I have always had the idea that the word 'hip' was derived from hep, short for hepetitis. This may of may not be the case, but for sure there has been a secret language among addicts that by definition keeps changing just enough to throw off pursurers, real and imaginary. Living out loud, we can share life and health giving information in many ways.
 

I have lost several friends to liver disease. I sponsor someone who told me a few weeks back the the cure rate for interferon is up from 40% just a couple of years ago to 80%. Breakthroughs are occurring daily, so don't give up hope. This prompts my posting the following information transcribed flawlessly, I hope, from material given me by my sponsee. Please contact the American Liver Foundation for my up to date information.
 

Other information I would like to display here:

• •obesity
• •apnea
• •anorexia nervosa
• •AIDS

If you have anything you think would help others, please email bo@bosewell.com.
 

Sincerely,
 

Bo Sewell
 

What is it?

Pegylated interferon is a new, longer lasting interferon that is currently undergoing clinical trials. This new form of interferon has special molecules attached to prevent the drug from being eliminated from the body too rapidly. This allows the drug to have a longer, more consistent effect against the hepatitis C virus and allows for once a week dosing.
 

There are two versions of pegylated interferon. The Hoffman-La Roche version is PEGASYS (peginterferon alfa-2a).
 

The Shering-Plough version is PEG-INTRON (peginterferon alfa-2b).
 

The FDA has not approved the marketing of pegylated interferon by either manufacturer at this time. Therefore, the drugs are only available in clinical trials.
 

How is it different?

Pegylated interferon is injected under the skin once a week. Conventional interferons approved by the FDA are usually injected three times a week.
 

Clinical trials suggest that the side effects from pegylated interferon are similar to conventional interferons. These include fatigue, headache, body aches, flu-like symptoms, nausea, vomiting, injection site reactions, fever, chills, diarrhea, partial hair loss, abdominal pain, depression, irritability, difficulty sleeping, dizziness and loss of appitite.
 

What are some of the preliminary data from clinical trials?

• •Results from a phase 2 study of 155 non-cirrhotic HCV patients found that 36 percent of patients treated with 180 mcg of Pegasys experienced a sustained response of undetectable levels of HCV.
• •In phase 2/3 studies of HCV patients with cirrhosis, 29 percent of the 87 patients treated with 180mcg of Pegasys had a sustained response of undetectable HCV virus compared to 6 percent of 88 patients treated with traditional interferon.
• •There are currently additional clinical trials being conducted to examine the effect of Pegasys in combination with ribavirin.
• •Phase 3 trials of Peg-Intron as a monotherapy for HCV patients have been completed.
• •Peg-Intron and Rebetol (ribavirin) combination therapy is currently in phase 3 trials.
• •Shering-Plough has not published or publicly presented their Phase 3 clinical data. They plan to do so at upcoming professiona conferences in the spring of 2000.

When will it be available?

Schering submitted a request to the FDA for marketing approval for Peg-Intron on Dec. 23, 1999.

A Hoffman-LaRoche representative states that Pegasys is in phase 3 clinical trials under FDA guidance and they have no date for release at this time.

The approval process is determined by the FDA and can take many months.
 
 

WHAT IS THE RELATIONSHIP BETWEEN DIET AND HEPATITIS C?
 

Hepatitis C (HCV) is a virus that infects the liver. Up to 85% of people exposed to this virus develop chronic liver disease. In general, chronic HCV appears to be a slowly progressive disease that may gradually advance over 10-40 years. While not as yet totally defined, many factors influence the rate of disease progression. Diet may play an important role in this process, as all foods and beverages that we ingest must pass through the liver to be metabolized.
 

General guidelines for individuals infected with HCV include maintaining a healthy lifestyle, eating a well-balanced, low-fat diet, and avoiding alcohol. A diet high in complex carbohydrates may be helpful in providing calories and maintaining weight. Since HCV infection may lead to loss of appetite, those individuals who appetite is diminished may find frequent, small meals more easily tolerated. Adequate rest and moderate exercise can also contribute to a feeling of well-being.
 

