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Hepatitis Disease
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information on treatment  
      options for viral hepatitis
      B and C. 
  
Acute Hepatitis C
  
Therapy for chronic 
      hepatitis C

  
Hep C: Presentation, 
      Diagnosis, Prevention

  
Diagnosis
  
Prevention
   Sexual transmission of
      the hepatitis C virus

 
What tests 
      may be done?

 
Hepatitis C Test Results
 
How Will I Know If I 
      Have Hepatitis C ?

 
Frequently asked 
      Questions About 
      Chronic Hepatitis C
 
Frequently asked
     Questions About
     Interferon Treatment


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WHAT TESTS MAY BE DONE?
Your physician will probably want to have blood drawn to determine your LFT's ("liver function tests" or "liver enzyme levels"). This will tell how well your liver is actually functioning at present. 
Your physician may also have blood drawn to determine viral load (i.e.. how many virus particles are present in the blood in a given volume). This test is most commonly performed using a quantitative polymerase chain reaction (i.e.. Quant PCR ) assay. For an example of more detailed information, see http://www.ngi.com/Services/Services.htm . 

Some physicians will order a genotype test, to determine whether you are genotype 1a or 1b, 2, 3, etc. Not all insurance companies will pay for these tests, and not all physicians are in agreement about the need for such tests. 

Your physician may also want to do a needle biopsy of the liver, to determine whether or not there is any degree of fibrosis or cirrhosis present at this time - in many cases there is only mild inflammation, with no fibrosis. 



WHAT DO THESE TESTS MEAN, AND: 
HOW HIGH ARE MY LEVELS?

Information about what it all means to you, in the world of lab tests, biopsies, fibrosis, pathology and more can be accessed by clicking on the hyperlinks in these paragraphs if reading the HTML version, or by browsing to http://www1.interpac.net/~dragonl/FAQ/labtest.html. More detailed and specific information can also be easily found in many of the Helpful Web Sites listed at the end of this FAQ, or by using any of the Medical Search Engines or Medical Libraries links also listed there. 


SHOULD I BE SCARED?
No. This is a very slow progressing disease in the vast majority of cases. Most of us with Hepatitis C will die with it, not from it. Take a deep breath, (and a big drink of pure water), be very calm, use this time to research, read and learn, and to carefully review all of your treatment options before you make an informed decision as to which you feel is the right way for you to proceed with your own treatment and management of the hepatitis virus. Learn all you can about this virus now, become informed, make lists of questions to ask your physician, and fully discuss all of your options with your physician and family members, and/or a counselor. Take all the time you need to learn more about many of the coping and treatment options you have (and there are many options available to you). Nor is an excellent time to begin learning to do Internet reseach - links at the end of this FAQ will show you how. 

HCV Infection Testing Algorithm for Diagnosis of Aysmptomatic Persons

HEPATITIS C TEST RESULTS

TEST  RESULTS Interpretation Recommendation
anti-HCV  pos.  chronic hepatitis, chronic hepatitis C recovered, recent acute hepatitis C, or false positive test  further evaluation 
anti-HCV  
ALT  
supplemental  
test (RIBA-2) 
pos.  
normal  
pos.  
. 
possible chronic HCV carrier, may have chronic hepatitis C   further evaluation 
anti-HCV  
ALT  
supplemental  
test (RIBA-2) 
pos.  
elevated  
pos.  
. 
presume chronic hepatitis C  further evaluation/ consider interferon therapy 
anti-HCV  
ALT  
supplemental  
test (RIBA-2) 
pos.  
normal  
neg. or  
indeterminate 
presume false positive anti-HCV or recovered  further evaluation by HCV-RNA PCR test if RIBA-2 negative or indeterminate 
anti-HCV  
ALT  
supplemental  
test (RIBA-2) 
pos.  
elevated  
neg.  
. 
presume false positive anti-HCV, false negative supplemental test unlikely  further evaluation for liver disease other than hepatitis C 
ALT  
(no other  
symptoms) 
elevated  
 
. 
possible fatty liver, chronic viral hepatitis, alcoholic liver disease, hemochromatosis, drug induced liver injury, other liver diseases  further evaluation 

Definitions:Anti-HCV-antibody to hepatitis C virus.
ALT-Liver enzyme released from liver cells that are injured, eg. by virus, alcohol, fat, drug, etc.

