however, been some reports that HCV has been spread between patients in hemodialysis units where supplies or equipment may have been shared between patients. 1. CDC, Viral Hepatitis C, Frequently Asked Questions, http://www.cdc.gov/ncidod/diseases/hepatitis/c/faq.htm#7a
- You may be surprised to hear that youâre HCV + because you feel great or you might have mistaken your symptoms for something else. Symptoms may come in cycles Some find out theyâre HCV + by the results of a series of tests to determine why theyâre so tired. Some may find out when they donate blood. The Red Cross will contact them to inform them that they cannot use their blood because their blood tested positive for HCV. If I have an infection in my liver shouldnât I be showing symptoms? Not necessarily, the symptoms can sneak up on you. Can discomfort in the liver be sharp, shooting pains? Yes.
- The first test is the antibody test. It tells if the patient has ever been exposed to HCV. The PCR test is done after the Antibody test and determines if the HCV is present in the blood stream. Liver function tests, such as AST (SGOT) and ALT (SGPT) detect inflammation of the liver. When your liver is working well, the levels of these are low. When your liver is not working as well as it should, they can get much higher. However, liver function tests do not give a good idea of whatâs really going on in the liver. 9. Department of Veteran Affairs, The Liver Brochure Series, What Is Your Liver, http://www.va.gov/hepatitisC Can you have a normal liver enzyme (e.g., ALT) level and still have chronic hepatitis C? Yes, it is common for persons with chronic hepatitis C to have a liver enzyme level that goes up and down, with periodic returns to normal or near normal. Some persons have a liver enzyme level that is normal for over a year but they still have chronic liver disease. If the liver enzyme level is normal, persons should have their enzyme level re-checked several times over a 6 to 12 month period. If the liver enzyme level remains normal, your doctor may check it less frequently, such as once a year. 1. CDC, Viral Hepatitis C, Frequently Asked Questions, http://www.cdc.gov/ncidod/diseases/hepatitis/c/faq.htm#7a
- Is it necessary to do genotyping when managing a person with chronic hepatitis C? Yes, as there are 6 known genotypes and more than 50 subtypes of HCV, and genotype information is helpful in defining the epidemiology of hepatitis C. Knowing the genotype or serotype (genotype-specific antibodies) of HCV is helpful in making recommendations and counseling regarding therapy. Patients with genotypes 2 and 3 are almost three times more likely than patients with genotype 1 to respond to therapy with alpha interferon or the combination of alpha interferon and ribavirin. Furthermore, when using combination therapy, the recommended duration of treatment depends on the genotype. For patients with genotypes 2 and 3, a 24-week course of combination treatment is adequate, whereas for patients with genotype 1, a 48-week course is recommended. For these reasons, testing for HCV genotype is often clinically helpful. Once the genotype is identified, it need not be tested again; genotypes do not change during the course of infection. Why do most persons remain infected?Persons infected with HCV mount an antibody response to parts of the virus, but changes in the virus during infection result in changes that are not recognized by preexisting antibodies. This appears to be how the virus establishes and maintains long-lasting infection. Can persons become infected with different genotypes?Yes. Because of the ineffective immune response described above, prior infection does not protect against reinfection with the same or different genotypes of the virus. For the same reason, there is no effective pre- or postexposure prophylaxis (i.e, immune globulin) available. 1. CDC, Viral Hepatitis C, Frequently Asked Questions, http://www.cdc.gov/ncidod/diseases/hepatitis/c/faq.htm#7a
- âThe progression of fibrosis in chronic hepatitis C determines the ultimate prognosis and thus the need and urgency of therapy.â There are four stages: 1 â 4. 4 being more severe âThe rate at which fibrosis progresses varies markedly between patients. The major factors known to be associated with fibrosis progression are older age at infection, male gender, and excessive alcohol consumption. â 22. P Marcellin and others. Fibrosis and disease progression in hepatitis C Hepatology 36(5): S47-S56. November 2003, part 2.
