Saturday, February 26, 2011

Preparing For Hepatitis C Treatment; Shaping Up, Before You Treat

Preparing For Hepatitis C Treatment
Shaping Up, Before You Treat

Today the IL28B test was Launced by AccuType® to physicians and for clinical trials research . In March, we all read the press release from Scripps which will be offering genetic testing to their hepatitis C patients. The nonprofit health system currently orders IL28B genotyping for HCV patients who are potential candidates for therapy.

Noted in the press release;

"If the patients have a favorable IL28B genotype and advanced fibrosis on liver biopsy, doctors can initiate therapy with the current standard of care. If patients have a less favorable genotype or they have mild fibrosis, doctors can recommend waiting for FDA approval of direct acting antiviral drugs to improve their chances of response. Currently, LabCorps Diagnostics is performing the IL28B testing for Scripps patients, a procedure covered by most insurance plans. The results are transmitted to the treating physician in about one week and the treatment choice is tailored based on the patient's likelihood to have a favorable response."

The test answers the most integral question left unanswered in regard to HCV treatment. Who will respond? Who will not? This advancement is extremely important, with published evidence showing the chances of achieving SVR are 2 to 3 times greater with the right genes. The test isn't perfect and is around 85% predictive, however, it sure is helpful to know what side of that 85% you might be on.
Early testing before and during therapy will predict the factors needed to guide you through a more successful and safer treatment regime. Another noted advancement mentioned by Scripps is a second test that will accurately predict anemia in hepatitis C patients during standard therapy. For just a moment, stop, compare the advancement in scientific research to five years ago, you may find that treating this disease has become much more attractive. Even if we become horribly unattractive while treating it. The side effects will be difficult and challenging but this time the outcome is encouraging.
However, there is another piece of the puzzle that is very seldom discussed, the medical and physical liability of the individual starting therapy. Ask yourself this; Am I in good medical shape to begin treatment, could I improve anything about my physical self to prepare?
Question; What did you have for breakfast ?
Answer; Facebook, Twitter a cigarette and a cup of coffee.
Me too, kidding, I never go on twitter before noon.
Seriously, its time to get in shape before starting treatment. Give yourself the best chance possible at achieving a cure.
Engaging in a healthy lifestyle can help avoid obesity, insulin resistance, and diabetes, which is linked to rapid disease progression, higher rates of HCC, and reduced antiviral responsiveness.
Starting With Alcohol
Abstaining from drinking alcohol, which is associated with a 30 times increased risk of cirrhosis and interference with antiviral effectiveness and adherence has always been recommended.
Studies have shown that people with HCV who abuse alcohol are more likely to die than those who have hepatitis C and do not drink. People with both alcoholic liver disease and hepatitis C have a higher chance of developing HCC than those with hepatitis C infection alone.
Alcohol contributes to the chronicity of Hepatitis C and the poor efficacy of interferon-based therapy
As published in a June 2010 edition of the journal Drug and Alcohol Dependence, researchers from Philadelphia found that undergoing interferon-based treatment to eliminate Hepatitis C is definitely not a reason to be lax with alcohol abstinence. Currently, the standard treatment for Hepatitis C is combination therapy with pegylated interferon and ribavirin.

Their study investigated whether alcohol impaired the immune function of human liver cells, which would promote Hepatitis C infection and replication.
The researchers found the following:
· Alcohol suppressed natural interferon action in the liver. (Our immune system contains natural interferons to protect us against disease.)

· Alcohol encouraged suppressors of cytokine signaling, which are negative regulators of interferon expression, thus impeding interferon action.

Based on their findings, the authors concluded that drinking alcohol contributes to the chronicity of Hepatitis C and the poor efficacy of interferon-based therapy.

Some people assume that as long as they are not an alcoholic, an occasional drink with Hepatitis C is OK. The evidence clearly indicates this assumption to be incorrect. Any bit of alcohol can worsen Hepatitis C infection and, for those who hope to clear the virus with interferon-based therapy, they shouldn't even bother with the treatment if they plan on drinking any alcohol...Continue reading....

The natural history of HCV infection is influenced by genetic and environmental factors of which chronic alcohol use is an independent risk factor for cirrhosis in HCV-infected individuals. Both the hepatitis C virus and alcohol damage the liver and result in immune alterations contributing to both decreased viral clearance and liver injury.
In 2009 at the Keck School of Medicine researchers found a complex molecular events that link alcoholism and HCV to increased risk of hepatocellular carcinoma (HCC)
Researchers conducted a series of experiments with mice and also examined liver biopsy samples from human patients infected with HCV, and found high levels of the protein NS5A and TLR4. In the subset of patients who were also alcoholics, the researchers saw signs of increased antibacterial response. The research also identified a specific molecule called Nanog, which acts as a stem cell marker in tumor development when activated by TLR4.