ALCOHOL AND HEPATITIS C
 

Alcohol is a potent toxin to the liver. Excessive intake can lead to cirrhosis and its complications, including liver cancer. Heavy drinkers are not the only individuals at risk for liver diseases, as damage can occur in even some moderate "social drinkers." The hepatitis C virus has frequently been isolated from patients with alcoholic liver disease. In fact, these patients have been found to have a higher incidence of severe liver damage, cirrhosis, and a decreased life span, when compared to individuals without the virus. It is suggested that the combination of alcohol and HCV accelerates the progression of liver disease. The consensus statement concerning management of HCV released in March, 1997 from the National Insitutes of Health further warned about the dangers of excessive alcohol use, and advised limitation of alcohol to no more than one drink per day. Therefore, patients with HCV would be unwise to drink alcohol in excess, and total avoidance of all alcohol intake is recommended.
 

IRON AND HEPATITIS C
 

The liver plays an important role in the metabolism of iron since it is the primary organ in the body that stores this metal. The average American diet contains about 10-20 mg of iron per day. About 10% of this iron is absorbed, in keeping with the body's need for 1 to 2 mg. of iron per day. Patients with chronic HCV sometimes have an increase in the iron concentration in the liver. Excess iron can be very damaging to the liver. Studies suggest that high iron levels reduce the response rate of patients with HCV to interferon. Thus, patients with chronic HCV whose serum iron level is elevated, or who have cirrhosis, should avoid taking iron supplements. In addition, these patients should restrict their intake of iron-rich foods, such as red meats, liver, and iron-fortified cereals, and should avoid cooking with iron-coated cookware and utensils.
 

FAT AND HEPATITIS C
 

Overweight individuals are often found to have abnormalities related to the liver, ranging from fatty deposits in the liver (steatosis) to fatty deposits accompanied by inflamation (steatohepatitis). In overweight patients with a fatty liver who subsequently lose weight, liver related abnormalities improve. Therefore, patients with chronic HCV are advised to maintain normal weight. For those who are overweight, it is crucial to start a prudent exercise routine and a low fat, well balanced, weight reducing diet. Diabetic patients should follow a sugar restricted diet. A low cholesterol diet should be followed in those with hypertriglyceridemia. It is essential that patients consult with their physician before beginning any diet or exercise program.
 

PROTEIN AND HEPATITIS C
 

Adequate protein intake is important to build and maintain muscle mass and to assist in healing and repair. Protein intake must be adjusted to one's body weight and medical condition. Approximately 1.0 to 1.5 gm. of protein per kilogram of body weight is recommended in the diet each day for regeneration of liver cells in non-cirrhotic patients.
 

In a small but significant number of individuals with cirrhosis, a complication known as encephalopathy, or impaired mental status, may occur. Affected individuals may show signs of disorientation and confusion. The exact caues(s) of encephalopathy is not fully understood. While some experts do not believe there is a link between dietary protein and encephalopathy, others believe in substantially reducing or even eliminating animal protein and adhering to a vegetarian diet, in order to help improve mental status. Patients who are at risk for encephalopathy may be advised to eat no more than .6 - .8 gm. Of animal source protein per kilogram of body weight per day. (Animal source proteings are meat, fish, eggs, poultry, and dairy products. Each provides 7 gm. Of actual protein per ounce of food.) There is no limit on vegetable protein consumption. Maintaining adequate protein intake and body weight should be considered a priority if vegetarian protein substitutes are not utilized.
 
 
 
 
 
 
 
 
 
 
 

The table below gives recommended grams of animal source protein intake per pound of body weight. (Note: The chart is intended to provide guidelines for patients with hepatitis C. For specific recommendations, consult your physician.)
 

Weight	Recommended average protein intake for regeneration of liver cells in non-cirrhotic patients	Maximum recommended protein intake for patients at risk for encephalopathy
100 lbs.	45-68 gm. (6-9 oz. Meat or equivalent)	27 gm.
130 lbs.	59-87 gm. (8-12 oz. Meat or equiv.)	35 gm.
150 lbs.	68-103 gm. (9.7-14 oz. Meat or equiv.)	40 gm.
170 lbs.	77-116 gm. (11-16 oz. Meat or equiv.)	46 gm.
200 lbs.	91-136 gm. (13-19 oz. Meat or equiv.)	54 gm.

