Thursday, September 30, 2010

Hepatitis C Newly Diagnosed, What Now?

In the United States

Hepatitis C infection is the most common chronic blood borne infection in the U.S. Approximately 4.1 million persons, or 1.6% of the total U.S. population, are infected with hepatitis C


Of persons infected with hepatitis C 85% will remain infected for life; of those: 60 - 70% will develop chronic liver disease 10 – 20% will develop cirrhosis (scarring of the liver) 1 – 5% will develop liver cancer Liver failure from chronic hepatitis C is one of the most common reasons for liver transplants.

In 2005, about 6,500 liver transplants were performed in the U.S. The number of liver transplants performed per year has been increasing steadily for more than 15 years. Chronic liver disease is the tenth leading cause of death among adults in the U.S., causing approximately 25,000 deaths annually. 40% of deaths from chronic liver disease can be attributed to hepatitis C. The Centers for Disease Control and Prevention predicts that deaths due to hepatitis C will double or triple in the next 15 to 20 years.
From year 2010 through 2019, direct medical costs of HCV-related liver disease are projected to reach $10.7 billion.
The first thing anyone diagnosed with Hepatitis C wants to know is how quickly, if at all, will the disease progress.

Here is an article from HCV Advocate to answer that question

Disease progression of hepatitis C
Alan Franciscus, Editor-in-Chief
(HCV) is highly variable, which means that it is difficult to tell
who will and who will not have severe HCV disease progression.In general about 80% of people with chronic hepatitis C will have a slow rate ofdisease progression that may not lead to serious complication.

The other 20% of people with chronic hepatitis C will have
severe disease progression that could lead to complications such
as severe fibrosis, cirrhosis, liver failure, liver cancer and death.
The question that has vexed us all is why some people with HCV
have serious disease progression while others only have mild progression.
Although we are far from completely understanding and
answering this important question there is information available about
some of the factors that will likely increase the risk for serious HCV
disease progression. This article will discuss the various factors that
increase the likelihood of disease progression and steps we can all
take to minimize these effects – at least for those factors over which
we have some control.


ALT Levels
Alanine aminotransferase or ALT (previously called SGPT) is
a chemical produced in the liver.
ALT levels are elevated when liver cells are inflamed, damaged, or
destroyed by HCV, HBV, alcohol and certain drugs.Persistently elevated ALT levels are more of a sign that there is ongoing damage to the liver,and, if elevated over a long period of time, indicate ongoing fibrosis progression. But it is important to know that people with
persistently normal ALT levels can also have fibrosis progression, although
the risk is much lower.

The amount or degree of inflammation in the liver roughly
correlates with the development of fibrosis and cirrhosis. The amount
of inflammation can be reduced by taking HCV medical treatment
and avoiding any substance that causes harm to the liver, such as
alcohol, etc.



Light, moderate, or severe scarring of the liver (fibrosis) can eventually
lead to even more severe scarring of the liver called cirrhosis.
The damage caused by hepatitis C is not linear – this means that once
fibrosis and cirrhosis start to develop, the progression of liver disease
speeds up. In other words, it may take 10 years to progress
from one degree or stage of liver damage to another, but the next
increase in the amount of damage may take less time – say 7 years.
Progression to the next stage may only take 5 years and so forth.
HCV treatment can help to reduce, slow down or stop the disease
progression progress especially if HCV treatment is successful.
Lifestyle changes can also help the liver to stay healthy by maintaining
a healthy weight, eating a healthy diet, avoiding alcohol and drugs,
moderate exercise, stress reduction, etc.


