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

1 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

1 Funciones del higalo Bila Sistema imuna Producion de cimicas- >500 funciones cimicas Detoxificar sustancias Agentes de coagulacion Hormonas ! Abilidad para regeneracion!

1 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

1 Algunos Statisticos 3% de populacion del mundo tiene VHC ( 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

1 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%)

1 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

1 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

1 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 transfused, products, procedures All Drug Paraphernalia Shared Needles

1 Harm Reduction Prevention – Needle exchange – clean needles and drug preparation tools – cookers & cottons Bleach – Does it work? 10 minutes! Safer Sex Cover wounds

1 HCV CAN NOT BE SPREAD BY: BREAST FEEDING SNEEZING HUGGING COUGHING FOOD OR WATER SHARING EATING UTENSILS OR DRINKING GLASSES CASUAL CONTACT

1 Symptoms Acute vs. Chronic Fatigue – mild to severe Flu-like symptoms (muscle/joint/fever) Brain Fog Liver Pain Loss of appetite Headaches Gastro Problems

1 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

1 Interferon and Ribavirin Interferon and ribavirin(capsule)- combo therapy INF – 3 mu units, thrice weekly - Ribavirin mg daily Overall SVR up to 45% Genotype 1 – 12 mos – 29% SVR Genotype Non 1 – 6 mos - 62% SVR

1 Pegylated Interferon Schering- PEG-Intron Approved by FDA – % 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%

1 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

1 Treatment Decisions General Treatment Guidelines Healthy Active HCV Elevated ALTs Compensated liver disease Optimal Response Younger Female Low visceral fat Low viral load Minimal liver damage Genotype 2 or 3

1 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)

1 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

1 Experimental Therapies Amantadine - pill Maxamine – by injection (phase II studies) Ribozymes Helicase Inhibitors Protease Inhibitors Interleukin-10

1 Complementary Medicine Herbs – milk thistle Always check with your doctor and herbalist – some herbs are TOXIC Acupuncture / Acupressure Traditional Chinese Medicine

1 Lifestyle Changes That Help! Alcohol - Avoid Get vaccinated – Hep A & Hep B Healthy balanced diet Exercise Stress Reduction Support Groups

1 Advocate for Yourself and Your Client! Educate yourself Establish a good relationship with your doctor Bring an advocate for doctors visits Ask questions Keep copies of all medical tests Keep a diary Keep an open mind

1 Conclusions