 

SODIUM AND HEPATITIS C
 

Advanced scarring of the liver (cirrhosis) may lead to an abnormal accumulation of fluid in the abdomen, referred to as ascites. Patients with HCV who have ascites must be on sodium (salt) restricted diets. Every gram of sodium consumed results in the accumulation of 200 ml. of fluid. The lower the salt content of the diet, the better this excessive fluid accumulation is controlled. Sodium intake should be restricted to 1,000 mg. a day or less. This requires careful shopping and reading all food labels. It is often surprising to discover which foods are high in sodium. For example, one ounce of corn flakes contains 350 mg. Of sodium; one ounce of grated parmesan cheese, 528 mg. of sodium; one cup of chicken noodle soup, 1,108 mg of sodium; and one teaspoon of table salt, 2,325 mg. of sodium. Avoid fast food restaurants, because fast foods are high in sodium. Meats, especially red meats, are high in sodium, so meat consumption may need to be reduced and vegetarian alternatives considered. Patients with chronic HCV without ascites are advised not to overindulge in salt intake, although their restrictions need not be as severe.
 

MEDICATIONS ARE NOT FOOD, BUT ...
 

Like foods and beverages, medications also pass through the liver to be metabolized. Individuals with chronic liver disease should be careful about taking medications, even those sold over-the-counter. Read package labeling carefully before taking medications, and discuss any questions you may have with your physician and/or pharmacist.
 
 

The information contained in this sheet is provided for information only. This information does not constitute medical advice and it should not be relied upon as such. The American Liver Foundation (ALF) does not engage in the practice of medicine. ALF, under no circumstances, recommends particular treatments for specific individuals, and in all cases recommends that you consult your physician before pursuing any course of treatment.
 
 

Tumors of the liver are classified as being either primary (originating in the liver) or metastatic (spread from another body organ to the liver). Primary liver tumors may be further divided into those that are benign (not cancerous and remain in the liver) or malignant (cancerous and may spread to other parts of the body).
 

Benign Tumors
 

The most common benign tumor of the liver is a cavernous hemangioma. This tumor, as well as other benign tumors, is typically found by chance on an imaging study of the liver, such as ultrasound or computed tomography (CT). Cavernous hemangioma can be diagnosed with reasonable accuracy by the use of various imaging tests. Unless it is extremely large, no specific therapy is usually required. This tumor may enlarge in women taking hormone pills; thus, physicians will often recommend discontinuing birth control pills or postmenopausal hormone replacement therapy.
 

The other common benign tumors of the liver are called hepatocellular adenoma and focal nodular hyperplasia. Both of these tumors are also usually found by chance, although hepatocellular adenoma has a substantial risk of bleeding within the tumor and into the peritoneal (abdominal) cavity. The use of a number of imaging tests, and occasionally hepatic arteriography or biopsy, may be required to made the diagnosis of this tumor. Hepatocellular adenomas are also quite sensitive to hormonal therapy and may regress when birth control pills or hormones are stopped. If feasible, removal of hepatic adenoma may be recommended if it is large in order to prevent the possibility of bleeding and/or rupture.
 

Malignant Tumors
 

The most common primary malignant tumor of the liver is a hepatocellular carcinoma. Primary liver cancer accounts for less than 1% of all cancers in this country. However, in other parts of the world such as Africa, Southeast Asia, and China, it is a major health problem, causing up to 50% of cancer cases seen in those areas. This difference is thought to be due to the much higher percentage of the population who are carriers of the hepatitis B virus, which predisposes to the development of heptocellular carcinoma.
 

It was recognized a number of years ago that chronic carriers of the hepatitis B virus, particularly those with chronic hepatitis or cirrhosis, are at substantially increased risk to develop hepatocellular carcinoma. Recent evidence indicates that patients who have long-standing chronic hepatitis C virus infection are also at increased risk for the development of hepatocellular carcinoma, although the exact risk is uncertain.
 

Certain toxins and chemicals are also rarely associated with liver cancer. In Africa, aflatoxin, a product of mold round in badly stored peanuts or other foods, has been recognized as a cause of liver cancer.
 

Finally, certain diseases other than chronic hepatitis B or C are associated with an increased risk of hepatocellular carcinoma. Iron overload cirrhosis (hemochromatosis) is associated with a substantial risk of hepatocellular carcinoma once cirrhosis has developed. Patients with longstanding alcoholic cirrhosis are also at risk for developing this tumor. Two congenital disorders, alpha;-antitrypsin deficiency and tyrosinemia, may also be complicated by the development of hepatocellular carcinoma.
 

