Hepatitis C and You
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 2014 Greenview Hepatitis C Fund
All Rights Reserved.
What You May Not Know
About Hepatitis C (HCV)
Differences Between
Hepatitis A, B and C
Transmission
Vaccine
Available?
HAV
Contaminated Food / Water
(e.g., when traveling)

HBV
Blood and Bodily Fluids
(e.g., sexually transmitted)
HCV
Blood
(e.g., transfusions, health care workers)


What You May Not Know
• Hepatitis C (HCV) now kills more people than HIV/AIDS
in the U.S. (16,600 in 2010)
• 1 in 30 baby boomers is infected
• About 75% of people who die from HCV were born
between 1945 and 1965
• 45% of people infected with HCV report no known risk
• ALT screening (routine liver test) misses > 50% of chronic
cases
HCV in the U.S.
Deaths from HCV vs. HIV
20,000
15,000
HIV
10,000
HCV
HBV
5,000
0
2004
2005
2006
2007
2008
2009
2010
Source: Centers for Disease Control
HCV in the U.S.
• Affects 3-5 times more people than HIV/AIDS
• Most common chronic blood borne infection
• 40-60% of adult liver transplants in the U.S.
• U.S.: 4 million (1.6%) people infected
HCV World-Wide
• Western Countries: Most common cause of chronic liver
disease
• About 170 million (3%) are chronically infected worldwide
Modes of Transmission
Intranasal
Drugs
Injected
Drugs
Occupational
Exposure
(Needle)
Piercing /
Tattoo
Sexual
Contact
Transfusion
Before 1992
Mother to
Infant
Hospital Stay
HCV
Organ/Tissue
Transplant
Source: NIH Consensus Development Conference Statement 2002
Natural History after Acute
HCV Infection
After 12 Months
Hepatitis C Symptoms
• Acute patients: Most have few or no symptoms
• Chronic patients: Many have no symptoms until they
develop complications of cirrhosis
• Common symptoms (e.g., fatigue, anorexia, other flulike symptoms) correlate poorly with severity of liver
disease
• Quality of Life: Frequently impaired, even before
cirrhosis (complications from liver disease)
Some Possible HCV Symptoms
Vagueness
Depression
Anxiety
Symptoms usually take more
than 10 years to develop.
Fatigue
Malaise
Liver Pain or
Discomfort
Some people never have
any symptoms
Dry Eyes
Dry Mouth
Itching
Rashes
Poor Appetite
Indigestion
Nausea
Feeling Sick
Aches and Pains in
Muscles Joints
Your Risk of Having HCV is
Higher if You:
• Were born between 1945 and 1965
• Have every injected illicit drugs, even once
• Have HIV
• Have received hemodialysis treatments
• Have received a blood transfusion or organ transplant
before 1992
• Are (or were) a health care worker and had been exposed
to infected blood
Factors in Disease Progression
• Heavy alcohol consumption Heavy
• Approx. 2 drinks/day
• 30 g/day in men, 20 g/day in women
• 40+ years old at the time of infection
• Male gender
• Coinfection: HIV / HBV
• Immunosuppression
• Obesity
Source: NIH Consensus Development Conference Statement. 2002. Poynard et al. Lancet.
1997;349:825-832.
Untreated HCV
Possible Long Term Complications
• Increased cirrhosis, liver cancer, liver failure
• Increased skin, joint and muscle problems
• Increased incidence of vascular disease: Circulation
problems, heart attack, stroke
• 3x higher rate of type 2 diabetes after age 40
• Increased incidence of kidney disease / possible failure
• Increased incidence of autoimmune thyroid disease
Untreated HCV
Possible Long-Term
Complications
After 20 Years
After 40 Years
50%
45%
45%
47%
40%
31%
30%
20%
20%
10%
7%
1%
4%
0%
None to Mild
Mild to Moderate
Cirrhosis
Liver Problems
Failure/Cancer
Current Treatment
• Standard: Injected Pegylated Interferon + oral Ribavirin
• Additional (for genotype 1): Oral Boceprevir or Telaprevir
• Duration: Typically 24-48 weeks; depends on response
and genotype
• Side Effects1
• As with any chemotherapy, side effects can be expected
• Dosage adjustment and other methods can reduce side effects
1
If you are currently undergoing treatment or are considering starting
treatment, please discuss possible side effects with your physician.
Improved Treatment
• Simeprevir: approved by the FDA in November 2013.
• Same class as telaprevir and boceprevir (protease inhibitor)
• Approved for genotype 1 infection in combination with
peginterferon and ribavirin
• Sofosbuvir: approved in Dec. 2013
• New class of antiviral therapy (nucleotide analog)
• For genotype 1 in combination with peginterferon/ribavirin
• For genotypes 2/3 with ribavirin and without interferon
• Advanced clinical trials
• Testing interferon-free and ribavirin-free treatment regimens,
including genotype 1
Who Should Get Tested for HCV?
What group is 5x more likely than
other adults to have HCV?
People born between 1945 and 1965
How many deaths could be prevented
if all baby boomers got tested for HCV?
120,000
Why All Baby Boomers
Should Get Tested
The CDC recommends testing of all baby boomers
• High rates of experimental drug use in the ‘60’s and ’70’s
• No widespread blood-supply screening before 1992
Getting Tested for HCV
• Contact your physician, your health department or local
clinic to find out how to get tested
• Results can take between a few days and a few weeks
• Rapid tests are available at some clinics
• The first blood test, a Hepatitis C Antibody Test ,
determines if you have ever been exposed to HCV
• If you have been exposed, then an RNA test is needed to
determine if you are currently infected with HCV
Cost of Testing
• Under the Affordable Care Act, most private health
insurance must now pay the full costs of screening. State
Medicaid programs receive extra funding for this.
• If your insurance doesn’t pay for testing, the antibody
test will cost between $50-75.
• Some free testing is also available.
Why Get Tested?
• A simple blood test could save your life and prevent you
from infecting others
• HCV is the leading cause of liver cancer and liver transplants
• Symptoms are so vague, most people don’t know they have HCV
until serious problems develop
• New treatments can eliminate the virus in most cases
• Even if you don’t get treated:
• You can adjust your lifestyle to reduce chances of progression
• You can be careful about spreading your HCV to others
Greenview Hepatitis C Fund
• www.hepcfund.org
• Supports HCV research to find a cure
• Supports educational efforts to increase awareness
• All donations large or small are accepted and appreciated
• Contributes over 85% of total revenue (more than 95% of cash
donations) directly to Hepatitis C research
• Recent Success:
• Provided seed money for research at the University of Michigan
to cut off HCV's lifeline
• Led to a $1.08 million NIH grant