Age plays a critical role in HCV disease progression. The age at
the time that someone acquired HCV plays an important role in
disease progression – so the older you are when you acquire HCV
the faster the disease progression.
This is because the body’s immune system doesn’t work
as well to minimize the damage HCV causes. On the other hand,
if someone acquires HCV at an early age, as they get older the
greater the chances of more severe disease progression due to the accumulation
of damage over time.
For instance, some studies have found that people over 60 years old
have a quicker disease progression and other studies have found that
having HCV for 25 years or longer increases the chances of disease

Fatty liver or steatosis can contribute to lower HCV treatment
response and a faster rate of HCV disease progression. The cause
of steatosis in most people with HCV is a synergistic effect of thevirus,
poor diet and lack of exercise. If you are HCV genotype 3,
however, steatosis is most likely caused by the hepatitis C virus.
For example, in people with genotype 3 who are successfully treated
with HCV medications steatosis has been found to be decreased
or eliminated. This is not true of steatosis in people with HCV non-3

For most people, steatosis can be prevented and even reversed by
the simple, but not so easy, methods that we all struggle with – a
healthy diet and exercise program.
We recommend that anyone who undertakes a diet and exercise
program consult with a medical provider and experts in the field of
diet and exercise.
Unfortunately,these tools are not available to
everyone; but there are still many avenues and resources open to
become even healthier. On the internet there is a wealth of diet
and exercise sites to help.


There have been some studies that have found that regular daily
use of marijuana can significantly increase the risk of fibrosis progression.
There is a caveat, however, about the data that has surfaced.
The studies have been self-disclosure studies that are typically extremely
difficult to gauge as to how truthful people may answer questions
about how much they smoke.
But the most important factor is that it is impossible to measure the
concentrations of THC (the active ingredient in marijuana) that the
participants were smoking. Interestingly,
the studies that report that daily marijuana causes significant
fibrosis progression also report that non-daily use of marijuana did not
accelerate fibrosis progression. The bottom line – more is not better
when it comes to many issues including using marijuana.

I don’t think anyone these days would be surprised to learn that
smoking cigarettes causes many health-related problems including
increasing the chances of fibrosis progression and liver cancer.

Another no-brainer is that alcohol consumption can increase
fibrosis and cirrhosis progression.
Excessive alcohol consumption – in and of itself – can lead to cirrhosis,
liver failure and liver cancer. If both of the negative effects, alcohol and
HCV, were combined I think it’s easy to see why people with HCV
should avoid alcohol. If someone has trouble stopping, they should
cut back on the amount of alcohol they drink and get help to stop.
There are many effective programs to help people stop drinking.
Metabolic Syndrome
In the last decade the relationship between metabolic disorders
and fibrosis progression has been well-documented. Metabolic disorders
are a group of conditions that increase the likelihood for
cardiovascular disease and other health problems.Components of
metabolic syndrome include:
• Abdominal obesity
• High blood cholesterol and
high triglycerides
• High blood pressure
• Insulin resistance
• State of inflammation caused
by obesity, insulin resistance,
• Prothrombotic state – increased
Although there are different components that define metabolic
syndrome they are also interconnected interconnected
especially with obesity.
Obesity and insulin resistance are the two factors that stand out as
factors that increase fibrosis progression.
A simple tool to measure insulin resistance is the HOMA-IR
– the higher the score, the higher the degree of insulin resistance.
The higher the HOMA-IR score, the more rapid fibrosis progression

Many of the factors of metabolic syndrome can be treated with
lifestyle changes (diet, exercise, stress reduction) and medications
to control diabetes, high blood pressure, cholesterol, etc.

How is hepatitis C spread? Who's at risk?

Hepatitis C virus (HCV) is transmitted through contact with an infected person's blood.

The following list outlines sources of hepatitis C transmittal:

-Blood and blood product transfusions;
-Sharing needles and syringes (IV drug abuse);
-Other possible risk behaviors: tattoos, body piercing, living and medical care in a developing country, folk medicine, intranasal cocaine;
-Extensive surgical procedures
-Unknown--up to 5% of patients have no identifiable risk factors;
-Sexual transmission is rare; the risk of sexual transmission to an individual is probably less than 3% when a person is in a stable monogamous relationship;
-Vertical transmission from mother to baby;
-Reused needles in a medical or health care setting.

Is hepatitis C transmitted sexually?