RIBA-2 - Supplemental test to detect antibody to hepatitis C virus.
Indeterminate means 1 of 4 antigens positive.

HCV-RNA test by polymerase chain reaction (PCR) determines whether the virus is multiplying.

 


How Will I Know If I Have Hepatitis C ? 

In general, individuals infected with HCV are often identified because they are found to have elevated liver enzymes on a routine blood test or because a hepatitis C antibody is found to be positive at the time of blood donation. In 1992, a more specific test for anti-HCV became available and eliminated some of the false positive reactions that were previously troublesome. In general, elevated liver enzymes and a positive antibody test for HCV (anti-HCV) means that an individual has chronic hepatitis C. However, the anti-HCV may remain positive for several years after recovery from acute hepatitis C. A small percentage of the patients still may have false positive hepatitis C antibody reactions. In these two cases, liver enzymes are typically normal. 

It appears that the formation of antibodies in response to the virus (associated with immunity in other forms of viral infections) does not apply with hepatitis C. Researchers believe this is because the virus changes to new forms of the original virus which caused the body to produce antibodies. It is estimated that up to 85% of the 150,000 people infected with the hepatitis C virus each year will develop chronic hepatitis. There are 3.5 million Americans chronically infected with HCV. 

Can I Give the Disease to Others? 
HCV can be transmitted through blood transfusions. However, all blood is now tested for the presence of this virus by the antibody test. It is estimated that the risk of post transfusion hepatitis C has been reduced from the 8-10% frequency of infection several years ago to less than 0.5%. Other individuals who may come in contact with infected blood, instruments, or needles, such as I.V. drug users, health care workers or laboratory technicians are also at risk of acquiring hepatitis C. Currently, there is no vaccine available to immunize individuals against this virus. 
The risk for transmitting hepatitis C sexually is unknown. There have been rare, documented cases of people with chronic hepatitis C transmitting the virus to their only, long-term sexual partner. The Centers For Disease Control and Prevention (CDC) says that because of the lack of sufficient information those with only one, long-term sexual partner need not change their sexual practices. Many physicians who counsel patients with hepatitis C recommend the same thing to those in a monogamous relationship. 

CDC says there is an increased risk of becoming infected with hepatitis C if you have multiple sex partners. Whether the use of latex condoms is 100% effective in preventing someone from infecting their sexual partner or becoming infected is uncertain. 


What is the Natural History of Hepatitis C? 
Specific information regarding the natural history of hepatitis C is not yet available. In general, however, chronic hepatitis C appears to be a slowly progressive disease that may gradually advance over 10-40 years. There is some evidence that the disease may progress faster when acquired in middle age or older. In one study, chronic hepatitis by liver biopsy was identified on the average of ten years following blood transfusions and cirrhosis on an average of 20 years. It also appears that HCV, like the hepatitis B virus, is associated with an increased chance of developing hepatocellular carcinoma, a type of primary liver cancer. Almost all HCV-related liver cancer occurs with cirrhosis (scarring) of the liver. The exact magnitude of this risk is unknown but appears to be a late risk factor occurring on the average of 30 years after the time of infection. This is more prevalent in the Far East than in the U. S. 

