You have been diagnosed with chronic hepatitis C. I I

Transcription

1 You have been diagnosed with chronic hepatitis C I I

2 Prevalence Estimated million people currently infected with hepatitis C. Estimated 50,000 people in New Zealand infected with chronic hepatitis C.

3 Six main risk factors of hepatitis C People who have ever injected drugs (once is enough). People who received a blood transfusion, or blood products, prior to 1992 (in New Zealand). People who have ever lived, or received medical treatment, in high-risk countries. (South East Asia, China, the Middle East, and Eastern Europe including Russia). People who have ever received a tattoo or body piercing using unsterile equipment. People who have ever been in prison. People born to a mother infected with hepatitis C.

4 What is hepatitis C? Hepatitis C is a virus Enters the blood and infects the liver Spread through blood to blood contact May lead to serious liver disease

5 The immune response What happens when the virus enters your body? Virus enters the body Immune system tries to kill infected liver cells Mild, moderate, or severe fibrosis. Cirrhosis Infects the liver cells Inflammation and scarring

6 Disease progression of hepatitis C For every 100 people infected with hepatitis C: 80 will develop chronic infection; 25 will develop cirrhosis 20 or more years after infection; 3-5 will develop liver cancer.

7 New technology to better understand your degree of liver disease -The FibroScan Stages the degree of liver disease; Painless; No sedation or complications; A non-invasive process; For most people, it will remove the need for a liver biopsy.

8 Stages of liver disease Liver Cancer Cirrhosis Fat Healthy Liver

9 Effects of alcohol on your liver Alcohol increases your chance of getting cirrhosis. Non-drinker Hepatitis C non-drinker Drinker without hepatitis C Drinker with hepatitis C

10 Strains of hepatitis C Six different strains of HCV know as genotypes, they are numbered 1-6; Within New Zealand: 55% are genotype 1 (G1); 45% are genotype 2 or 3 (G2/3); 5% are made up of the other genotypes.

11 Why is your liver so important? Filters waste products Aids digestion Stores sugar, iron & vitamins, giving your body energy Helps fight infection Helps with blood clotting The liver has over 500 functions: It processes virtually everything you eat, drink, breath in and rub onto your skin It can repair itself Is the largest organ in the body Weighs over 1kg

12 How to avoid infecting others? Cover open sores or cuts. Clean any spilt blood with household bleach. The virus can survive for up to 4 days. Don t share razors, toothbrushes or nail clippers. Do not donate blood. Do not share unsterilized equipment for drug taking, tattooing or piercing. Avoid sexual practices that might risk blood contact.

13 Is there a cure? Funded treatments: DAAs (Direct-Acting Anivirals) Viekira Pak and Viekira Pak with RBV (Ribavirin) for genotype 1a and 1b. Harvoni for decompensated cirrhosis. Both treatments are taken orally, have 90+ per cent cure rates, are non invasive and treatment is taken for 12 to 24 weeks. Other funded treatment: Pegylated Interferon (weekly injection) plus Ribavirin (tablets taken twice daily). Treatment is taken for 24 to 48 weeks, depending on genotype. Future treatments We are now awaiting funding for DAAs which will treat all genotypes of hepatitis C. DAAs offer a shorter course of treatment & higher success rate. May be a staged funding process. Refer to our website for up to date information.

14 Should I have treatment for my HCV An assessment and FibroScan are an important part of your assessment which will help determine this decision. Most people are holding off and waiting for newer noninterferon treatments to become funded providing their liver is not too badly damaged. The FibroScan will help determine your stage of liver damage and your nurse will complete an assessment to help determine the best plan for you.

15 How do I look after my liver? Ensure you have regular blood tests Avoid alcohol or limit to one standard drink per day Reduce or stop smoking cigarettes Do not use cannabis. It is associated with more fibrosis (liver disease) Discuss using herbal/ alternative medicine with your doctor/pha rmacist, as some may affect your liver Avoid fatty/ sugary drinks and foods as they contribute to fatty liver syndrome and liver disease Keep within a healthy weight range. Drinking Kava should also be avoided as it is associated with causing liver damage.

16 Other things you should know Hepatitis C cannot be spread through: Sneezing; Coughing; Shaking hands; Hugs; Sharing cooking and eating utensils.

17 The role of The Hepatitis Foundation (NZ) Support when living with chronic hepatitis C The Hepatitis Foundation no longer operates a National Hepatitis C Follow-up Programme as patient services are now managed by regional DHBs (District Health Boards). If you think you have hepatitis C or would like to access treatment please contact your local GP. However if you have any questions about hepatitis C or need someone to talk to you can call our helpline on If you live in the Midlands region (BoP, Waikato, Taranaki, Lakes, Tairawhiti) your monitoring and follow-up is now managed by Waikato DHB. If you live in the Central region (Capital & Coast, Hutt, Wairarapa) your monitoring and follow-up is now managed by Compass Health. If you live in any other region please contact your local GP.

18 Treatment Options Current Funded Treatment in NZ DAAs (Direct-Acting Antivirals) Viekira Pak and Viekira Pak with RBV (Ribavirin) for genotype 1a and 1b. Harvoni for decompensated cirrhosis. o week course. o Non invasive, 90+ per cent cure rates, taken orally. Other treatment Pegylated Interferon and Ribavirin (Pegasys RBV); o week course depending on Genotype. Triple therapy Pegylated Interferon, Ribavirin and a direct acting anti viral (DAA), Boceprevir. For HCV Geno 1, and ct or tt. WHO no longer recommends triple therapy. Clinical trials If available DAA s that treat all hepatitis C genotypes may become funded in the next few years. Refer to the Foundation s website for updates on new treatment options.

19 Pegylated Interferon and Ribavirin Common Questions How does the treatment work? How is it administered? Answer Pegylated interferon boosts the immune system. Ribavirin reduces the amount of virus in the blood. They work together to help clear the virus. Sub Cut injection given once a week at the same time each week plus Ribavirin tablets taken morning and night every day, your hepatitis nurse will inform you how many tables are required. How long is the treatment for? Genotype 1 or 4 = 48 weeks Genotype 2 or 3 = 24 weeks What is the chance of a cure? Genotype 2 and 3 = % Genotype 1 IL28B CC= 70% CT= 50% TT= 30% What else can affect the success rate? Alcohol intake Weight Compliance with treatment Stage of Liver disease Age How are the medicines stored? Pegasys- keep refrigerated Ribavirin-room temperature Do I need to use contraception? YES- you need to use 2 reliable methods of contraception during treatment and for 6 months after

20 Pegylated Interferon and Ribavirin What can you expect when you go onto treatment. You will be provided with regular appointments with the hepatitis nurse at the hospital; The Hepatitis Nurse will keep in close contact with you; The nurse will provide you with a patient support kit; Monthly blood tests, or more frequently if required; Adjustments to the medicine as required; The nurse will provide advice on how to manage any side effects; Flu like symptoms, Skin rash, lack of appetite, loss of weight, hair thinning, mood swings, tiredness, exacerbation of depression or suicidal thoughts, low haemoglobin, low neutrophils.

21 Viral Suppression Improves Histology Regression of Fibrosis Pre-treatment Fibrosis Score = 4 Month 36 Fibrosis Score = 2