Metastatic or secondary tumors of the liver come from cancers originating elsewhere in the body. Because the liver filters blood from all parts of the body, it is often the site in which cancer cells will lodge and develop into metastatic nodules. An enlarged liver secondary to cancer may be an early sign of cancer in other organs. Secondary or metastatic cancer should not be confused with primary cancer of the liver.
 

Primary liver cancer may be detected by screening high risk patients or by chance on an imaging study of the abdomen performed for another reason, or it may be detected because of symptoms such as abdominal pain. Studies performed in several countries have demonstrated the the periodic use of abdominal ultrasound and a blood tumor marker, called alpha-fetoprotein, may lead to the early detection of small hepatocellular carcinomas in patients at high risk. This screening strategy has not been widely adopted because its cost-effectiveness has yet to be proven. In patients who develop symptoms from more advanced hepatocellular carcinoma, weight loss, periodic severe pain and other generalized symptoms may occur. Health may deteriorate rapidly and jaundice (yellow skin) may appear.
 

The diagnosis of primary cancer of the liver is typically made by liver imaging tests, such as abdominal ultrasound and CT scan in combination with the measurement of blood levels of alpha-fetoprotein. The final diagnosis is confirmed by needle biopsy, which is typically performed by a radiologist who can direct the biopsy needle to the exact position of the tumor. It may be necessary to also examine the arteries and veins of the liver by hepatic arteriography, particularly if surgery is considered.
 

Treatment of primary cancer of the liver may be directed towards a cure, or focused at palliation (the relief of symptoms and prolongation of life). When the tumor is small and limited to one lobe of the liver, surgical removal offers a chance at cure. If the tumor is larger or involves more than one lobe of the liver such that it cannot be removed, liver transplantation has also been performed. In either case, the cure rate averages only 20-30%, which has limited somewhat the use of liver transplantation for this problem.
 

There are a number of newer therapies that offer good palliation for hepatocellular carcinoma. In particular, the direct injection of alcohol into the tumor via a small needle or the embolization at the time of hepatic arteriography of a specific chemotherapeutic agent (chemo-embolization) has resulted in prolonged survivals. These measures may also be used together with either surgical resection or liver transplantation.
 

The American Liver Foundation is a national voluntary health organization dedicated to preventing, treating and curing liver and gallbladder diseases through research and education.
 
 

Copyright (C) 1995

The American Liver Foundation cancer,liv:mal,pubs. 10/95
 

What is interferon? - Interferon is produced by the body's cells in response to viral hepatitis and other infections. There are three types - alpha, beta and gamma. All are proteins. Commercial alpha interferon mixtures consist of the types of interferon produced by the body. Iinterferon alpha-2b is the only commercial form approved by the U.S. Food and Drug Administration for the treatment of hepatitis B and C (HBV and HCV). Interferon alpha-2a is approved for the treatment of HCV only. Other forms of alpha interferon (lymphoblastoid-alpha N1 and consensus interferon) have also been evaluated. Interferons stimulate the body's immune system to fight viral infections and affect the ability of viruses to divide in liver cells. Patients with chronic HBV or HCV infections also appear to be unable to produce normal amounts of interferon.
 

Which patients with HBV should take interferon? - Not every patient is eligible for interferon therapy. Patients should have infection documented for at least six months, with elevated liver enzymes (AST of SGOT, and ALT or SGPT tests). Liver enzymes are proteins found in the blood that come from damaged liver cells. Patients should also have evidence of an actively dividing virus in their blood (hepatitis "e" antigen [HbeAg} and/or hepatitis B virus DNA (HBV DNA] positive tests). Patients with normal liver enzymes are less likely to benefit than those with high HBV DNA levels. A biopsy, where a needle is inserted into the live to obtain a small sample of tissue, is helpful in determining the degree of liver damage prior to treatment. Patients with acute infection, advanced cirrhosis or other major medical problems should not be treated.
 