- When a patient has cirrhosis large parts of the liver are damaged and thus may not work as well. Can be caused by anything that damages the liver after years of irritation, not just alcohol. Cannot predict who will develop cirrhosis. Men have a higher risk. Is there a correlation between cirrhosis and liver enzyme levels? No, there is no correlation. Images were copied from Hepatitis C Virus Infection Presentation, put together by the Centers of Excellence in Hepatitis C Research and Education. http://www.va.gov/hepatitisc/pted/pted.htm#hepc
- Results from long-term advanced liver disease Does not occur in every patient and does not develop over night Swelling (edema) Fluid in the abdomen (Ascites)
- Occurs in about 2% of patients with chronic hepatitis C Exact cause is unknown. Symptoms are not always present Typically diagnosed by liver imaging tests and biopsy The type of treatment depends on how early the cancer is caught. Surgery offers the best chance for a cure. 11. Department of Veteran Affairs, The Liver Brochure Series, Liver Cancer, http://www.va.gov/hepatitisC For more information refer to references 11 & 12
- Patients with cirrhosis or liver cancer may have liver failure and will need a liver transplant. The transplant is very stressful on the body. Only considered when the patient might die from liver disease. Does not mean the patient is in danger of dying right away. For more information refer to reference 13
- Chronic disease means that the person will carry the virus in their blood long-term. No chronic disease means that the person will not carry the virus in their blood long-term, but will still have the antibodies in their blood.
- A liver biopsy will help you and your doctor find out more about the health of your liver and can help you decide when to start treatment. Patients who are interested in treatment need to have a liver biopsy. Why do I need to be off alcohol and street drugs? If we get a liver biopsy of somebody who has been drinking recently, it is going to be hard to tell how much of the inflammation or irritation in the liver is really hepatitis C, and how much is from the alcohol. Can I be tested for liver scarring without having a liver biopsy? The only sure way to tell how much scarring your liver has is to have a liver biopsy. Can I begin treatment without having a liver biopsy done? We prefer to have a liver biopsy performed before we start treatment, but there are exceptions. Does the liver biopsy hurt? Generally no. Patients describe it as a sharp pinch. Can I have a liver biopsy done without being sober? We prefer that the patient be off drugs and alcohol for six months before we perform a liver biopsy. For more information refer to reference 10
- To read the above graph in black and white: The first bullet ânon-drinkerâ corresponds to the smallest circle. As you go down the list of bullets the circles get bigger with âhepatitis C drinkerâ being the largest circle. Alcohol is a direct poison to your liver. It prevents your body from absorbing certain vitamins that it needs to work properly. It can also make your hepatitis C medicine less effective. Alcohol damages your liver even when you are healthy. Drinking alcohol when you have hepatitis C make the damage much worse. 14. Department of Veteran Affairs, Hepatitis C Brochure Series, If You Have Hepatitis C Infection, http://www.va.gov/hepatitisC What about alcohol? How much is bad? 1-3 ounces? Iâve heard that a small amount of alcohol is good for you. At this time, weâre not sure. Is it okay to drink non-alcoholic wines? Itâs not suggested. In the future when I clear the HCV can I drink alcohol? It depends on the amount of scarring in your liver. For more information refer to reference 15 at the end of the slide set
- We donât know what a âsafeâ amount of alcohol is for patients with hepatitis C. Remember, even ânon-alcoholicâ drinks have a certain amount of alcohol in them (i.e. Near Beer) Can alcohol and/or smoking cause or transmit HCV? No, drinking alcohol and/or smoking cannot cause or transmit HCV. Remember blood-to-blood contact. However, we do see a lot of HCV patients who are heavy drinkers, but do not have other risk factors. We cannot explain this yet. We rely on people telling us their current and past behavior. As for smoking, a patient with HCV can develop more scar tissue and advance to cirrhosis faster than a non-smoking patient with HCV. Alcohol and smoking have been proven in scientific studies to absolutely cause further damage to your liver. For more information refer to reference 15 & 16
- What is HIV/Hepatitis C co-infections? Co-infection is a medical term meaning that you have two or more infections in your body at the same time. If you have HIV and hepatitis C co-infection, then you have both HIV and hepatitis C. These two illnesses are very different, so it is important that you learn about both of them. 21. Department of Veteran Affairs, Hepatitis C Brochure Series, HIV and Hepatitis C, http://www.va.gov/hepatitisC
- Get vaccinated for hepatitis A and B (having hepatitis C does not mean that you cannot get other kinds of hepatitis) Avoid weight gain
- What is it about ibuprofen that can cause liver problems? In general, certain medications in the right doses, in the right person can cause severe problems. In terms of ibuprofen, one of the chemical ends is toxic to the liver. What about aspirin?
- Is iron in my vitamins and supplements okay? Dietary iron is fine, however, try to take a multi-vitamin or supplements without iron. For more information refer to references 17, 18, & 19
- Primary goal is to clear the virus. You will still need to be followed your M.D. You can relapse, or be a non-responder to treatment. Throughout your treatment you will be monitored by labs that will screen your blood for hepatitis C viral load and serologies.
