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Hep C - Current Issues in the Pharmacologic Management of...

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M. Zito, 2004 Current Issues in the Pharmacologic Management of Chronic Hepatitis C Infection Michele Zito, Pharm.D. Pharmacy Resident Department of Pharmacy Brookhaven Memorial Hospital Medical Center
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M. Zito, 2004 Objectives: At the completion of this discussion the participant should be able to: Discuss the epidemiology of chronic hepatitis C infection; Design appropriate treatment regimens for chronic hepatitis C infected patients Discuss appropriate monitoring parameters for patients receiving HCV therapy; Outline strategies for preventing/managing adverse effects associated with therapy
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M. Zito, 2004 Hepatitis C: Scope of the Problem Common chronic viral infections 170 million chronically infected worldwide 2.7 million Americans chronically infected 36,000 new infections annually Annual fatality rate of 8,000 – 10,000 Leading cause of cirrhosis, liver carcinoma, and liver transplant in the US and worldwide
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M. Zito, 2004 Hepatitis C Virology and Pathophysiology RNA virus Member of the Flavivirdae family HCV enters hepatocytes, uncoats, releases its genome, and begins replication Cellular immune and humoral responses are activated The effectiveness of the T-cell response seems to correlate with the eradication of HCV or the development chronic HCV infection
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M. Zito, 2004 Hepatitis C Genotypes 6 major genotypes (over 80 subtypes) Genotype diversity among infections in US Type 1 most prevalent (70%) 1a and 1b equally prevalent Less responsive to interferon therapy Type 2 14% Type 3 16% No major differences in viremia or pathogenesis among different genotypes
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M. Zito, 2004 Hepatitis C: Routes of Transmission High Transmission Percutaneous exposure IVDA (65%) Transfusions prior to 1990 Iatrogenic Low Transmission Occupational Perinatal (<6%) Sexual (<5%) Others ?? Tattooing Acupuncture Piercings
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M. Zito, 2004 Sources of Infection for Persons With Hepatitis C Sexual 15% Other 1%* Unknown 10% Injecting drug use 60% Transfusion 10% (before screening) * Nosocomial; iatrogenic; perinatal Occupational 4%
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M. Zito, 2004 HCV Symptomatology Incubation period is 2-9 weeks 2/3 of patients remain asymptomatic following infection 1/3 of patients become mildly symptomatic for 2 – 20 weeks Constitutional symptoms Malaise, fatigue, weakness Anorexia Arthralgias Low grade fever ALT values may fluctuate
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M. Zito, 2004 Serologic Pattern of Acute HCV Infection Followed by Recovery Symptoms +/- Time after Infection Titer anti- HCV ALT Normal 0 1 2 3 4 5 6 1 2 3 4 Years Months HCV RNA
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M. Zito, 2004 Chronic Hepatitis C Infection Up to 85% of acutely infected patients will progress to chronic HCV infection Within the chronically infected group 25% will develop cirrhosis 1-4% incidence of hepatocellular carcinoma 75% will develop varying degrees of hepatic inflammation Average time to onset from initial infection = 20 years
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M. Zito, 2004 Chronic HCV Infection: Factors Associated with Disease Progression or Increased Severity
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