When is it indicated for HCV? - Patients with elevated liver enzymes for six or more months and who have a detectable antibody (ELISA test) to HCV (anti-HCV) are eligible for therapy. Patients who have a risk factory for HCV (blood transfusion, needle-stick exposure or illegal intravenous drug use) usually do not need to have the HCV result confirmed by additional testing. However, patients without such a risk factor should have a second test: either the RIBA test, to confirm the presence of the antibody, or the PCR test, which detects the presence of the virus. Liver biopsy is helpful in the diagnosis of viral hepatitis, assessing live damage prior to treatment. Patients with acute infection, complication from cirrhosis, other major medical problems and autoimmune live disease should not be treated with interferon.
 

What are the doses used? - For HCV, the standard approved dose of interferon alpha-2b is three million units, three times weekly for 24 weeks; for interferon alpha-2a, it is three million units, three times weekly for 12 months for those who respond after three months. Approved treatment for HBV is five million units daily of ten million units three times weekly for 16 weeks. Treatment may be modified for significant side effects. However, lower doses may result in lower rates of response. The value of higher doses or longer therapy is being tested. Interferon treatment is administered by injection.
 

What are the side effects of treatment? - Many patients will have side effect from interferon treatment, including "flu-like symptoms" such as fever, chills, headaches, muscle or joint aches, tiredness, and weakness. When these symptoms occur, they usually go away after the first few injectinos. Later, or more long-term, side effects of interferon could be hair loss, irritability, depression, difficulty sleeping, tiredness, and muscle aches. A small number of patients (about 1%) may develop thyroid disease. Not all patients have these side effects, and many patients receive interferon without any difficulty at all.
 

When is the treatment not indicated? - Patients with cirrhosis from chronic HCV or HBV, with fluid in the abdomen (ascites), bleeding from dilated veins in the esophagus (variceal bleeding), or mental confusion (encephalopathy) should be treated only in a clinical trial. Others not suitable for treatment are those with symptomatic heart, lung or kidney diseases, organ transplant recipients on prednisone, cyclosporine and FK-506 and some patients on antidepressants or those with a history of suicide attempts. Interferon should not be given to pregnant or nursing women. Patients with substance abuse (alcohol or illegal drugs) should not be offered this therapy.
 

What can be expected from treatment for HCV? - Approximately 35-40% of patients with chronic HCV receiving full dose therapy will have improvement on liver enzymes and reductions or elimination of damage to liver cells seen on liver biopsy. If scar tissue (fibrosis, cirrhosis) it present on liver biopsy, it will probably not get better, but it should not worsen if treatment is successful.
 

If patients respond to interferon (i.e., liver enzymes return to normal) then treatment is continued for at least six months, and often up ot 12 or 18 months. If no response is seen after three to four months, treatment should be stopped. In patients who respond and are treated for six to 18 months, about 35-40% have continued normal liver enzymes after the end of treatment.
 

Once treatment has stopped, about 60% of patients who responded will see their liver enzymes elevated again. This is called a relapse. The majority of patients who respond, but then relapse, respond again with further therapy. Longer treatments will likely result in longer positive responses. Ultimately 10-15% will have long-lasting, sustained response with normal liver enzymes. Some of these patients will have no detectable trace of the virus in blood.
 

What can be expected from treatment for HBV? - A positive response to treatment for hepatitis B occurs in about 35% of patients. This is usually associated with a normalization of liver enzymes, and a loss of two of the three "markers" for an active infection. These two markers are hapatitis "e" antigen (HbeAg) and hepatitis B DNA (indicating that the virus is reproducing_. About 10% of patients also lose hepatitis B surface antigen (HbsAg). A positive response to therapy is preceded by an unexplained rise in liver enzymes, called a flare, in about 70% of patients. Complete elimination of the virus is seldom achieved.
 

What happens if interferon is not given? - The long term prognosis of chronic hepatitis C is poorly understood. However, hepatitis C is generally a slowly progressive disease, with evolution to cirrhosis over many years if not decades. There is no proof that treatment with interferon alters this. The changes vary from mild chronic hepatitis (least amount of liver damage) to moderate or severely active chronic hepatitis, with or without fibrosis or cirrhosis (most amount of liver scar damage). It is not known who will develop complications of chronic liver disease and liver failure. In contrast, chronic hepatitis B tends to progress more rapidly over years. Not all patients with either hepatitis B or C will develop complications of liver disease. However, for hepatitis B, interferon should be considered strongly in eligible patients. Patients with chronic HBV and HCV are candidates for liver transportation. Patients trasplanted for hepatitis B or C will have a recurrence of the viruses.
 
