Update on Hepatitis C Management

Image from: Hepatitis Foundation International. (2013). ‘Hepatitis C (HCV)’ [Online] Available from: http://www.hepatitisfoundation.org/HEPATITIS/Hepatitis-C.html (Accessed: 11 May 2013)

Colleen M Terriff, PharmD, BCPS (AQ‐ID), AAHIVP Clinical Associate Professor WSU College of Pharmacy Deaconess Hospital and Rockwood Health Systems June 2013

Objectives • At the completion of this presentation, – pharmacists should be able to (1‐4)… – technicians should be able to (2‐4): 1. Identify appropriate monitoring tests for diagnosis of  hepatitis C (HCV) and assessment of liver function. hepatitis C (HCV) and assessment of liver function. 2. Select appropriate vaccinations for a hepatitis C  patient. 3. Recognize the most common and/or severe side  effects of interferon, ribavirin and HCV protease  inhibitors. 4. Contrast the dosing differences between boceprevir and telaprevir.

Definitions‐ Hepatitis • • • • • • • •

Incubation period Prodrome Icteric Resolution Anicteric Flare Fulminant Prolonged

1

Hepatitis Viruses Most commonacute

Acute A

E

Nonpathogenic

B

Hepatitis

GB

Most commonhepatitis

Co-infection

D

C

Acute and Chronic

Clinical Symptoms • Acute hepatitis: – fever – jaundice, dark  urine – fatigue, malaise,  anorexia – nausea,  abdominal  discomfort

• Chronic: – fatigue – jaundice Image from: Available from: http://www.hivandhepatitis.com/2010_conference/easl/docs/0430_2010_c.html (Accessed 1 July 2010)

Incidence of Acute Hepatitis C in United States, 1992‐2007

CDC. (2009). ‘Surveillance for acute viral hepatitis- United States, 2007’ [Online] Available from: http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5803a1.htm [Accessed 14 July 2011]

2

Sources of Infection for Persons with Hepatitis C Injecting drug use 60% Sexual 15%

Transfusion 10% (before screening)

Other* 5% Unknown 10% *Nosocomial; Health-care work; Perinatal CDC. (2001). ‘A comprehensive strategy for the prevention and control of hepatitis C virus infection and its consequences’ [Online] Available from: http://www.cdc.gov/hepatitis/HCV/Strategy/NatHepCPrevStrategy.htm [Accessed 14 July 2011]

HCV Genotype in United States • Genotype 1 (a, b):

72%

• Genotype 2 (a-d):

17%

• Genotype yp 3 ((a-f): )

10%

• Others (4 a-j, 5a, 6a):

1%

•6 genotypes (@15 subtypes)

Magnitude of the Problem • • • • •

Nearly 200 million worldwide 3‐5 million persons in U.S. infected Approximately 35,000 new cases yearly Plus hepatitis B= 75% all cases of liver disease L di Leading cause of: f     

chronic liver disease* cirrhosis* liver cancer* *death due to liver disease liver transplantation

C. Everett Koop Institute. (n.d.). ‘Hepatitis C an epidemic for anyone: Worldwide prevalence’ [Online] Available from: http://www.epidemic.org/thefacts/theepidemic/worldPrevalence/ (Accessed: 11 May 2013)

3

Features of Hep C Infection Incubation Acute Illness Case Fatality Rate y Chronic Infection Chronic Hepatitis Cirrhosis Mortality from CLD

Average 6‐7 weeks Range 2‐26 weeks Mild (