I am a professional pharmacist. These slides provide for pharmacy department students. And these slides describe disease.

1. HEPATITIS

2. CONTENTS
• Definition
• Types
• Signs and symptoms
• Diagnosis
• Vaccination
• Treatment
• Side effects
• Interactions

3. DEFINITION
Hepatitis is an inflammation of the liver. The condition can be self-
limiting or can progress to fibrosis (scarring), cirrhosis or liver
cancer. Hepatitis viruses are the most common cause of hepatitis
in the world but other infections, toxic substances (e.g. alcohol,
certain drugs), and autoimmune diseases can also cause hepatitis.
-WHO

4. TYPES
Scientists have identified 5 unique hepatitis viruses,
1. A,
2. B,
3. C,
4. D, and
5. E

5. 1. Hepatitis A virus (HAV) is present in the faeces of infected
persons and is most often transmitted through consumption of
contaminated water or food. Infections are in many cases
mild, with most people making a full recovery and remaining
immune from further HAV infections. However, HAV infections
can also be severe and life threatening. Safe and effective
vaccines are available to prevent HAV.

6. Most people in areas of the world with poor sanitation have been
infected with this virus.
There is no treatment specifically for hepatitis A. The doctor will
advise the patient to abstain from alcohol and drugs during the
recovery. The vast majority of patients with hepatitis A will recover
spontaneously. Your doctor may take tests that check your liver
function to be sure your body is healing.

7. 2. Hepatitis B virus (HBV) is transmitted through exposure to
infective blood, semen, and other body fluids. HBV can be
transmitted from infected mothers to infants at the time of birth
or from family member to infant in early childhood.Transmission
may also occur through transfusions of HBV-contaminated blood
and blood products, contaminated injections during medical
procedures, and through injection drug use. HBV also poses a risk
to healthcare workers who sustain accidental needle stick injuries
while caring for infected-HBV patients. Safe and effective vaccines
are available to prevent HBV.

8. 3. Hepatitis C virus (HCV) is mostly transmitted through
exposure to infective blood. This may happen through
transfusions of HCV-contaminated blood and blood products,
contaminated injections during medical procedures, and through
injection drug use. Sexual transmission is also possible, but is much
less common. There is no vaccine for HCV.

9. 4. Hepatitis D virus (HDV) infections occur only in those who
are infected with HBV. The dual infection of HDV and HBV can
result in a more serious disease and worse outcome. Hepatitis B
vaccines provide protection from HDV infection.
5. Hepatitis E virus (HEV) is mostly transmitted through
consumption of contaminated water or food. HEV is a
common cause of hepatitis outbreaks in developing parts of the
world and is increasingly recognized as an important cause of
disease in developed countries. Safe and effective vaccines to
prevent HEV infection have been developed but are not widely
available.

10. Hepatitis C is NOT Spread By:
• Sneezing
• Coughing
• Food or water
• Sharing drinking glasses or eating utensils
• Handshakes
• Hugging
• Playing with children

11. SIGNS AND SYMPTOMS

12. Signs and symptoms of acute hepatitis appear quickly.They include:
• fatigue
• flu-like symptoms
• dark urine and pale stool
• abdominal pain
• loss of appetite
• unexplained weight loss
• yellow skin and eyes, which may be signs of jaundice
Since chronic hepatitis develops slowly, these signs and symptoms
may be too subtle to notice.

13. DIAGNOSIS
• Physical Exam
• Liver Biopsy
• Liver FunctionTests
• Ultrasound
• BloodTests
• Viral AntibodyTesting
• PCR
• Rapid diagnosis test (RDTs)

14. Rapid Immunoassays: The
OraQuick HCV Rapid Antibody Test
was FDA approved in 2010 as a
point-of-care test for use with
whole blood samples obtained
either by venipuncture or
fingerstick. The OraQuick test is
read between 20 to 40 minutes
after the test device is inserted into
the buffer and the result is either
reactive or nonreactive

15. FIBROSIS
Anything that damages the liver over many years can lead the
liver to form scar tissue. Fibrosis is the first stage of liver
scarring. Fibrosis of the liver is excessive accumulation of scar
tissue that results from ongoing inflammation and liver cell death
that occurs in most types of chronic liver diseases. Nodules,
abnormal spherical areas of cells, form as dying liver cells are
replaced by regenerating cells. This regeneration of cells causes
the liver to become hard. Fibrosis refers to the accumulation of
tough, fibrous scar tissue in the liver.

17. CIRRHOSIS
Cirrhosis (Means “scarring of the liver”) is a slowly progressing
disease in which healthy liver tissue is replaced with scar tissue,
eventually preventing the liver from functioning properly. The scar
tissue blocks the flow of blood through the liver and slows the
processing of nutrients, hormones, drugs, and naturally
produced toxins. It also slows the production of proteins and
other substances made by the liver.

19. Cirrhosis can lead to further complications including:
•Kidney failure
•Reduced oxygen in the blood
•Diabetes
•Changes in blood counts and bleeding and bruising
•Increased risk of infections
•Gynacomastia in men
•Premature menopause
•Loss of muscle mass
Most of these complications can initially be treated with medicines
or dietary changes. Once treatment for these complications
becomes ineffective, a liver transplant is considered.