 
 

The American Liver Foundation is a national voluntary health organization dedicated to preventing, treating and curing liver and gallbladder diseases through research and education.
 
 

The information contained in this sheet is provided for information only. This information does not constitute medical advice and it should not be relied upon as such. The American Liver Foundation (ALF) does not engage in the practice of medicine. ALF, under no circumstances, recommends particular treatments for specific individuals, and in all cases recommends that you consult your physician before pursuing any course of treatment.
 
 

The term "liver function tests" and its abbreviated form "LFTs" is a commonly used term that is applied to a variety of blood tests that assess the general state of the liver and biliary system. Routine blood tests can be divided into those tests that are true LFTs, such as serum albumin or prothrombin time, and those tests that are simply markers of liver or biliary tract disease, such as the various liver enzymes. In addition to the usual liver tests obtained on routine automated chemistry panels, physicians may order more specific liver tests such as viral serologic tests or autoimmune tests that, if positive, can determine the specific cause of a liver disease.
 

There are two general categories of "liver enzymes." The first group includes the alanine aminotransferase (ALT) and the aspartate aminotransferase (AST), formerly referred to as the SGPT and SGOT. There are enzymes that are indicators of liver cell damage. The other frequently used liver enzymes are the alkaline phosphatase (alk. Pphos.) And gamma- glutamyltranspeptidase (GGT) that indicate obstruction to the biliary system, either within the liver or in the larger bile channels outside the liver.
 

The ALT and AST are enzymes that are located in liver cells and leak out and make their way into the general circulation when liver cells are injured. The ALT is thought to be a more s pecific indicator of liver inflammation, since the AST may be elevated in diseases of other organs such as the heart or muscle. In acute liver injury, such as acute viral hepatitis, the ALT and AST may be elevated to the high 100s or over 1,000 U/L. In chronic hepatitis or cirrhosis, the elevation of these enzymes may be minimal (less than 2-3 times normal) or moderate (100-300 U/L). Mild or moderate elevations of ALT or AST are nonspecific and may be caused by a wide range of liver diseases. ALT and AST are often used to monitor the course of chronic hepatitis and the response to treatments, such as prednisone and interferon.
 

The alkaline phosphatase and hte GGT are elevated in a large number of disorders that affect the drainage of bile, such as a gallstone or tumor blocking the common bile duct, or alcoholic liver disease or drug-induced hepatitis, blocking the flow of bile in smaller bile channels within the liver. The alkaline phosphatase is also found in other organs, such as bone, placenta, and intestine. For this reason, the GGT is utilized as a supplementary test to be sure that the elevation of alkaline phosphatase is indeed coming from the liver or the biliary tract. In contrast to the alkaline phosphatase, the GGT is not elevated in diseases of bone, placenta, or intestine. Mild or moderate elevation of GGT in the presence of a normal alkaline phosphatase is difficult to interpret and is often caused by changes in the liver cell enzymes induced by alcohol or medications, but without causing injury to the liver.
 

Bilirubin is the main bile pigment in humans which, when elevated, causes the yellow discoloration of the skin and eyes called jaundice. Bilirubin is formed primarily from the breakdoen of a substance in red blood cells called "heme." It is taken up from blood processed through the liver, and then secreted into the bile by the liver. Normal individuals have only a small amount of bilirubin circulating in blood (less than 1.2 mg/dL). Some conditions, including liver disease or the destruction of red blood cells, cause increased levels of bilirubin in the blood stream. Levels greater that 3 mg/dL are usually noticeable as jaundice. The bilirubin may be elevated in many forms of liver or biliary tract disease, and thus it is also relatively nonspecific. However, serum bilirubin is generally considered a true test of liver function (LFT), since it reflects the liver's ability to take up, process, and secrete bilirubin into the bile.
 

Two other commonly used indicators of liver function are the serum albumin and prothrombin time. Albumin is a major protein which is formed by the liver, and chronic liver disease causes a decrease in the amount of albumin produced. Therefore, in more advanced liver disease, the level of the serum albumin is reduced (less than 3.5 mg/dL). The prothrombin time, which is also called protime or PT, is a test that is used to assess blood clotting. Blood clotting factors are proteins made by the liver. When the liver is significantly injured, these proteins are not normally produced. The prothrombin time is also a useful test of liver function, since there is a good correlation between abnormalities in coagulation measured by the prothrombin time and the degree of liver dysfunction. Prothrombin time is usually expressed in seconds and compared to a normal control patient's blood.
 