“There were several major findings that resulted from this study,” Machida said. “We established a mouse model which will enable us to better understand alcohol and hepatitis C virus infection and we found the signaling that causes tumor development in mice through the receptor TLR4.” ...Continue reading......
Smoking and Fibrosis
In this older study authors looked at liver biopsies from 310 patients with chronic HCV who were under going their first liver biopsy. They then went on to compare those biopsies with the patients who were current cigarette smokers (176 patients) or former cigarette smokers (56 patients). Last but not least, biopsies from patients who had never smoked (77 patients).

They found that current and former smokers had more inflammation and scarring of their livers than did nonsmokers. This finding could not be explained by other factors, such as concurrent alcohol use, that are known to aggravate the inflammation and scarring in hepatitis C. The authors concluded that smoking cigarettes could worsen their liver disease.

From HIV and Hepatitis
In 2008 a study suggested that cigarette smoking may enhance activity grade in patients with chronic hepatitis C, thereby increasing progression of fibrosis. This assumption mostly relies on epidemiological evidences in the absence of pathogenic studies.
Are we there yet ? Are you inspired to stop smoking ?

Smoking and Liver Cancer
NEW YORK (Reuters Health) - There appears to be a synergistic link between smoking and hepatitis C virus (HCV) infection, leading to a more than 136-fold increased risk of hepatocellular carcinoma (HCC) in men, according to a team at The University of Texas MD Anderson Cancer Center.

.Well, we have established that cigarette smoking increases fibrosis, how about the increased risk in men for developing liver cancer. Here we go, published in 2008 in the International Journal of Cancer, researchers investigated HCC and the risk factors such as smoking in men and women who have HCV.

The Results:
· Men with HCV who smoke have a more than 136-fold increased risk of HCC.
· Women with HCV who consume large amounts of alcohol have a more than 13-fold increased risk of HCC.

The facts; smoking increases the risk of liver cancer by over 100 times. Does this inspire you to stop smoking?

While on HCV therapy I was forced to stop smoking. Not because I wanted to, but because I developed a cough that I can only compare to an old, ugly, void of any sex appeal house woman.

This is the kicker, I found out nine years later I had developed COPD. My point: Even if you have never smoked you may still experience a chronic cough during therapy, If you do smoke, be prepared to wake up in the middle of the night gasping for air.

I wanted to take this opportune moment to suggest that if you're a chronic smoker you may want to ask for a spirometry; (COPD) test before you begin treatment. If you are over forty and have smoked for more then 15 years, you may want to find out if you have COPD. Sadly, a horrendous thing to be diagnosed with, but a good thing to know before starting therapy.

Metabolic steatosis, HCV-induced steatosis and smoking, Oh My

This brings us to smoking and fatty liver disease. HCV has been proven to be caused directly from the virus. Genotype 3 patients are known to have a higher rate of fatty liver then other genotypes. .
There are two different forms of steatosis (Fatty Liver) that may be found in people with HCV:
Metabolic steatosis can result from obesity, raised blood fat levels (hyperlipidemia), insulin resistance and type II diabetes and is similar to the type of fatty infiltration caused by excessive alcohol consumption and that is also found in Non-Alcoholic Fatty Liver (NASH).

Metabolic steatosis is not triggered by the hepatitis C virus; however the combination of this form of steatosis and the presence of HCV can lead to a more rapid progression of scarring or fibrosis.
HCV-induced steatosis is fatty infiltration that is directly caused by the presence of the virus. It is possible for people with HCV to have both forms of steatosis simultaneously.
The Study

July 2010; accepted 16 July 2010. published online 18 November 2010

Conclusions/Bottom Line
Smoking history was associated with advanced liver fibrosis in this large multicenter cohort of NAFLD patients. The results indicate that smoking may enhance the progression of NAFLD partly through its effect on insulin resistance. Our results are consistent with recent animal studies suggesting that cigarette smoke may aggravate fatty liver. To our knowledge, this is the first study to show that cigarette smoking is associated with increased fibrosis severity in human NALFD, suggesting it may accelerate disease progression. These results may support a formal recommendation of smoking cessation in patients with NAFLD.
Fatty Liver and You, What Can You Do ?.

From Mayo;

Lose weight; If you're overweight or obese, reduce the number of calories you eat each day and increase your physical activity in order to lose weight.
Aim to lose 1 or 2 pounds a week. If you've tried to lose weight in the past and have been unsuccessful, ask your doctor for help.

Choose a healthy diet; Eat a healthy diet that's rich in fruits and vegetables. Reduce the amount of saturated fat in your diet and instead select healthy unsaturated fats, such as those found in fish, olive oil and nuts. Include whole grains in your diet, such as whole-wheat breads and brown rice.