According to studies in the Journal of the American Medical Association, a low sexual transmission rate of hepatitis C was suggested. Of the 62 patients studied, none of the monogamous heterosexual partners had developed the hepatitis C antibody. In general, the probable risk of heterosexual transmission of hepatitis C is less than 3%.
It is recommend that all patients in a non-monogamous relationship use a condom or spermicide and patients in a monogamous relationship use a barrier method only if they are anxious or concerned about transmission.

All non-monogamous individuals should use safe sex practices.
For patients with hepatitis C, testing of spouses, babies and significant others is recommended by Centers for Disease Control(CDC). Please discuss these issues with your physician.

Is hepatitis C transmitted by breast milk to infants?

There is no substantial evidence that hepatitis C is transmitted through breast milk, however, a few studies have been performed that tested breast milk and very rarely is hepatitis C found in the breast milk--even using the most sensitive tests such as PCR. The CDC has issued a statement explaining that mothers who have HCV can breast feed, but should avoid it if there are sores around the nipple.

Can hepatitis C be transmitted to other members of my family (household contacts)?

There is a slight risk of hepatitis C transmission among household contacts, so family members should not share items such as razors or toothbrushes that may transmit blood or secretions. Women who have hepatitis C and are menstruating as well as men or women with hepatitis C and sores in the genital area should avoid sexual contact. The CDC recommends that spouses or partners of a hepatitis C patient be tested for hepatitis C.

Can a pregnant woman give hepatitis C to her baby?

A report in New England Journal of Medicine suggested a 7% transmission rate of hepatitis C from mother to child at birth. Though this is a high estimate, the possibility of transmission must be considered when a woman with hepatitis C is deciding whether to have children.
For infants who have received the hepatitis C virus from their mother, brief elevations of liver enzymes may occur, but no chronic liver disease has been reported. There have been no reports of cirrhosis in newborns, infants or child due to mother-to-child hepatitis C infection. It is recommended that all babies born to mothers with HCV be tested annually until age three with antibody tests.

Women with AIDS and hepatitis C are at high risk for transmitting the virus to their babies, and research has shown that these women consistently transmit the virus to their babies at birth.

Is hepatitis C transmitted by insects?

There is no documented transmission of hepatitis C through insects. The virus, however, is related to a group of viruses including yellow fever and Dengue, and those are known to have been spread by insects.

Exams and Tests »

The following tests are done to help diagnose hepatitis C:

ELISA assay to detect hepatitis C antibody
Hepatitis C genotype. Six genotypes exist. Most Americans have genotype 1 infection, which is the most difficult to treat.

Hepatitis C RNA assays to determine virus levels (called viral load)

Viral Load Test

Unlike antibody tests, HCV RNA tests directly measure for the presence of the hepatitis C virus. HCV RNA tests may be qualitative or quantitative.

Qualitative HCV RNA tests are used to diagnose hepatitis C. Your doctor might choose to perform an HCV RNA test instead of the ELISA, especially if you are at high-risk for hepatitis C. The HCV RNA test will be positive in as little as 1 to 2 weeks after exposure.

A positive HCV RNA test means a person has hepatitis C infection.Quantitative HCV RNA tests allow your doctor to determine exactly how much virus is in the blood. This is referred to as the viral load.

The viral load is usually expressed as units per milliliter or copies per milliliter. In patients with chronic hepatitis C infection, viral loads vary widely from 50,000 to 5 million copies per milliliter. A higher viral load may not necessarily be a sign of more severe or more advanced disease but it does correlate with likelihood to respond to treatment. HCV RNA tests can also be used to monitor response to hepatitis C treatment. For example, if the viral load decreases during treatment, this suggests that treatment is working and should be continued. Conversely, if the viral load remains the same, it suggests that the patient is not responding to treatment.

The following tests are done to identify and monitor liver damage from hepatitis C:
Liver function tests
Albumin level
Prothrombin time

Can you have a "false positive" anti-HCV test result?

Yes. A false positive test means the test looks as if it is positive, but it is really negative. This happens more often in persons who have a low risk for the disease for which they are being tested. For example, false positive anti-HCV tests happen more often in persons such as blood donors who are at low risk for hepatitis C. Therefore, it is important to confirm a positive anti-HCV test with a supplemental test as most false positive anti-HCV tests are reported as negative on supplemental testing.

