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Hepatitis C Overview

– Patricia Perkins, MS, MPH

– Tri City Institute: LA, CA– www.pperkins.org

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El Higalo Mas grando organo internal

Aproximatamente 3 hecho (hombres)

Dimenion del futbol americano (EU) Locacion en lado derecho superior 1.5 quartos de galon se flue cado

minuto

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Funciones del higalo Bila

Sistema imuna

Producion de cimicas-

>500 funciones cimicas

Detoxificar sustancias

Agentes de coagulacion

Hormonas!Abilidad para regeneracion!

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Como mantener la salud del higalo: (La gente saludable) No mas que:

2 bebidas alcoholicas cada dia -- hombres

1 bebida alcoholica cada dia -- mujeres Cuidate de mixar drogas (licito o

ilicito)– especialmente con alcohol Coma dieta equilibria y saludable Haga vacunas por HAV & HBV Evite humos/vapores/sustancias

toxicos

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Algunos Statisticos 3% de populacion del mundo tiene VHC

(150-200 milion) 3.9 Million en los EU se infectade con

VHC * Chronico – 2.7 Milion en los EU 8-10,000 en EU murie de complicaciones de

VHC – in 10 anos this numero triplicara VHC causa primera por trasplantes del higalo 50-80% de infecciones de VHC hacer

chronicos* Numero no se incluye prisoneros o gente sin casa

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Mas Statisticos Populacion de EU

1.8% todo

2.1% Americanos-Mejicanos

3.4% Americanos Africanos

California 500,000 se

infecte con VHC

85-95% - IDUs

Prison/carcel – 63,500 se infecte o (41%)

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What lo Hace? Solo 10-25%

hacer enfermedad serioso del higalo

Opciones del tratamiento pueden trabajar para algun gente

Con esperenza, mas mejor opciones del tratamiento hacer disponible dentro de 5 anos

Cambios en conducta puede hacer gran diferencia

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Examenes diagnosticas Elisa II / Riba – Examen para anti-cuerpo VHC RNA por PCR->50 particulos en el

sero VHC RNA por branched DNA Assay –

>200,000 particulos en el sero TMA – mas sensitivo, menos cara Genotip (seis mayor subtipos – 72% de

populacion de EU tiene genotipo 1) Biopsia del higalo

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Transmission / Prevention

<10% of routes cannot be identified

Tattoos / Piercing

Neonatal – <5%

Shared House-hold items – razors & toothbrushes

Healthcare workers – needle sticks

Sexual Transmission(1-3%)

Blood before 1992 - transfused, products, procedures

All Drug Paraphernalia

Shared Needles

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Harm Reduction Prevention –

Needle exchange – clean needles and drug preparation tools – cookers & cottons

Bleach – Does it work? 10 minutes!

Safer Sex Cover wounds

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HCV CAN NOT BE SPREAD BY: BREAST FEEDING

SNEEZING

HUGGING

COUGHING

FOOD OR WATER

SHARING EATING UTENSILS OR DRINKING GLASSES

CASUAL CONTACT

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Symptoms Acute vs. Chronic

Fatigue – mild to severe

Flu-like symptoms (muscle/joint/fever)

‘Brain Fog’

Liver Pain

Loss of appetite

Headaches

Gastro Problems

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Treatment Medications

Interferon – by injection - first FDA approved treatment (3 MU, thrice weekly for 48 weeks)

Genotype 1 - 9% SVR Genotype other than 1 –30% SVR

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Interferon and Ribavirin Interferon and ribavirin(capsule)-

‘combo therapy’ INF – 3 mu units, thrice weekly -

Ribavirin 800-1200 mg daily Overall SVR up to 45% Genotype 1 – 12 mos – 29% SVR Genotype Non 1 – 6 mos - 62% SVR

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Pegylated Interferon Schering- PEG-Intron

Approved by FDA – 1-2001 25% sustained response rate

Genotype 1 – 14% Genotype 2 & 3 – 47%

ROCHE – Pegasys – FDA approval pending 39% sustained response rate

Genotype – 1 – 28% Genotype – 2 & 3 – 56%

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Pegylated and Ribavirin Schering – PEG-Intron plus ribavirin

Phase III clinical data – 54% sustained response rates

One group improved SVR - Genotype 1 low viral load FDA Approved

Roche – Pegasys plus ribavirin Phase III clinical data – 56% sustained response

rate – Genotype 1 – 46% - Genotype 2-3, 76% Pending FDA Approval

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Treatment Decisions General

Treatment Guidelines

Healthy Active HCV Elevated ALT’s Compensated liver

disease

Optimal Response Younger Female Low visceral fat Low viral load Minimal liver

damage Genotype 2 or 3

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Side-effects Interferon

Fatigue Muscle/Joint pain Nausea Headaches Anxiety Depression Dry Skin/rashes

Ribavirin seems to make

interferon side effects worse – especially fatigue-Anemia

(both men & women must use birth control)

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Managing Side-Effects Inject before

bedtime Drink lots of water Low doses of

ibuprofen or acetaminophen

Pain medications

Light exercise Daily moisturizing Vary injection

sites Anti-Depressants Plenty of rest Frequent small

meals

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Experimental Therapies Amantadine - pill Maxamine – by injection (phase II

studies) Ribozymes Helicase Inhibitors Protease Inhibitors Interleukin-10

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Complementary Medicine Herbs – milk thistle

Always check with your doctor and herbalist – some herbs are TOXIC

Acupuncture / Acupressure

Traditional Chinese Medicine

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Lifestyle Changes That Help! Alcohol - Avoid

Get vaccinated – Hep A & Hep B

Healthy balanced diet

Exercise

Stress Reduction

Support Groups

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Advocate for Yourself and Your Client! Educate yourself

Establish a good relationship with your doctor

Bring an advocate for doctor’s visits

Ask questions

Keep copies of all medical tests

Keep a diary

Keep an open mind

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Conclusions