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Dx Hepatitis C Treatments: Read more....


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Observations:
Hepatitis C

The Merck Manual
states:
"Chronic hepatitis is inflammation of the liver that lasts at least 6 months.
*Common causes include hepatitis B and C viruses and certain drugs.
*Many people have no symptoms, but some have vague symptoms, such as a general feeling of illness, poor appetite, and fatigue.
*Chronic hepatitis can result in cirrhosis, with an enlarged spleen, accumulation of fluid within the abdomen, and deterioration of brain function.
*A biopsy is done to confirm the diagnosis.
*Drugs, such as antiviral drugs or corticosteroids, may be used, and for advanced disease, liver transplantation may be needed.

Chronic hepatitis, although much less common than acute hepatitis, can persist for years, even decades. In many people, it is quite mild and does not cause significant liver damage. However, in some people, continued inflammation slowly damages the liver, eventually resulting in cirrhosis (severe scarring of the liver), liver failure, and sometimes liver cancer.

Hepatitis C virus was not identified until 1989. People may have been infected before this time without knowing it. Because unrecognized infection is possible, researchers tested various age groups for hepatitis C. They found that among adults in the United States, about three fourths of all chronic hepatitis C cases occur in people born between 1945 and 1965.

Causes
Chronic hepatitis is usually caused by one of the hepatitis viruses. Hepatitis C virus causes about 60 to 70% of cases, and at least 75% of acute hepatitis C cases become chronic. About 5 to 10% of hepatitis B cases, sometimes with hepatitis D coinfection, become chronic. Hepatitis A and E viruses do not cause chronic hepatitis.

Certain drugs can cause chronic hepatitis, particularly when they are taken for a long time. They include isoniazid, methyldopa, and nitrofurantoin. Other causes include alcoholic hepatitis and fatty liver not due to alcohol use (nonalcoholic steatohepatitis). Less often, chronic hepatitis results from alpha1-antitrypsin deficiency (a hereditary disorder), celiac disease, a thyroid disorder, or, in children and young adults, Wilson disease—a rare hereditary disorder involving abnormal retention of copper in the liver (see see Wilson Disease).
No one knows exactly why a particular virus or drug causes chronic hepatitis in some people but not in others or why the degree of severity varies. In many people with chronic hepatitis, no obvious cause can be identified. In some of these people, the chronic inflammation resembles inflammation caused by the body attacking its own tissues (an autoimmune reaction—see see Autoimmune Disorders). This type of inflammation, called autoimmune hepatitis, is more common among women than men.

Symptoms In about two thirds of people, chronic hepatitis develops gradually, often without causing any symptoms of a liver disorder until cirrhosis occurs. In the remaining one third, it develops after a bout of acute viral hepatitis that persists or returns (often several weeks later).

Symptoms often include a vague feeling of illness (malaise), poor appetite, and fatigue. Sometimes affected people also have a low-grade fever and some upper abdominal discomfort. Jaundice is rare.

Complications of chronic liver disease and cirrhosis may eventually develop. They can include an enlarged spleen, small spider-like blood vessels visible in the skin (called spider angiomas), redness of the palms, and accumulation of fluid within the abdomen (ascites). Liver malfunction may lead to deterioration of brain function (hepatic encephalopathy–see Hepatic Encephalopathy), particularly in people with cirrhosis due to hepatitis C.

Autoimmune hepatitis may cause other symptoms that can involve virtually any body system, especially in young women. Such symptoms include acne, cessation of menstrual periods, joint pain, scarring of the lungs, inflammation of the thyroid gland and kidneys, and anemia.

In many people, chronic hepatitis does not progress for years. In others, it gradually worsens. The outlook depends partly on which virus is the cause:
*Chronic hepatitis C leads to cirrhosis, which develops over a period of years. Without treatment, about 20 to 30% of people develop cirrhosis. The risk of liver cancer is increased but only if cirrhosis is present.
*Chronic hepatitis B tends to worsen, sometimes rapidly but sometimes over a period of years, leading to cirrhosis. Chronic hepatitis B also increases the risk of liver cancer.
*Chronic co-infection with hepatitis B and D, if untreated, causes cirrhosis in up to 70%.
*Autoimmune hepatitis can be effectively treated in most people, but some develop cirrhosis.
*Chronic hepatitis caused by a drug may completely resolve once the drug is stopped.

Diagnosis
Doctors may suspect hepatitis C when people have typical symptoms, when blood tests (done for other reasons) detect abnormally high liver enzymes, or when people have had acute hepatitis before. Also, everyone born between 1945 and 1965, regardless of whether symptoms are present, should be tested once for hepatitis C. Such testing is recommended because hepatitis C is common among this age group and is often unrecognized.

Blood tests are done.
*[Editor] The H.I.S. or H.E.R. Blood Panels and the Liver/Hepatitis panels are available On-line.

They may help establish or exclude the diagnosis, identify the cause, and determine the severity of liver damage. However, a liver biopsy (see see Biopsy of the Liver) is essential to confirm the diagnosis. The liver biopsy also enables a doctor to determine how severe the inflammation is and whether any scarring or cirrhosis has developed. The biopsy may help identify the cause of hepatitis.

If people have chronic hepatitis B, ultrasonography and blood tests to measure alpha-fetoprotein levels are done every 6 to 12 months to screen for liver cancer. Levels of alpha-fetoprotein—a protein normally produced by immature liver cells in fetuses—usually increase when liver cancer is present. People with chronic hepatitis C are screened similarly, but only if they have cirrhosis.

Treatment
If a drug is the cause, the drug is stopped. If another disorder is the cause, it is treated.

