Hepatitis

Deborah A. Orr, Ph.D.

The Center For Drug Free Living

Orange County Corrections Department

Training and Staff Development Section

Where is my liver?

What does my liver do?

Acts as a filter
Converts food into

nutrients
Detoxifies
substances
that are harmful
to the body
Processes the
medications we take

What does my liver do?

The liver converts nutrients in blood for
use by the body
The liver affects many body systems
The body needs a functioning liver to
survive

Hepatitis is:

Inflammation of the
Liver

Causes of Hepatitis
Viruses
Medication side effects
Alcohol

Viral Hepatitis
A systematic infection that attacks the

liver, causing inflammation and death of

liver cells.
An inflamed liver is unable to break down
waste products in the blood.

Normal Liver

Liver with viral hepatitis

Hepatitis Data
According to the Centers For Disease

Control (CDC), hepatitis is the leading

cause of liver disease in the United States
the number of hepatitis C-related deaths
will triple over the next 10 years

Hepatitis Data
An estimated 80%-90% of HIV-infected

injection drug users are also infected with

Hepatitis C
One out of every 3 people with HIV has
Hepatitis C

Hepatitis Data
Liver disease has become an increasingly

significant cause of serious illness and

complications among people with HIV
infection
Treatment of liver disease improves
prognosis significantly.

Definitions
Acute viral hepatitis ranges from

mildly
symptomatic and self-limiting to lifethreatening
Chronic hepatitis: symptoms last longer
than 6 months

Types of Hepatitis
Each is caused by a different virus:
Hepatitis A: Feces-Mouth
Hepatitis B: Blood-to-blood
Hepatitis C: Blood-to-blood

Hepatitis A (HAV)

CONCENTRATION OF HEPATITIS A VIRUS

IN VARIOUS BODY FLUIDS

Hepatitis A Transmission
Exposure to stool (feces) from

the
environment or directly from another
person

Prevention of Hepatitis A

Vaccination
Avoid drinking water in areas where untreated
sewage is near drinking sources
Good hand washing in clean water (food
preparation, etc.)
Avoid sexual behavior where fecal matter may
be ingested

Hepatitis A

Symptoms can include:

*fever
*malaise
*dark urine
*jaundice
*Loss of appetite *nausea
*abdominal discomfort

Hepatitis A
Complications of hepatitis A include

sudden serious liver inflammation, with a

risk of fatality (fulminant hepatitis, rare)
Chronic infection does not occur following
Hepatitis A infection.
Lifelong immunity after infection
TREATMENT: Supportive fluids, rest

Hepatitis B (HBV)

Hepatitis B
Transmitted from

blood and blood

products
Injection drug use, tattoos, other blood
exposure
Sexual transmission rates are moderate
Maternal-child transmission occurs
Health care workers at high risk

Concentration of Hepatitis B Virus

in Various Body Fluids
Highest

concentrations of virus are in

blood and serous fluids
Lower concentrations are found in semen,
vaginal fluid, and saliva.
Therefore, blood exposure and sex
contact are relatively efficient modes of
transmission.
Saliva can be a vehicle of transmission
through bites

Safe Sex as Prevention

Hepatitis B
Most acute HBV infections in adults result

in complete recovery, with lasting

immunity (90-95%).
Lifelong immunity after infection.
Some people go on to have chronic HBV
infection (approximately 2-5% of adults)

Hepatitis B
People with chronic HBV infection often

have no symptoms, but they are at high

risk for developing cirrhosis, and being
continuously contagious to others.
Approximately 15%-25% may die
prematurely from either cirrhosis or liver
cancer.

Prevention of Hepatitis B
Vaccination
Avoid exposure to blood and sexual fluids

(abstinence or condoms)
Avoid sharing needles (tattoos, injectable
drugs)
Avoid sharing razors, toothbrushes, cuticle
trimmers, etc.
Treatment of newborns of infected moms

Treatment of Hepatitis B
Previously, just supportive fluids, rest
Newer treatments include specific antiviral

medications (same medications used for

HIV)

Hepatitis C (HCV)
Similar to Hepatitis B and to HIV in its

blood-to-blood mode of transmission

Prevalence of Hepatitis C
Hepatitis C is the most common chronic

bloodborne infection in the U.S.

Hepatitis C is the leading cause for liver
transplantation in the U.S.
1.8% of the U.S. population is infected

Prevalence of Hepatitis C
Each hour of every day, three people die
from
Hepatitis C or it's related conditions!

Prevalence of Hepatitis C
Two of these people have Military backgrounds.

Hepatitis C Illness

70-90% of people with HCV will develop chronic

hepatitis (compared to 2-5% of people with HBV)
If continuous hepatitis C viral load over years,
then high chance of liver damage (70%)
Over a 20 year period, 20% of people with HCV
will develop cirrhosis
HCV is rarely a cause of fulminant hepatitis

Chronic Hepatitis C Factors

Promoting Progression or
Severity

Injecting Drug Use and HCV

Highly efficient
Transmission

Contamination of drug paraphernalia, not just

needles and syringes

Four times more common than HIV

Sexual Transmission of HCV

Low sexual transmission rates when no

blood contact identified

MSM no higher risk than heterosexuals

Preventing HCV Transmission to

Others
No Vaccine for Hepatitis C!
Avoid Direct Exposure to Blood (same as

for Hepatitis B)
Do not donate blood, body organs, other
tissue or semen when you have hepatitis
Cover cuts and sores on the skin

Hepatitis Transmission
Hepatitis transmission (A,B,C)
is 20 times more efficient
(successful) than HIV
transmission!!!!

What if I also have HIV?

Treating HIV helps the immune system

handle hepatitis C
Treating the liver disease of Hepatitis C
helps medications work better to treat HIV

Treatment For Hepatitis C

Blood Test
Vaccinate for Hepatitis A & B, as needed
Viral Load + Liver Biopsy = decision to

treat
Interferon + oral antiviral medication
Treatment lasts 6-12 months

Treatment For Hepatitis C

Interferon (more than 1 formulation or

brand name) = weekly injection

Antiviral capsules (usually 2-4 capsules) =
taken 2 times per day

Treatment For Hepatitis C

Potential Side Effects:
mild-severe flu-like symptoms
Fatigue, nausea, loss of appetite
anemia (-> short of breath, tired, mental
fog)
depression
Neurologic symptoms (dizzy, poor
concentration, balance problems)

Treatment For Hepatitis C

Side effects of medication
+ hepatitis symptoms
= unpredictable energy, mood, mental status
How does this affect client participation in
substance abuse treatment program?
Work? Family?

Relapse triggers
For people being treated for
hepatitis
Needles for injections
Medication and illness-related changes in

mood and mental status similar to illicit

drug effects
Medication side effects that mimic opiate
withdrawal symptoms
Depression
Pain & Fatigue
Others?

Summary of Hepatitis
Always practice safe

sex
Get tested for Hepatitis
Get vaccinated for Hepatitis A & B
Never share items that could contain blood
Practice good hand washing
Reduce alcohol usage
Always use protection when in contact with
others body fluids

Its Test Time!

Click on the picture to go to the test.