Hepatitis: A Basic Overview

1
Hepatitis A Basic Overview

• Seattle, Washington

2
Topics of Discussion

• What is hepatitis?
• How is hepatitis C caused and prevented
• Treatment (and CURE!!!) update
• Hepatitis Education Project and YOU

3
HCV Cascade of Care
4
Rates of Mortality in WA State
5
State/Fed Prevention Funding
6
Hepatitis Affects Your

• 2nd largest organ
• Weighs 3-5 lbs
• Has 500 functions
• Filters and cleans your blood
• Uncomplaining organ
• Able to regenerate and heal

7
What is hepatitis ???

• Hepa means liver itis means inflammation
• Hepa titis Liver Inflammation
• Liver inflammation can lead to scarring called
  cirrhosis

8
Long-term effects of hepatitis Cirrhosis and
liver scarring

• Healthy livers are plump and smooth
• Cirrhotic livers are nodular bumpy and shrunken
• Hepatitis C is the leading cause of liver failure
  and liver transplant in the U.S.

9
Healthy vs. Cirrhotic Liver Function
10
What causes hepatitis?
Alcohol

• Viruses

are the most common causes of liver inflammation
11
Hepatitis Viruses

• Hepatitis A, B, and C
• all different
• all cause liver inflammation
• named in order of discovery, not severity

12
A, B, C Virus Transmission Comparison

• Hep A
• Fecal-oral transmission
• Injesting contaminated food water, unsafe sex
• Prevention Get vaccinated! Wash hands!
• Hep B
• Bodily fluids Semen, vaginal fluid, blood
• STD, mother-child, sharing drug/tattoo/piercing
  equipment
• Prevention Get vaccinated! Have safer sex!
• Hep C
• Bodily fluid Blood only
• Sharing drug/tattoo/piercing equipment, blood
  transfusion
• Prevention Use clean drug/tattoo/piercing
  equipment every time!

13
Hepatitis A and B VaccinesTwinrix

• Twinrix is a combo HAV/HBV vaccine
• Safe and easy- 3 shots within 6 mos
• Lifetime immunity
• Wont hurt if vaccinated twice
• No need to restart if you have a
• break between shots
• No vaccine for Hep C

14
Acute vs chronic infection
Acute Chronic
Hepatitis A 100 0
Hepatitis B 90 (as adult!) 10
Hepatitis C 20-25 75-80
HCV is more common than HAV/HBV and more likely
to become chronic
15
Hepatitis C is transmitted

• through blood to blood contact!

How does blood-to-blood contact happen?
16
Summary of Risks for Transmitting Hepatitis C
Hepatitis viruses are NOT spread by casual
contact such as hugging, kissing, sharing food or
drinks, playing, sharing a house/bed/toilet
17
Injection Drug Use is the 1 way that HCV is
spread in U.S.

• Sharing any injection drug equipment can pass hep
  C (and hep B)
• works needles, syringes, cottons, cookers,
  rinse water, tourniquets, gauze, drugs etc.
• Cleaning needles reduces, but does not eliminate
  risk

18
Tattoos

• Tattoos done in prison, jail, or other unsterile
  settings are the most risky
• Use a new needle, ink, barrel, and gloves every
  time
• Get tattoos at licensed shops (autoclave,
  disposable inks and needles)

19
Natural History of Hep C
20
Possible Complications of Cirrhosis

• Portal hypertension (blood pressure)
• Weakened blood vessels can cause bleeding, often
  in esophagus or stomach
• Fluid retention
• Liver cancer up to 48 of liver cancer cases are
  related to HCV
• Frequent infections
• Malnutrition
• Dark urine/Light colored stool
• Brain fog

21
Hepatitis C Testing

• Testing for HCV is a 2-step process
• Step 1 Antibody test
• looks for exposure to virus
• Step 2 PCR or confirmatory test
• looks for actual virus

22
Genotype Testing

• Genotypes different strains of the virus
• 6 different genotypes
• 1,2,3 are most common
• Genotype tells your doctor
• which medication to prescribe
• how long you will need to take the medication
• how effective the treatment will be

23
Liver Health Testing

• There are several different ways to evaluate the
  liver
• Liver Enzyme Tests
• APRI Score and other blood tests
• Ultrasound
• Fibrosure
• Fibroscan
• Liver Biopsy