Hepatitis B and C:
If chronic hepatitis B or C is worsening or if liver enzyme levels are high, people are usually given antiviral drugs.
For hepatitis B, entecavir or tenofovir is usually used. These drugs are taken by mouth. These drugs are very effective, and the chance that viruses will develop resistance to them is slight. Other drugs that can be used include telbivudine and lamivudine (taken by mouth) and interferon alfa and pegylated interferon alfa (given by injection under the skin).

In some people, hepatitis B tends to recur once drug treatment is stopped and may be even more severe. Thus, these people may need to take an antiviral drug indefinitely.

There are several types of hepatitis C virus (called genotypes). Each type has a slightly different its genetic material. Treatment varies by type. For some types, pegylated interferon alfa plus ribavirin(taken by mouth) is most effective. This combination may stop the inflammation. After taking these drugs for 6 months, 45 to 75% of people improve and have no further problems. For other types of hepatitis C, people are given pegylated interferon alfa and ribavirin plus a type of drug usually used to treat HIV infection, called a protease inhibitor (such as telaprevir or boceprevir).

Antiviral drugs taken by mouth (such as entecavir, tenofovir, telbivudine, and lamivudine) have few side effects. Lamivudine may have fewer side effects than the others. Ribavirin can cause birth defects. Both men and women who have to take this drug should use birth control during treatment and for 6 months after treatment ends.

Pegylated interferon alfa can cause a flu-like illness at first. Later, it can cause fatigue, a general feeling of illness (malaise), and depression. The drug may also suppress activity in the bone marrow, including the production of blood cells.

Pegylated interferon alfa should not be taken by people who have certain conditions:
*Advanced cirrhosis due to hepatitis B
*A transplanted organ
*A reduced number of blood cells (cytopenia), such as red blood cells (anemia)
*Substance abuse

If family members and close contacts of people with chronic hepatitis B have not been vaccinated, they should be. They are also given hepatitis B immune globulin by injection. Such measures are not necessary for chronic hepatitis C.

Autoimmune hepatitis:
Usually, corticosteroids (such as prednisone) are used, sometimes with azathioprine, a drug used to suppress the immune system. These drugs suppress the inflammation, relieve symptoms, and improve long-term survival. Nevertheless, scarring in the liver may gradually worsen. Stopping these drugs usually leads to recurrence of the inflammation, so most people have to take the drugs indefinitely.

Hepatitis B and C increase the risk of pancreatic cancer.

Treatment of complications:
Regardless of the cause or type of chronic hepatitis, complications require treatment. For example, treating ascites involves restricting salt consumption and taking a drug that helps the kidneys excrete more sodium and water into the urine (a diuretic—see Treatment). If brain function deteriorates, eliminating meat and other animal protein from the diet can help.

Liver transplantation:
Transplantation may be considered for people with severe liver failure. However, in people with hepatitis C, the virus virtually always recurs in the transplanted liver, and transplantation is less likely to be successful than transplantation done for other reasons.

Medications Used in Treatment:
1. Nuceloside Analogue Antivirals: Copegus® Rebetol® Ribasphere®/ribavirin
2. Interferon Alphas: Pegintron®/ peginterferon 2-b, Pegasys®/peginterferon alfa-2a Infergen®/interferon alfacon-1
3. Hepatitis C Protease Inhibitors: Victrelis®/boceprevir, Incivek®/telaprevir, Olysio®/simeprevir
4. Thrombopoiesis Stimulating Agents: Promacta®/eltrombogag
5. Glycyrrhiza
6. Direct Acting Antiviral Agents (Sofosbuvir and ABT-450):

[Editor] The United States is about to experience a surge in deaths from Hepatitis C much like Japan realized after WWII. The Baby Boomers who experimented with intravenous drugs will now be faced with either the very uncomfortable side effects of interferon and ribovarin (with only a 50% chance of clearing the disease) or the likelihood of developing liver cancer. The new Direct Acting Antiviral agents offer an alternative to interferon and ribovarin as they are released in 2014. Whether they will stem the proliferation of liver cancer is yet to be determined.

*[Editor] Glycyrrhiza is used to reduce cellular liver damage in Chronic Hepatitis B and C. It is the subject of the published works, Prevention of Progression in Chronic Liver Disease: An Update on SNMC (Stronger Neo-Minophagen C). The program is available in the U.S. through professors at NYU. Physicians can order the medication from select compounding pharmacies. This clears mild abnormal liver enzyme elevations of AST, ALT and GGT very well.

[Editor]
A general recommendation for vitamin supplementation for individuals with chronic hepatitis C could include a dose of 600 mg. of alpha-lipoic acid a day in 2 divided portions of 300 mg. each. The silymarin dose was 900 mg. per day in 3 divided portions of 300 mg. The selenomethionine dose was 400 mcg in 2 divided portions of 200 mcg. Silymarin is complexed with phosphatidyl choline. Because alpha-lipoic acid depletes some of the B vitamins, the patients were prescribed 2 B-100 capsules a day. In addition, each patient also took between 1,000 and 6,000 mg of vitamin C, 400 IU of vitamin E, and a mineral supplement. The patients were also requested to eat a daily diet that included at least 6 servings of fresh vegetables and fruits, only 4 oz or less of meat per meal, and 8 glasses of fresh water.

Suggested Links:
*N.H.S. Choices
*Medscape
*Liver foundation


*[Editor]An in-office finger-stick and venous whole blood test by OraQuick offers a 20-minute FDA approved, CLIA waived test for hepatitis C (HCV) antibodies.

Copyrighted 2014©; Revised May 21, 2015