Is There a Treatment for Chronic Hepatitis C? 
The drug, interferon -alpha 2b has been approved for the treatment of chronic hepatitis C. Approximately 40% of patients treated for six months with interferon will respond, showing major improvement or normalization of liver tests and reduced inflammation on liver biopsy. However, of those who respond to treatment, approximately 60% will suffer a relapse during several months after interferon treatment is discontinued. Thus, only 10-15% of patients treated with interferon have a sustained, long-lasting response. Patients can be treated a second time and 85% of patients will enter a second remission; however, the duration of treatment and dosage required for long-term remission in this group of patients has yet to be determined. In a recent multi-center trial in Europe, 44% of the hepatitis C patients on the standard dosage for 18 months had their elevated liver enzymes return to normal. This group was evaluated 19 to 42 months after this initial 18 month therapy and half of them (22%) still had normal liver enzymes. The hope is that improvement or normalization of liver tests and reduced inflammation in the liver will slow or interrupt the development of progressive liver disease. However, the true impact of interferon treatment on the long-term course of chronic hepatitis C and survival is unknown. 

Side effects caused by interferon therapy are frequent and include "flu like" symptoms, depression, headache, and decreased appetite. The "flu like" symptoms can be minimized by taking two doses of acetaminophen (e.g., Tylenol). In addition, interferon may depress the bone marrow leading to difficulties with the white blood cells and platelets. Frequent blood tests are needed to monitor white blood cells, platelets and liver enzymes. A liver biopsy is typically done prior to treatment to determine the severity of liver damage and provide confirmation of the underlying disease. 

What Should I Do If I Test Positive for the Hepatitis C Virus? 
You should seek referral to a gastroenterologist or liver specialist so that further testing can be performed to determine the significance of the reactive antibody and whether or not you have chronic hepatitis C. 

 


FREQUENTLY ASKED QUESTIONS ABOUT 
CHRONIC HEPATITIS C

BY VERA SIMON, R.N., M.Sc.N.

(1) WHAT IS HEPATITIS C?
Hepatitis C is a viral illness that affects the liver. In 1990 an antibody to the hepatitis C virus was identified but before that the illness was known as "non-A, non-B hepatitis".

(2) WHAT IS THE DIFFERENCE BETWEEN ACUTE AND  
     CHRONIC HEPATITIS C?

The term acute means that the virus has been present in the blood for less than six months. The term chronic means that a person has had the illness for more than six (6) months. The differences between the two stages of treatment are in the dosage and length of time of treatment. If a patient has chronic HCV the virus will probably be with them throughout their life.

(3) HOW DO I GET HEPATITIS C?
Hepatitis C is spread by blood-to-blood contact. Therefore, anyway that one person’s blood may be in contact with an infected person’s blood will spread the hepatitis C virus (HCV). Some of the most common ways of spreading the virus are: transfusion of blood products, intravenous drug use, tattooing, body piercing, sharing needles. The risk of transmitting HCV through transfusions of blood products has decreased significantly since all blood donors are now screened for hepatitis C.

(4) WHAT ARE THE SYMPTOMS OF HEPATITIS C?
Most people who have HCV do not know that they have the illness. Most are free of any symptoms. Interestingly, in many people the presence of the symptoms does not bear a direct relationship with the extent of the disease. In other words, someone with very mild HCV may have many of the symptoms, while another person who has much more advanced disease does not have any symptoms. It is very individual. Some of the more common symptoms of HCV include: extreme tiredness, itch, joint pain.

(5) HOW DO I KNOW IF I HAVE HEPATITIS C?
Usually people with HCV are found because the liver enzymes in their blood are above normal limits, and their doctors do more blood tests to find the cause. Others are found through testing positive while donating blood or because their doctor identified risk factors and requested the blood test.

(6) WHAT ARE LIVER ENZYMES?
Liver enzymes are proteins produced by the liver. Everyone has a low level in their blood but when the liver is injured in any way more liver enzymes are released into the blood stream. Elevated liver enzymes are a red flag to doctors to investigate the cause of this increase. The two most common liver enzymes that doctors check are the ALT( SGPT) and AST(SGOT).

(7) HOW CAN I PREVENT GIVING THIS INFECTION TO  
     SOMEONE ELSE?