- Some patients may undergo mono-therapy or combination therapy with either standard or pegylated interferon. How do you determine which treatment a patient should go on? Knowing the genotype or serotype (genotype-specific antibodies) of HCV is helpful in making recommendations and counseling regarding therapy. Patients with genotypes 2 and 3 are almost three times more likely than patients with genotype 1 to respond to therapy with alpha interferon or the combination of alpha interferon and ribavirin. Furthermore, when using combination therapy, the recommended duration of treatment depends on the genotype. For patients with genotypes 2 and 3, a 24-week course of combination treatment is adequate, whereas for patients with genotype 1, a 48-week course is recommended. 1. CDC, Viral Hepatitis C, Frequently Asked Questions, http://www.cdc.gov/ncidod/diseases/hepatitis/c/faq.htm#7a What is Ribavirin? Ribavirin is an antiviral pill. By itself, Ribavirin does not treat HCV, but in combination with interferon it is highly effective in treating HCV.
- Length of treatment depends on genotype and response to medications during treatment.
- Side effects are how most people with hepatitis C feel everyday but worse. You may have several side effects from the medications used to treat HCV, but side effects can be dealt with effectively in many ways . IFN and ribavirin each have their own set of side effects. We donât know whose going to get which side effects. Itâs completely variable, on average you get 2-3 side effects These are the common side effects seen, but these can vary between individuals. Flu-like symptoms - These tend to occur in the first few weeks of therapy and many are manageable. Mood changes can sometimes occur late in therapy and should be constantly monitored. Depression and mood disorders must be under control before treatment. Your physician & health care provider will refer you to a professional if needed, and work closely with that person during your course of treatment. On treatment, depression and other mood disorders can occur because of a direct response to the medication on your levels of serotonin in your brain. To treat the side effects: Fatigue - regular light exercise, get a good night sleep, manage stress Mood changes/sleeplessness - relaxation exercises, support systems, discuss meditations with physician.
- Nausea, vomiting, diarrhea, poor appetite Try to eat small meals, choose nutritious foods, and drink plenty of fluids to help these symptoms. Weight loss Most patients are happy about this. Hair loss Is reversible Wear hats/scarves Use mild hair products
- Interferon is not for everyone. Alpha interferons in treatment, cause or aggravate fatal or life-threatening neuropsychiatric, autoimmune, ischemic, and infectious disorders. Patients should be monitored closely with periodic clinical and laboratory evaluations. The ribavirin pills can cause birth defects if either parent is taking the medicine. Patients taking ribavirin need to use two forms of birth control if there is any chance of conceiving a child. No attempts to conceive should be made during treatment or for six months after. Can I be treated if Iâm already being treated for depression? Yes, however, we may need to monitor you more closely during treatment.
- Aromatherapy is based on the idea that certain smells can change the way you feel. People use it to reduce stress or to help with fatigue. Meditation and visualization are common tools people use to cope with pain and stress. Yoga is an ancient set of exercises that is often combined with meditation. It helps may people improve their fitness, reduce stress, and increase their flexibility.
- References noted in slides: CDC, Viral Hepatitis C, Frequently Asked Questions, http://www.cdc.gov/ncidod/diseases/hepatitis/c/faq.htm#7a CDC, http://www.cdc.gov/ncidod/diseases/hepatitis/c_training/edu/1/epidem-trans-5.htm Nishioka SA, Gyorkos TW, Collet JP, et al. Tattooing and risk for transfusion transmitted diseases: the role of the type, number and design of the tattoos, and the conditions in which they were performed. Epidemiol Infect. 2002;128:63-71. Haley RW, Fischer RP. Commercial tattooing as a potentially important source of hepatitis C infection. Medicine. 2001;80:134-151. Reuters Health. Tattoos source of hepatitis without symptoms: Study, 2003-06-02. NDDIC, Chronic Hepatitis C: Current Disease Management, http://digestive.niddk.nih.gov/ddiseases/pubs/chronichepc/index.htm Mikhailov, M I 1. Gomberg, M A 2. Dolzhanskaya, N A 3. Koubanova, A A 2. Significance of sexual route of transmission of hepatitis B and C in Russia. International Journal of STD & AIDS. 13 Supplement 2:9-11, December 2002. Alter, M., Kruszon-Moran, D., Nainan, O.V., et al. The prevalence of hepatitis C virus infection in the united states, 1988 through 1994. N Engl J Med 1999;341:556-62. Department of Veteran Affairs, The Liver Brochure Series, What Is Your Liver, http://www.va.gov/hepatitisC Gebo, K.A., Herlong, H.F., et al., Role of liver biopsy in management of chronic hepatitis C: A systematic review., Hepatology, Vol. 36, No. 5, Suppl. 1, 2002: S161-72