20. VACCINATION
Hepatitis A
Two hepatitis A vaccines are available in the US, (Havrix [available
in Pakistan], Vaqta). Both contain inactive (killed) hepatitis A virus.
For adults, two doses of the vaccine are recommended. After the
first dose, protective antibodies develop in 70% of vaccine
recipients within 2 weeks, and almost 100% of recipients by 4
weeks. After two doses of the hepatitis A vaccine, immunity
against hepatitis A infection is believed to last for many years.

21. Hepatitis B
For active vaccination, a harmless hepatitis B antigen is given to
stimulate the body's immune system to produce protective
antibodies against the surface antigen of hepatitis B.
These recombinant hepatitis B vaccine (Energix-B and
Recombivax-HB) contain only that part of the surface antigen that
is very potent in stimulating the immune system to produce
antibodies.

22. Hepatitis B vaccines should be given in three doses with the
second dose 1 to 2 months after the first dose, and the third
dose 4 to 6 months after the first dose.
A combination vaccine (Twinrix) that protects against both
hepatitis B and hepatitis A also is available.

23. Hepatitis C and D
There is currently no vaccine for hepatitis C. Development of such
a vaccine is difficult due to the six different forms (genotypes) of
hepatitis C.
No vaccine for hepatitis D is available. However, HBV vaccine can
prevent an individual not infected with HBV from contracting
hepatitis D because hepatitis D virus requires live HBV to
replicate in the body.

24. TREATMENT OF HEPATITIS
Acute hepatitis
In patients with acute viral hepatitis, the initial treatment consists of
relieving the symptoms of nausea, vomiting, and
abdominal pain (supportive care). It occasionally is necessary to
provide intravenous fluids to prevent dehydration caused by
vomiting.
Only those medications that are considered necessary should be
administered since the impaired liver is not able to eliminate drugs
normally, and drugs may accumulate in the blood and reach toxic
levels.

25. Acute HBV is not treated with antiviral drugs. In most cases,
hepatitis B goes away on its own.
A patient with hepatitis B needs to rest. He will require a diet that
is high in protein and carbohydrate - this is to repair damaged liver
cells, as well as to protect the liver.
Acute HCV - though rarely diagnosed - can be treated with several
of the drugs used for treating chronic HCV. Treatment of HCV is
recommended primarily for the patients who do not eradicate the
virus early. Treatment results in clearing of the virus in the majority
of patients.

26. Chronic hepatitis
1. HBV
Treatment depends on how active the virus is in your body and
your chance of liver damage. The goal of treatment is to stop liver
damage by keeping the virus from multiplying. Most people with
chronic hepatitis B can live active, full lives by taking good care of
themselves and getting regular checkups.
Antiviral medicine is used if the virus is active and you are at
risk for liver damage. Medicine slows the ability of the virus to
multiply.

30. 2. HCV
In pharmacological treatment of hepatitis C, interferons
and direct acting antivirals(DAA) are used.
Interferons are of 2 types
1) Pegylated interferons
2) Non pegylated interferons
In pegylated interferon a chemical compound
polyethylene glycol (PEG) is added to increase the stay
time of drug in body.

32. Rs: 13000.00
Rs: 6200.00 to 18000.00

33. Sofosbuvir is a nucleotide analog inhibitor, an
enzyme that blocks a specific protein required
Hep C virus to reproduce Sovaldi is
available in Pakistan from Jan, 2015. The
subsidized Sovaldi Price in Pakistan is
around Rs.1142 Pakistani rupees per tablet
and costs around Rs.32,300 PKR per month.
Sovaldi tablet is taken once a day.
However, in future, Sovaldi tablet price in
Pakistan is expected to lower further.

35. SIDE EFFECTS
The most common side effects of hepatitis drugs are:
• Flu-like symptoms
• Fatigue
• Headache and belly aches
• Hair loss
• Low blood counts
• Trouble thinking and sleeping
• Nervousness
• Depression

36. Anti virals Side effects
Daclatasvir (Daklinza) Headache, feel a little tired, slowing of the heart rate
Elbasvir and grazoprevir (Zepatier) slight headache, bellyache, or feel tired
Ledipasvir and sofosbuvir (Harvoni) Slight headache, belly ache, diarrhea, and trouble sleeping.
Ombitasvir, paritaprevir, ritonavir (Technivie) feeling tired or week, stomach upset, itching, and trouble
sleeping. It might cause severe liver damage in people with
advanced cirrhosis.
Ombitasvir, paritaprevir and ritonavir, with
dasabuvir (Viekira Pak)
feeling itchy, weak, tired, or having trouble sleeping.This
medicine might cause severe liver damage in people with
advanced cirrhosis.
Simeprevir (Olysio) and sofosbuvir (Sovaldi) Sofosbuvir (Sovaldi) can cause fatigue, headache, tummy
troubles, and make it hard for you to sleep. Simeprevir
(Olysio) may cause dry skin and a rash, and make you more
sensitive to sunlight.

37. INTERACTIONS
• Taking an acid-reducing drug may change the way your body
metabolizes ledipasvir, one of the two medications in Harvoni
(ledipasvir/sofosbuvir). Antacids can lower the amount of
ledipasvir in the body if both drugs are taken within four hours
of each other.
• However, if you take Harvoni with a proton-pump inhibitor such
as Prilosec (omeprazole), these need to be administered
simultaneously, before the Prilosec reduces the acid
concentration in the digestive system.

38. • Viekira Pak (ombitasvir/paritaprevir/ritonavir; dasabuvir) may
increase the amount of Xanax (alprazolam) in the body, so a
lower dose of Xanax may be necessary.