Can you have a "false negative" anti-HCV test result?

Yes. Persons with early infection may not as yet have developed antibody levels high enough that the test can measure. In addition, some persons may lack the (immune) response necessary for the test to work well. In these persons, research-based tests such as PCR may be considered.
How long after exposure to HCV does it take to test positive for anti-HCV?
Anti-HCV can be found in 7 out of 10 persons when symptoms begin and in about 9 out of 10 persons within 3 months after symptoms begin. However, it is important to note that many persons who have hepatitis C have no symptoms..

How long after exposure to HCV does it take to test positive with PCR?

It is possible to find HCV within 1 to 2 weeks after being infected with the virus
Will I need a Liver Biopsy ?

According to your genotype some doctors may want you to have a liver biopsy.

A good reason for having a liver biopsy is that it can show just how much damage has been done to the liver
Understanding Your Liver Biopsy Results
When you receive the results of your liver biopsy, you will hear the terms inflammatory grade and fibrotic stage. Health care providers use these terms to indicate the amount of injury to the liver.There are three different methods used for scoring liver biopsies. This can cause confusion for both patients and health care providers. Be aware that the scoring systems are also subject to interpretation by the pathologist who examines your biopsy.
Grading and Staging
There are a variety of ways to interpret a liver biopsy. The most common scoring methods include Metavir and the histologic activity index (HAI) also called the Knodell. There are important things to know about how biopsies are scored in order to understand what your score means.
A score for a given biopsy characteristic in one system does not mean the same thing in the other systems.
The scores for all of the characteristics of the tissue sample are added together for a final score, except as specified in the notes under the table for that systemA final score from one biopsy may have the same score as that of a follow-up biopsy, but the scores for individual characteristics may have changed.
This means your situation could actually be better or worse depending on the individual characteristic scores.Until there is a single biopsy scoring system, there are things you need to know and track regarding your liver biopsy results.
What system did the pathologist use to grade each of your biopsies?
If you have had more than one biopsy, you need to look at changes in both the individual characteristics and the overall score.Make sure your health care provider completely explains the results of your biopsy to you. Ask for an explanation of the individual scores as well as the overall score. You should be given a description of the inflammatory grade and fibrotic stage. Ask to speak with the pathologist who evaluated your biopsy if your health care provider is unable to provide this information.
Biopsies are invasive and therefore, you are not likely to have one done often. For this reason, it is very important that you understand the results of your liver biopsy so you can use this information to help you make decisions about your health care.
The Metavir scoring system was specially designed to evaluate the liver in people with HCV. The scoring consists of using a grading and a staging system. The grade gives an indication of the activity or amount of inflammation and the stage represents the amount of fibrosis or scarring.

The grade is assigned a number based on the degree of inflammation, which is usually scored from 0-4 with 0 being no activity and 3 or 4 considered severe activity.
The amount of inflammation is important because inflammation somewhat correlates with the development of fibrosis.
The fibrosis score is also assigned a number from 0-4:
• 0 = no scarring
• 1 = minimal scarring
• 2 = scarring has occurred and extends outsidethe areas in the liver that contains blood vessels
• 3=bridging fibrosis is spreading andconnecting to other areas that contain fibrosis
• 4=cirrhosis or advanced scarring of the liverKnodellThe Knodell score or histologic activity index (HAI) is also commonly used to stage liver disease.

