Hep 202Just when you thought you

knew everything.

Today We Will

• Review Hepatitis 101• Take a more in-depth look at

Hepatitis C• Look at hepatitis C tests, nutrition,

HIV co-infection, extra hepatic effects and treatment

Case Study Jane and Julia

What Would You Tell Jane and Julia if You Were Bob?

Discuss in your groups:

1. What does hepatitis and viral hepatitis mean and what do you know about the five major types of viral hepatitis?

2. What are the signs and symptoms of hepatitis C?

3. What are the risk factors for hepatitis C and how can one prevent getting it?

Hep 101 Overview

• Hepatitis C– Name signs/symptoms, risk factors

and prevention

•Hepatitis =

•Viral Hepatitis =

•Name 5 identified types of viral hepatitis

Liver inflammationVirus that causes liver inflammation

How Does Hep C Damage The Liver?

BC Hepatitis Services, 2003

Hepatocellular Carcinoma

Viral Hepatitis5 Major Identified Types:A: oral-fecal transmission

B: sexual fluids & blood to blood

C: blood to blood

D: travels with B

E: oral-fecal transmission

VaccinePreventable

Adapted from Corneil, 2003

There are also other less common strains

Other Types are Being Discovered!

• Hepatitis G (HGV or HGBV-C)– Similar transmission to Hep C – Appears to cause chronic infection– Long term effects of virus on the liver

still to be determined

Hepatitis C

More on Hepatitis C

• RNA Virus (Flaviviridae Family)6 major variations maybe up to 11

+

50 to 90 subtypes (e.g. Hepatitis C genotype 1 subtype B)

•Type 1 is most common type found in North America

Unfortunately it is also the most difficult to treat

More Info (con’t)

• Other routes of transmission–Mother-to-child, breastfeeding, dialysis

• Certain locations also increase risk– E.g. prisons because more individuals

already have the virus than in general population

Highly Debatable

Health Canada, Hepatitis C Prevention, Support and Research Program, 2002

Health Canada, Hepatitis C Prevention, Support and Research Program, 2002

Health Canada, Hepatitis C Prevention, Support and Research Program, 2002

Health Canada, Hepatitis C Prevention, Support and Research Program, 2002

Health Canada, Hepatitis C Prevention, Support and Research Program, 2002

Tests Screening:

Detects if the body has produce antibodies to Hepatitis C (anti-HCV)

•Usually need a minimum of six weeks to detect antibodies. After 6 months 95% will have detectable antibodies

1st test that is done when someone gets tested

Tests

• Other tests are required to confirm the screening test and whether someone still has the virus• They look for the specific genotype and the amount of virus in the blood stream.

Looks for virus RNA

Tests• Other tests are used to monitor

liver function and damage• They include:

Liver Enzymes(ALT, AST, GGT, LDH)

Checks for amount of liver cell inflammation

Liver Function(Bilirubin, Albumin, INR)

Checks to see if liver is clearing toxins and producing proteins

Liver Biopsy Microscopic look at how badly the liver is scarred

Liver Ultrasound Liver cancer screen

Corneil, 2003

Hepatitis C Nutrition/Health Tips

• Eat frequent smaller meals• Avoid Alcohol• May need to decrease iron intake• Protein intake may need to increase

– 1-1.5g/kg/Day is generally recommended

Dieticians of Canada, Hepatitis C Nutrition Care, 2003

More Tips• Salt restrictions may need to be

implemented depending on fluid retention

• Consult with dietician or health care professional to best tailor needs

Dieticians of Canada, Hepatitis C Nutrition Care, 2003

Complimentary & Alternative Therapies

• For the most part, are considered experimental due to lack of research

• Some herbs have shown to have some benefit – E.g. Milk Thistle (Silymarin)

•Just because herbs are natural does not mean they are all safe some can harm the liver!

Dieticians of Canada, Hepatitis C Nutrition Care, 2003

Milk Thistle Example

Other HCV-related conditions

These may occur when the immune system tries to fight off the virus

Dead antibodies deposit in the body causingBlood & Kidney Disorders

Toxins in the blood maydeposit in the body causing:Skin DisordersMental Disorders

HIV Co-infection

Seems tospeed upthe rate ofviralreplication

Appears to increase rate of liver scarring and long-term complications such as cirrhosis

Treatment

Goal is to achieve a sustained virological response (SVR)

• Means that virus RNA is no longer detectable after treatment over a sustained period of time (will still have antibodies)

More likely to achieve a SVR if:• Treating genotype other than genotype 1• Low viral levels and liver damage at

treatment onset• Low body weight or surface area

Treatment• Best treatment currently available is

a combination of two antiviral drugs:

Pegylated Interferon

+Ribavirin

Treatment• Side effects can include:

– Depression– Flu-like symptoms

• Some cannot complete treatment due to side effects

• Others may not qualify because – Liver is too damaged– Addicted to drugs and/or alcohol

Questions?