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
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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.
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.
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.
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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.
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
progression.
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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
genotype.
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.
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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.
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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,
etc.
• Prothrombotic state – increased
platelets
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
is.
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.
http://www.hcvadvocate.org/
-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.
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.
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.
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.
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)
Liver function tests
Albumin level
Prothrombin time
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The fourth component indicates the amount of scarring in the liver and is scored from 0 (no scarring) to 4 (extensive scarring or cirrhosis).
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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
Treating HCV
New Drug Update/Sept 2010
HCV Advocate Video Update Top Line Phase III Data:
Telaprevir -- REALIZE
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DONT MISS
Below : Link To HCV Advocates Video/Phase III Results :Boceprevir
Top Line Phase III Results: Boceprevir
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Video/Treating With Standard Of Care
Talking To Your Doctor
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.
Continue Reading...........
Clinical Trials and Medical Research.
The FAQ List WILL answer evey question
you may have about Hepatiitis C.
FAQ English (PDF) 881 KB
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.
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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