1 Hepatitis C Overview –Patricia Perkins, MS, MPH –Tri City Institute: LA, CA –.
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Transcript of 1 Hepatitis C Overview –Patricia Perkins, MS, MPH –Tri City Institute: LA, CA –.
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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