There is no need for anyone with HCV to be socially isolated. Because HCV is spread through blood-to-blood contact people with HCV should take some precautions. They include: - do not donate blood - let anyone who is contact with your blood know that you are HCV positive.
This includes dentists, blood technicians, nurses.
- Do not share razors or toothbrushes.
- Do not share needles or other equipment if you are using intravenous drugs.

(8) SHOULD MY FAMILY BE TESTED FOR HCV?
Ask your doctor. The likelihood is small that HCV was spread to a family member. Treatment is not generally used for children with HCV. Testing may ease a person’s concern if family members are tested.

(9) AM I GOING TO DIE IF I HEPATITIS C?
Most people who have HCV have a normal life span. However, there is still much information to be learned about HCV. In approximately 10% of people with chronic HCV, or, 10 people in 100 with HCV, their disease will gradually progress over 10 to 30 years to develop scarring, or cirrhosis of the liver. In a small number of these people HCV can lead to cancer of the liver and/or death.

(10) WHAT SHOULD I EAT IF I HAVE HEPATITIS C?
People diagnosed with HCV can eat anything they want. The only recommendation is that they eat nutritiously. Avoidance of drinking alcohol in any form is recommended because studies have shown that the hepatitis C virus infection progresses more rapidly in people who drink alcohol. Some doctors believe that having no alcohol may stop HCV from progressing at all.

(11) IS THERE A TREATMENT FOR HEPATITIS C?
Treatment for HCV varies depending upon the extent of a person’s disease. Sometimes lifestyle changes such as stopping drinking alcohol is sufficient. For some people with more active disease doctors may recommend a treatment with alpha interferon alone or a combination of alpha interferon and Ribavirin.

(12) CAN I GIVE MY SEXUAL PARTNER HEPATITIS C?
Because hepatitis C is spread through blood the likelihood of spreading it to your sexual partner is low. However, menstrual blood can contain the virus. It is recommended that a person who has multiple sex partners practices "safe sex".

(13) CAN I GIVE HEPATITIS C TO MY CHILD WHILE I AM 
        PREGNANT OR BREAST FEEDING?

It is very unlikely that pregnant women with HCV can transmit the virus to their baby either in the womb or at childbirth. At the present time it is not known whether HCV can be spread from a mother to her baby through breast milk. However, the likelihood is very small and some liver specialists recommend that mothers if they want, breast feed their babies.

(14) CAN I GET A VACCINE FOR HEPATITIS C?
Presently there is no vaccine for HCV. Recent studies show that people with HVC become much sicker and their liver becomes much more damaged if they develop another form of viral hepatitis. Doctors are now recommending that people with HCV receive the hepatitis A and/or the hepatitis B vaccine(s) if they have not been exposed to one, the other or both. That means if a person with HCV is immune to hepatitis B but not to hepatitis A then he/she should get the hepatitis A vaccine. If they are not immune to either than they should receive both the hepatitis A and B vaccine. There is a combination hepatitis A and B vaccine available. Checking for immunity involves a simple blood test.

(15) HOW SHOULD I DEAL WITH PEOPLE WHO AVOID ME
       BECAUSE I HAVE HEPATITIS C?

People who do not know very much about HCV may avoid people HCV. Mainly they are afraid they might "catch" the virus from you. If they are acting this way you may try to explain about HCV. If this does not work you may try to teach them more by giving them pamphlets or other written information about HCV.


FREQUENTLY ASKED QUESTIONS ABOUT INTERFERON 
TREATMENT
FOR CHRONIC HEPATITIS

(1) WHAT IS INTERFERON?
Interferon is a protein naturally produced in our bodies to fight viruses by boosting the immune system. The medication "Alpha Interferon " is a synthetic reproduction of the naturally-produced interferon.

(2) HOW WILL THE TREATMENT HELP ME?
Alpha interferon is used in the treatment of Acute Hepatitis C to try to remove the virus totally from the body and thus prevent the virus from doing any damage to the liver.