24

• Yes!
• Hepatitis C is curable

25
Treatment Goals

• Kill the virus
• SVR CURE
• Prevent cirrhosis
• If cirrhotic, prevent further scarring
• Get rid of fatigue and other symptoms

26
Hep C Treatment - Interferon

• Injected once a week
• Boosts your immune response

Side Effects

• Diarrhea
• Hair Thinning
• Thyroid Problems

• Depression
• Irritability
• Fatigue

• Fever
• Headache
• Nausea

27
New Hep C Treatments are

• All oral medications (no more injections!)
• Olysio (simeprevir)
• Sovaldi (sofosbuvir)
• Harvoni (ledipasvirsofosbuvir)
• Viekira Pak (4 medicine combo)
• Ribavirin
• 90 95 effective
• 8 24 weeks
• Few side effects (fatigue, headache, nausea,
  trouble sleeping, diarrhea)

28
Some factors affecting treatment options

• Genotype and other genetic factors
• Amount of liver scarring (fibrosis)
• Patients age
• Previous treatment for hep C
• Other medical conditions

29
How do I pay for treatment?

• With insurance coverage
• Public or Private
• If no insurance
• Clinical Trials
• Patient Assistance
• Affordable Care Act
• How?
• Research online
• Contact drug companies
• HEPs Medical Case Management (MCM) Program!!!

30
HEPs Mission

• The Hepatitis Education Project is committed to
  providing support, education, advocacy and direct
  services for people affected by hepatitis and to
  helping raise hepatitis awareness among patients,
  medical providers and the general public

31
HEP History Lesson

• Started in 1993 by a group of patients and
  medical professionals to support newly diagnosed
  patients
• Formally incorporated in 1994 Aided patients
  through support groups and resource assistance
• Opened one of the nations first hepatitis
  resource centers in 2000!
• Provided local support at Seattle resource center
  and other agencies
• Provided national support via telephone and video
  conference

32
Current Programs Services

• Testing and Vaccinations
• Youth Outreach and Education
• Medical Case Management
• Support Groups in Seattle Tacoma
• Advocacy and Outreach Education in
• WA prisons and King County jail
• Local, State, National, and Global Advocacy

33
Who do we work with?

• Emphasis on supporting stigmatized communities
  including
• people experiencing poverty/unstable housing
• people who use drugs or are in any stage of
  recovery
• people who are incarcerated
• Some partner agencies include
• Evergreen Treatment Services (ETS)
• Peoples Harm Reduction Alliance (PHRA)
• Project NEON
• Seattle Area Support Groups (SASG)
• Aurora Commons
• Youthcare
• Teen Feed

34
Medical Case Management Program (MCM)

• MCM services (like all of HEPs programs) are
  always
• FREE!
• Non-judgmental, supportive, and compassionate
• Client-driven
• Available at any stage of a clients hepatitis
  diagnosis

35
Medical Case Managers can help your clients

• Navigate the health care system
• Access confirmatory (PCR) tests
• Find a PCP and/or liver specialist
• Enroll in health insurance/Medicaid
• Access new HCV treatment including insurance
  appeals, patient assistance programs, charity
  care
• Advocate for fair access to treatment
• Take control of their own medical decisions

36
How do clients and community agencies access MCM?

• Walk-ins, calls, or emails for support
• HEP outreach program referrals
• CBO and medical provider referrals
• Once referrals are received, initial contact is
  made within one week

37
How to live healthily with hepatitis C

• Avoid/reduce alcohol intake
• See the doctor regularly
• Have a liver cancer screening every 6 months a
  year (if needed)
• Talk to doctor about every supplement or OTC
  medication
• Follow a healthy diet and exercise regularly
• Get vaccinated against HAV/HBV
• Avoid co-infection with HIV and/or HBV
• If cured, prevent re-exposure

38
Some Helpful Resources!

• HCV Advocate (Fact Sheets)
• www.hcvadvocate.org
• HBV Advocate
• www.hbvadvocate.org
• National Hepatitis Corrections Network (NHCN)
• www.hcvinprison.org

39
Thank you!
Maritime Building, Suite 302 911 Western Ave
Seattle, WA 98104 206-732-0311 www.hepeducation.o
rg