Exercise and be more active; Aim for at least 30 minutes of exercise most days of the week. Incorporate more activity in your day. For instance, take the stairs instead of the elevator. Walk instead of taking short trips in your car. If you're trying to lose weight, you might find that more exercise is helpful. But if you don't already exercise regularly, get your doctor's OK first and start slowly.

Control your diabetes; Follow your doctor's instructions to stay in control of your diabetes. Take your medications as directed and closely monitor your blood sugar.
Lower your cholesterol; A healthy plant-based diet, exercise and medications can help keep your cholesterol and your triglycerides at healthy levels.
Protect your liver; Avoid things that will put extra stress on your liver. For instance, don't drink alcohol. Follow the instructions on all medications and over-the-counter drugs.
.Insulin Resistance And HCV

Insulin resistance is associated with a poorer treatment response in standard HCV therapy. Experts advise managing this complication by prescribing medications to address insulin resistance. One medication is the oral drug Metformin, a study in 2008 looked at adding Metformin to standard therapy.

The results from the study showed people who received metformin in combination with pegylated interferon/ribavirin had a better outcome than those without metformin, with women having a more dramatic reduction in their viral load than men.

Although using metformin along with pegylated interferon/ribavirin may not be the solultion for everyone, research has confirmed maintaining your blood sugar will hinder the progression of liver disease and increase the likelihood of achieving SVR.

ScienceDaily (Mar. 10, 2010)
In studying the insulin resistance of 29 people with Hepatitis C, Australian researchers have confirmed that they have high insulin resistance, a precursor to diabetes. However, almost all insulin resistance occurs in muscle, with little or none in the liver, a very surprising finding given that Hepatitis C is a liver disease.

Insulin, a hormone made by the pancreas, helps the body use glucose for energy. The two most important organs that respond to insulin are the liver and muscle. A healthy liver responds to insulin by not producing glucose, while healthy muscle responds by using glucose. An insulin resistant liver produces unwanted glucose, while insulin resistant muscle cannot absorb it from the bloodstream, leading to high levels of sugar in the blood.
Fatty Liver
"Contrary to all expectations, not only did we find no significant insulin resistance in the liver of the patients in the study, half of them suffered from a strain of Hepatitis C that causes about three times the normal level of fat to accumulate in the liver," said Professor Chisholm.
"The fifteen people with very high levels of fat in the liver had the same degree of insulin resistance as the fourteen that didn't have fatty livers."
The extra insulin resistance caused by Hepatitis C apparently brings on diabetes at 35 or 40, instead of 65 or 70."
"In our study, we gave intravenous glucose, a specific stimulus to insulin secretion, and showed that insulin secretion was not impaired in Hepatitis C patients compared to our control group."
"This finding tells us that people with Hepatitis C who develop diabetes probably have susceptible insulin-producing cells, and would probably get it anyway -- but much later in life. The extra insulin resistance caused by Hepatitis C apparently brings on diabetes at 35 or 40, instead of 65 or 70."
"At this stage, it is helpful for people with Hepatitis C to understand insulin resistance and what it can mean for them. If they have relatives with Type 2 diabetes, they will be genetically prone to developing it themselves and so would be advised to manage their diets very carefully and take plenty of exercise -- to slow onset.".... Continue reading........
Fatty Liver , What Now ?
As the study suggested if you have type II diabetes in the family then you are advised to manage your diet. Hate it, but what choice do ya have ?

Researchers have preached that changes in diet and exercise reduced the development of type II diabetes by 58%. So there you have it, the free ticket needed to help prepare yourself for treatment, and a healthy lifestyle.

Lose weight.; Losing as little as 5 to 10 percent of your body weight can reduce insulin levels and blood pressure, and decrease your risk of diabetes.
Exercise; Doctors recommend getting 30 to 60 minutes of moderate-intensity exercise, such as brisk walking, every day.
Stop smoking; Smoking cigarettes increases insulin resistance and worsens the health consequences of metabolic syndrome.
Eat fiber-rich foods. Make sure you include whole grains, beans, fruits and vegetables in your grocery cart. These items are packed with dietary fiber, which can lower your insulin levels.
Stop the sugar, fats, and anything wrapped up to go.
Click here to Check It Out Folks.

If you're getting ready to treat with telaprevir or boceprevir then take the time to prepare your mind, body and soul for treatment. Start today, walk instead of smoking, eat lean instead of mean, read instead of watching TV, and work the body, instead of the computer. . .

The goal is to help increase your cure rate, the benefits are enormous. Enter you, free of HCV with a post-treatment healthy lifestyle. ,

Wishing you all a successful, healthy and safe HCV journey.
... .

No comments:

Post a Comment