Alpha interferon is used in the treatment of Chronic Hepatitis C to try to arrest or stop the hepatitis C virus from damaging the liver anymore. It can stop the inflammation in the liver in some patients and sometimes rids the patient of the hepatitis C virus. It does not improve the scarring already present in the liver.

Alpha interferon is used in the treatment of Chronic Hepatitis B to try to arrest or stop the hepatitis B virus from damaging the liver anymore. Interferon alpha does this by trying to remove the hepatitis B virus from the body.

(3) WHO SHOULD RECEIVE TREATMENT?
Alpha interferon not recommended for all people diagnosed with chronic hepatitis B or C.

Firstly, it is recommended for people who are known to have had hepatitis B for greater than six (6) months, or HVC in either acute or chronic stage.

Secondly, it is recommended for people who have liver enzymes ALT(SGPT) and AST(SGOT) greater than one and a half times normal.

Thirdly, it is recommended for anyone drinking alcohol no more than two drinks a week for the last six months.

As well it is recommended for only people with chronic hepatitis B who are "e" antigen positive. Because there is limited information about treating children with alpha interferon , this should only be done by specialists who have had considerable experience with the medication.

(4) WHAT DOES THE TREATMENT CONSIST OF?
Treatment consists of giving yourself needles just below the skin. It is the same kind of needles that diabetics use to give insulin to themselves. You are taught how to give yourself the needles. The number of times a week you give yourself injections depends upon whether you are diagnosed with acute HCV, chronic HCV, or hepatitis B.

(5) HOW LONG DO I TAKE THE TREATMENT FOR?
For people with Chronic Hepatitis C the recommended standard treatment lasts for twelve (12) months if a person is responding. The doctor will know by the eighth week of treatment if it is working. If it is not, the treatment is stopped.

For people with Chronic Hepatitis B the recommended standard treatment consists of four (4) months.

For people with Acute Hepatitis C the treatment consists of four (4) months.

(6) WHAT WILL I FEEL LIKE ON THE TREATMENT?
Each person responds very differently to the treatment. The first needle of the medication usually produces the most severe side effects of the whole treatment. People get flu-like symptoms: fever, chills, muscle aches. This lasts between four (4) to eight (8) hours. The flu-like symptoms disappear as the body gets used to the extra interferon. Alpha interferon is known to cause other side effects such as headaches, tiredness, decrease in appetite, joint pains. Tylenol and rest help these. People on treatment will have their blood work checked at least once a month because alpha interferon has an effect on some of the blood cells. There are some other side effects that are less frequent.

(7) CAN I WORK WHILE I AM ON TREATMENT?
Doctors encourage people on treatment to continue with their work and regular daily habits. It is best to consider oneself "healthy" and have a positive attitude to the treatment. Anybody who is having trouble coping with the treatment should talk to their doctor.

(8) DO I NEED TO FOLLOW A SPECIAL DIET WHILE ON0 
     TREATMENT?
People can eat whatever they normally eat while they are on treatment.

(9) CAN I TRAVEL WHILE I AM ON TREATMENT?
Yes. Your doctor encourages you to continue with your normal activities as much as possible. If you are planning a trip or you travel for business, taking Interferon should not interfere. You can take a cooler on your trip, or an insulated lunch bag. There are also small refrigerators which get their energy from plugging into either a car/truck lighter or a wall socket. These cost under fifty dollars and can be bought in any large hardware store.

(10) HOW WILL I KNOW IF THE TREATMENT IS WORKING?
For people with Chronic Hepatitis C treatment is working if liver enzymes have decreased. Ideally, the liver enzymes should be within normal limits by week eight (8) of treatment. A sustained response is defined as liver enzymes remaining within normal limits six (6) months after finishing treatment.

For people with Chronic Hepatitis B it may take up to a year or more after the treatment is finished to know whether the treatment was successful. The reason for this is that the measure in the blood that indicates successful treatment can take up to a year to change.

