Hepatitis C

Differences Between Hepatitis A, B and C

Hepatitis A (HAV)

• Transmitted through drinking water or eating food contaminated by fecal matter
• Usually runs its course in 6 months without treatment
• Vaccine available

Hepatitis B (HBV)

• Transmitted through bodily fluids
• About 5% of adult cases result in chronic condition which can lead to serious liver problems and death (approx. 5,000/year in U.S.)
• Vaccine available

Hepatitis C (HCV)

• Transmitted through blood
• About 80% result in chronic condition which can lead to serious liver problems and death (about 10,000 - 12,000/year in the U.S.)
• No vaccine available (about 50 subtypes of the virus)

Hepatitis C (HCV) - Magnitude of the Problem

• Worldwide: 170 million (3%)


• U.S.: 4million (1.6%)


• Most common chronic blood borne infection in the U.S., affecting 3-5 times as many people as HIV/AIDS


• Most common cause of chronic liver disease in western countries and accounts for 40-60% of adult liver transplants in the U.S.

Death rate from HCV vs. AIDS

• Annual deaths in the U.S related to HCV as estimated by the National Institute (NIH): 10,000 - 12,000


• CDC figures for HIV/AIDS deaths have not been updated since 2005 when they were 16,000, but a poll of the Departments of Health in all 50 states conducted by www.fairfoundation.org, yielded 10,962  deaths in 2007

At Risk Populations

• IV drug abusers
• Veterans, especially Vietnam veterans
• Homeless
• Minorities
• Prison inmates
• Recipients of blood products prior to 1992

Hepatitis C Symptoms

• Most patients with acute hepatitis C have few or no symptoms


• Many patients with chronic hepatitis C have no symptoms until they develop complications of cirrhosis


• Common symptoms including fatigue, anorexia, and other flu-like symptoms correlate poorly with severity of liver disease


• Quality of life frequently becomes impaired, even in pre-cirrhotic patients

Diagnosis of Hepatitis C

• Clinical evaluation
• Lab tests
• Liver biopsy

Factors Associated with Disease Progression

• Alcohol consumption
  • 30 g/day in men
  • 20 g/day in women
• Disease acquisition at >40 years
• Male gender
• HIV coinfection
• Hepatitis B virus coinfection
• Immunosuppression
• Obesity

Current Treatment

• 48 weeks of injected Pegylated Interferon and Ribavirin pills

Currently, the only treatment is combination therapy with pegylated interferon and ribavirin. This treatment can lead to virus clearance in roughly 50% of patients. However, the treatment is expensive and associated with many side effects. Only a small percent of hepatitis C patients are treated because of lack of access to medical care or presence of other medical conditions that preclude them from treatment. Of those who are started on treatment, 15%-30% are unable to complete the course of treatment due to inability to tolerate the side effects. Following expected FDA approval, a choice of two new drugs, boceprevir or telaprevir, should be added in 2011. This should improve the effectiveness of the treatment to 80%, but the side effects will still be significant. Thus, there is still a need to develop more effective and better tolerated treatments. There is also an urgent need to develop treatments that would be effective for those who have failed to respond to currently available treatments.

Possible Side Effects of Treatment

• Flu-like symptoms - fever, chills, headache, muscle ache
• Anemia, fatigue and/or sleep disturbance
• Anxiety, irritability, depression
• Hair loss, dry cough, skin rash
• Decrease in white cells and platelets
• Retinal hemorrhage/loss of vision in rare cases
• Birth defects and miscarriages
• Unmasking or exacerbation of autoimmune disease

Possible Long Term Complications of Untreated HCV

• Increased cirrhosis, liver cancer, liver failure
• Increased skin, joint and muscle problems
• Increased incidence of vascular disease (circulation problems, heart attack, stroke)
• 3 times higher rate of type 2 diabetes after age 40
• Increased incidence of kidney disease and possible kidney failure
• Increased incidence of autoimmune thyroid disease

Goals of Treatment of Individual

Primary Goal

• Eradicate HCV infection

Secondary Goals

• Slow or prevent disease progression and scarring of the liver (fibrosis) which otherwise might lead to extensive scarring, (cirrhosis)
• Reduce risk of liver cancer
• Improve health-related quality of life

More information on Hepatitis C

For more information, please view our Basics on Hepatitis C presentation.

You are welcome to use this PowerPoint for educational purposes. Please keep me informed at: Debbie@vedit.com

Below are some links to websites:

• HCV Advocate
• National Aids Treatment Advocacy Project

More information on Liver Cancer

• American Liver Foundation
• Liver Cancer Treatment Options

Financial Assistance for HCV patients

We have been receiving several inquiries on how to get financial assistance for HCV treatment both in the U.S. and abroad. We are not able to provide any money from the Greenview Hepatitis C Fund for this purpose, but are interested in steering people to available resources.

Most major pharmaceutical companies offer “Patient Assistance Programs” to provide free or low cost medications to those unable to pay. Here are some sources:

• Merck/Schering-Plough
• General search
• Roche
• Pegasys
• BioPlus Specialty Pharmacy Services
• NeedyMeds