What is Hepatitis C?
Hepatitis C (HCV) is an infection caused by the hepatitis C. virus, which is carried in the blood. This virus can cause liver disease, including cirrhosis and cancer. More than 110,000 people in Ontario are infected with the hepatitis C virus. Often there are no symptoms for many years, and about 35,000 Ontarians do not even realize they are infected.

Why is my liver important?
It ensures uptake of nutrient-rich blood, production and storage of proteins, control of the metabolism of many by-products of protein metabolism, storage of sugar, regulation of blood sugar level, storage and utilization of lipids, production of blood coagulation factors, formation of red blood cells and other blood components, and production of bile and bile salts. As well as detoxifying harmful substances, the liver also breaks down medications into substances that can be excreted via the kidneys.

Chronic destruction of liver tissue is known as cirrhosis. The cirrhotic process the liver is restructured, shrinks, and becomes harder. These severe changes not only impair function, but also reduce the flow of blood through the organ.

The impairment of liver function often leads to loss of appetite, anemia, nausea, vomiting, and weight loss. In advanced liver destruction mental confusion may develop because of inadequate breakdown of ammonium, as ammonium level increase this will interferes with certain brain and nerve cell reactions, and will lead to coma and then ultimately death

How you could become infected?
Sharing used needles or syringes, other drug-using equipment, straws, bills or other utensils used for snorting cocaine or other drugs. Receiving a blood transfusion or blood products before 1992. Needle-stick injuries. Tattooing, piercing or acupuncture with equipment that may have been improperly sterilized. Sexual activity that includes contact with blood or exchange of blood. An expectant mother carrying the hepatitis C virus can infect her unborn baby. Sharing razors, toothbrushes, tweezers, manicure or pedicure equipment (such as nail clippers).

How the hepatitis C virus can affect you?
Without treatment, over 80 percent of hepatitis C infections progress to chronic hepatitis C, a disease that attacks your liver. After 10 to 20 years, chronic hepatitis C can cause cirrhosis. After 20 to 40 years it can cause liver cancer.

Common Symptoms
Because hepatitis C progresses slowly, most infected people experience no symptoms at all for many years after being infected. If you do have symptoms, they could include: jaundice (your skin or eyes turn yellow), itching in different parts of your body, fatigue, and abdominal tenderness.

Getting Tested?
First a basic blood test to screen for the Hep C antibody is re required. If the antibody test is positive for the Hep C antibody then further blood test need to be done to determine if active virus exists ( this is the viral count) and to blood tests to determine liver’s functional status.

How to maintain your health if you have hepatitis C?
Get plenty of rest, 6– 8 glasses of water a day, ensure a healthy diet, daily multivitamin,  avoid all alcohol and ensure you are immunized for hepatitis A and hepatitis B (there is no vaccination against hepatitis C).

Do I need Treatment?
There are several tests and evaluations that must occur to validate the need for treatment. An detectable viral count , defined genotype of the Hep C Virus,  and evidence of chronicity of disease (> 6 months) Other evaluations include; various other blood tests, physical examination,  medical history, social assessment,  abdominal ultrasound and other tests as needed.

Treatment
The medication regime consists of 2 medications that are taken for 24 –48 weeks. The length and effectiveness of treatment depends on the genotype of the virus. There are 2 pharmaceutical companies that produce the medications; both are equally effective, the prescription of the medication is based upon the physician's discretion.

The first medication is a once a week subcutaneous injection (shot) of Pegylated interferon.  This drug stimulates the immune system by triggering a cascade of intracellular events, which results in the production of antiviral proteins that inhibit viral replication and help to kill the virus, The patient is taught how to self administer the injection, which is given in the abdomen or upper thighs. The second medication is Ribavirin, this is an antiviral drug that enhances the initial effect of peglated interferon and reduces the likely hood of the virus return. This medication is in pill form and is taken twice a day.

Support
Direct support is a key component of this program and treatment success for the patient. Support is provided throughout the pre, intra and post treatment phases of HCV treatment. One on one counseling and education is provided with a registered nurse at the clinic and other locations held throughout the greater Windsor and Essex region. An addiction counselor and laboratory testing on site is available to the patient and if needed with an addictions counselor. Bi weekly blood tests during treatment as are monthly appointments with the RN. The patient also has “off hours” phone access to Hep C RN in order to address any concerns that may arise during treatment. Assistance is also provided in order to ensure that there is no financial burden due to drug costs. Various assistance programs are reviewed with the client to ensure appropriate financial coverage during the treatment phase.

Hepatitis C Support & Treatment Program Team Members
Medical Director: Anthony Hammer MD
Program Coordinator & Treatment Nurse: Beth McLellan RN MN
Administration & Client Support: Byron Klingbyle

Contact us at:
Drouillard Road Clinic
1052 Drouillard Road
Windsor, ON, N8Y 2P8
(519) 946-0267 or (519) 977-9772
Fax: (519) 977-9772
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Are There Side Effects?
Each patient’s experience with the medication regime is unique and variable. Common side effects may include hair loss, flu like symptoms, fatigue, depression, irritability, aggression, isolation, mental confusion, weight loss, and dry skin. All patients are counseled into methodologies that will minimize the side effects, for example since depression is common antidepressants are often prescribed for the duration of treatment; this improves the patients’ ability to tolerate this side effect.

Key Points for the patient during HCV Treatment
Take medications as prescribed, failure to take injections and pills as scheduled reduces effectiveness of therapy.

• No ALCOHOL, now or ever.
• At least 8-10 glasses of water a day.
• Acetaminophen or ibuprofen to lessen the side effects.
• Small frequent meals, the “healthier” the better, consider shakes and meal supplements (if appetite is reduced.
• Multivitamin daily.
• Exercise daily.
• Rest frequently.
• Take the pills with food.
• Take the shot 1- 2 before bedtime, and plan to rest the day after the shot.
• Birth control and avoidance of pregnancy during treatment is a must.
• Depression & worsening depression is common, talk to your health care provider if this occurs.

Recommended Resources:
www.health.gov.on.ca
www.hepcontario.ca
www.liver.ca
www.publichealth.gc.ca
www.Hepcnetwork.net
www.nccam.nin.gov/health/hepatitis