For people with Acute Hepatitis C the treatment is considered successful if at the end of treatment the hepatitis C virus was no longer detectable. This is checked by doing a blood test.

(10) CAN I BE ON THIS TREATMENT IF I AM PREGNANT OR  
        PLANNING TO  BECOME PREGNANT SOON?

At the present time very little is known about the effect alpha interferon has on the development of cells of an embryo or fetus. Therefore, to be safe no woman who thinks she is pregnant or is planning on becoming pregnant soon is prescribed alpha interferon. Any woman who has the potential of becoming pregnant must use contraception while she is on treatment and for six (6) months afterwards. Very little is known about the effect of alpha interferon on sperm. It is recommended that while a man is on treatment he does not conceive any children.

This injection site map can help you with your interferon treatment.

WHAT ARE THE TREATMENT OPTIONS FOR CHRONIC HCV INFECTION?
Those of us who post to this group follow a wide variety of treatment options, and have very differing opinions, and differing degrees of success with various treatments. Some of us are on Interferon (INF) alone (monotherapy), with a small number of us having been on one form or another of Interferon for as long as six years. Some of us are taking a combination therapy ("the combo": one or another of the forms of injected Interferon, along with oral Ribavirin). Some with hepC augment the standard (allopathic) Western Medicine treatment by employing alternative therapies such as herbal supplements and controlled diet, acupuncture, Traditional Chinese Medicine (TCM) . Some of us have chosen to treat solely with nutrition, supplements, acupuncture, herbs, and various other alternative remedies. Reading the sci.med.diseases.hepatitis newsgroup posts will give you some idea who is having success with what type(s) of treatment. No matter what treatment option(s) you choose, it is very important for all of us to drink a large amount of water every day, to help flush toxins from our livers and to keep well hydrated. 
WESTERN MEDICINE (ALLOPATHIC): 

There are two treatment options approved by the FDA at this time: monotherapy with injections of Alpha Interferon (Intron A or Infergen, usually), or the combo therapy, which combines daily oral Ribavirin and injections of Alpha Interferon. Opinions differ amongst physicians as to the duration of treatment to use; some limit treatment to 6 months while others favor treatment in excess of 1 year. The frequency of IFN doses is also a point of debate amongst physicians - some advocate daily IFN injections while others recommend administration three times per week. There are also differing opinions among various physicians as to which strength of medication to prescribe. 

These drugs are not without some rather serious side effects, and your physician should fully discuss those possible side effects with you. Some people in this newsgroup find the side effects to be quite manageable, others find them very difficult to tolerate. Your physician should be questioned thoroughly about the possibilities before you decide on a course of treatment. 

Some interferon or combo coping tips have been offered by posters to this newsgroup, for helping deal with some of the side effects which people may be experiencing from treatment. 

If you are considering these chemotherapy treatments, a lengthy but very worthwhile read can be found at http://www.acponline.org/journals/annals/15aug98/mildhepc.htm . Opinions on treatment vary; many articles and abstracts can be found by clicking on this link. 

At the end of this FAQ is a list of website links specifically dealing with information relating to treatment. 

RESEARCH: NEW AND ONGOING
See http://www.frontiernet.net/~monty/hcvpipel.html for a wonderful Web Site maintained by FrankM, giving approximate timelines on some of the ongoing scientific drug therapy research in various areas. Reasearch is continually ongoing in several different areas of science to find new allopathic (medical) treatments which may have a more successful long-term sustained remission rate than those treatments currently available. 
ALTERNATIVE THERAPIES: 

There are many links which will enable you to find information on herbs and other helpful forms of alternative methods of treatment. Alternative treatment options may include any combination(s) of these and other therapies: 

Food and nutrition 
Milk Thistle (Silymarin) 
Other herbs 
Nutritional supplements 
Acupuncture 
TCM (Traditional Chinese Medicine) 
Ozone therapy 
http://hepatitis-central.com/hcv/herbs/toc.html  

 


 






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