It is somewhat of a more complex process, but some experts believe that it is a better tool for defining the extent of liver inflammation and damage because it provides more information about various aspects of inflammation and scarring. It is composed of four individually assigned numbers that make up a single score.
The first component (periportal and/or bridging necrosis) is scored 0-10. The next two components (intralobular degeneration and portal inflammation) are scored 0-4.
The combination of these three markers indicates the amount of inflammation in the liver:• 0 = no inflammation
• 1-4 = minimal inflammation
• 5-8 = mild inflammation
• 9-12 = moderate inflammation
• 13-18 = marked inflammation
The fourth component indicates the amount of scarring in the liver and is scored from 0 (no scarring) to 4 (extensive scarring or cirrhosis).
Information about the grade and stage of liver disease is helpful for the healthcare provider and the patient in guiding medical management


When you are first exposed to the hepatitis C virus and become infected, you are said to have "acute hepatitis C". Most people have no symptoms of infection during this time.
In 70 to 80 percent of people, the infection becomes chronic. The word "chronic" implies that the infection will be prolonged, or even lifelong, unless you get treatment that cures the infection.
Many people with chronic hepatitis C have no symptoms, even if there is serious liver damage. Of those who do develop symptoms, the most common symptom is fatigue; other less common symptoms include nausea, lack of appetite, muscle or joint aches, weakness, and weight loss.

Also See :Symptoms

Treatment for Hepatitis C

Treating HCV

New Drug Update/Sept 2010

HCV Advocate Video Update Top Line Phase III Data:

Telaprevir -- REALIZE



Below : Link To HCV Advocates Video/Phase III Results :Boceprevir

Top Line Phase III Results: Boceprevir


Video/Treating With Standard Of Care

Talking To Your Doctor

.The first thought on treating HCV is you may wish to discuss the new HCV therapies ready tobe FDA approved with your physician. With that said the links below will give you the information you need to know before you start treatment, or even if you should treat this disease.The new drugs are Telaprevir or Boceprevir , Telaprevir should be FDA approved by the end of the year.

This drug is giving genotype 1 a 70 percent or higher success rate.Your chances of an effective response to FDA current treatment SOC= (Pegylated+Ribavirin) can be up to 40% in the more difficult-to-treat type of the virus, genotype 1, and nearly 70% in the easier-to-treat type of the virus.

Read Study Results: Boceprevir & Telaprevir
Merck/Schering and Vertex released exciting news about their top-line results from phase III studies in August 2010.
Merck’s top-line data included the use of their HCV protease inhibitor, boceprevir, in combination with pegylated interferon and ribavirin in HCV Genotype 1 patients who have never been treated (treatment-naïve) and people who have ‘failed’ a previous course of pegylated interferon plus ribavirin therapy.
Vertex’s data included a study with their HCV protease inhibitor, telaprevir, used in combination with pegylated interferon and ribavirin for treatment of HCV Genotype 1 treatment-naïve patients. This is the data that we have all been waiting to hear about – with one exception—we are still waiting to hear the results of the phase III study of telaprevir triple therapy (pegylated interferon plus ribavirin) for people who have not achieved an SVR with a previous course of pegylated interferon and ribavirin combination therapy. Unfortunately, the three studies only include top-line results so we will have to wait until AASLD to hear more in-depth information.
These results, however, give hope that the new triple combinations of HCV protease inhibitors, pegylated interferon and ribavirin will increase the efficacy for people who have never been treated and for those who have been treated, but didn’t achieve an SVR.
Continue Reading...........

Clinical Trials and Medical Research.

A clinical trial is a rigorously controlled test of a new drug or a new invasive medical device on human subjects. In the United States, it is conducted under the direction of the FDA before being made available for general clinical use.

If you're looking for up-to-date information about federally and privately supported Hepatitis C clinical research studies, helps link patients living with Hepatitis C to medical research.


The FAQ List WILL answer evey question
you may have about Hepatiitis C.
FAQ English (PDF) 881 KB

Questions for a specialist.

It's important to keep an open dialogue with your doctor, especially when it comes to understanding your treatment options, and how your body is responding to the therapy.


The following list of questions may be helpful to print and take to your appointment:
What is my genotype and how does it impact my therapy?
What is my viral load and how does it impact my therapy?
What are my expected outcomes with treatment?
What are my expected outcomes without treatment?
Do I have any other conditions that will complicate treatment?
What changes should I make in my everyday life?
What is the most important information I need to know before starting treatment?
What should I do next?

A specialist can help determine whether treatment is right for you. Ask your doctor to recommend one today; your chances for recovery may be better than you think.

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