Finally, specific and specialized tests may be used to make a precise diagnosis of the cause of liver disease. Elevations in serum iron, the percent of iron saturated in blood, or the iron storage protein ferritin may indicate the presence of hemochromatosis, a liver disease associated with excess iron storage. In another disease involving abnormal metabolism of metals, Wilson's disease, there is an accumulation of copper into the urine. Low levels of serum alpha;-antotrupsin may indicate the presence of lung and/or liver disease in children or adults with alpha;-antitrypsin deficiency. A positive antomitochondrial antibody indicates the underlying condition of primary biliary cirrhosis. Striking elevations of serum globulin, another protein in blood, and the presence of antinuclear antibodies or antismooth muscle antibodies are clues to the diagnosis or autoimmune hepatitis. Finally, there are specific blood tests that allow the precise diagnosis of hepatitis A, hepatitis B, hepatitis C, and hepatitis D.
 
 

The information contained in this sheet is provided for information only. This information does not constitute medical advice and it should not be relied upon as such. The American Liver Foundation (ALF) does not engage in the practice of medicine. ALF, under no circumstances, recommends particular treatments for specific individuals, and in all cases recommends that you consult your physician before pursuing any course of treatment.
 
 

What is Hepatitis C?
 

Five different viruses (termed A, B, C, D, and E) cause viral hepatitis. Four other viruses that are believed to cause hepatitis have been identified, but not much is known about them. Hepatitis C virus (HCV) accounts for the great majority of what was referred to as non-A, non-B hepatitis. The hepatitis C virus was identified in 1989, and in 1990 a hepatitis C antibody test (anti-HCV) became available to identify individuals exposed to HCV.
 

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 reastions 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. The anti-HCV test will remain positive after recovery from acute hepatitis C. Despite new, more sophisticated diagnostic tests, a small percentage of patients still may have false positive hepatitis C antibody reactions. In these two cases, liver enzymes are typically normal. A small number of patients (less than 30%) may recover from acute hepatitis C, but their anti-HCV test will remain positive.
 

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 on the original virus which caused the body to produce antibodies. It is estimated that up to 85% of the people infected with hepatitis C virus each year will develop chronic infection. Currently, there are approximately 4 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 (before 1990) to less than 0.5% (after 1990). 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, as are those who undergo tattooing or body piercing. Currently, there is no vaccine available to immunize individuals against this virus.
 

The risk of transmitting hepatitis C sexually is unknown. There have been occasional documented cases of people with chronic hepatitis C transmitting to virus to their only, long-term sexual partner. The U.S. Public Health Service 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. Spouses of long-term sexual partners of newly diagnosed patients are advised to be tested for hepatitis C. The Centers for Disease Control and Prevention (CDC) say there is a slight 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 confirmed by liver biopsy was identified on th eaverage 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 occuring 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 drugs, recombinant interferon alfa-2b and recombinant interferon alfa-2a, have been approved for the treatment of chronic hepatitis C. The approved length of therapy for recombinant interferon alfa-2b is 18 to 24 months. Patients treated for this length of time experienced an initial response rate (normalization of liver tests) of 47%. Among the initial responders, approximately 24% (of the initial group) had a sustained, long-lasting response.
 

The approved length of therapy for recombinant interferon alfa-2a is 12 months. Patients treated for this length of time experienced an initial response rate (normalization of liver tests) of 23%. Among the initial responders, approximately 12% (of the initial group) has a sustained, long-lasting response. Patients can be treated a second time and a large percentage 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. The hope is that improvement or normalization of liver tests and reduced inflamation 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 can include "flu-like" symptoms, depression, headache, and decreased appetite. The "flu-like" symptoms can be minimized by taking acetaminophen (e.g. Tylenol). In addition, interferon may depress the bone marrow leading to reduced levels of 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.
 
 

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.

The information contained in this sheet is provided for information only. This information does not constitute medical advice and it should not be relied upon as such. The American Liver Foundation (ALF) does not engage in the practice of medicine. ALF, under no circumstances, recommends particular treatments for specific individuals, and in all cases recommends that you consult your physician before pursuing any course of treatment.
 
 

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