Showing posts with label liver function tests. Show all posts
Showing posts with label liver function tests. Show all posts

Tuesday, November 6, 2018

Laboratory Tests - Need help making sense of your test results?


During a regular checkup, or yearly physical, your doctor may request laboratory tests to monitor your health, or perhaps to get a diagnosis.

Laboratory Tests
If you need help making sense of your test results, check out the National Institutes of Health's Web site, where you can find out; why your doctor ordered the test, what it's used for, and what the results may mean.  
Updated this month: Laboratory Tests.

Liver Chemistries Is The New Liver Function Tests
If you're a liver patient, like myself, you might be all about the liver function test, now called "liver chemistries." In 2016 the American College of Gastroenterology (ACG) issued new guidelines on the evaluation of abnormal "liver chemistries," and suggested that "liver function tests" be referred to as "liver chemistries" or "liver tests." The reasoning behind the name change is simple "Liver Function Tests" are not true measures of hepatic function.

Liver Function Testing - Oldie But Goodie

An interesting article published in 2010 by Dr. Pullman:
The first thing to know is that what is commonly called liver function testing (LFTs) has little if anything to do with the function of the liver. They are really tests that are clues to liver injury or disorders, but not really liver function. The first two tests are the ALT (Alanine aminotransferase) and AST (Aspartate aminotransferase) were formally called SGPT and SGOT respectively. These are enzymes that normally function inside liver cells primarily, and are present in the blood stream in small quantities. When there is something causing injury to liver cells, these enzymes leak into the bloodstream in large quantities, and elevated serum levels of these enzymes what physicians call hepatocellular injury.
Continue reading article: http://drpullen.com/liverfunctiontests

FYI
Both Fatty liver Disease and Hepatitis C are two liver disorders often first detected through a routine blood test, both may not have any symptoms, talk to your doctor to see if you might be at risk.

Stay happy, stay healthy.
Tina

Friday, February 3, 2017

Update - New Liver Test Guidelines

Anyone living with chronic liver disease is all too familiar with a simple blood test called a "liver function test." When my own test results are good - it's a huge relief.

An Update
If you haven't heard, the American College of Gastroenterology (ACG) has issued new guidelines on the evaluation of abnormal "liver chemistries."

A Big Change
According to Medscape; The new guidelines state that the normal ALT range is 19 to 25 IU/L for women and 29 to 33 IU/L for men. The article is patient friendly, an easy read, start here.

Don't Call It A Liver Function Test
As for "liver function tests" the ACG now suggests that "liver function tests" be referred to as "liver chemistries" or "liver tests.

The reasoning behind the name change is simple "Liver Function Tests" are not true measures of hepatic function. If you skipped the Medscape article, listen to this short podcast hosted by Arefa Cassoobhoy, MD, MPH to learn more about the liver test guidelines.

Here is a quick summary from Consultant 360;
ACG: Guidelines for Evaluating Abnormal Liver Chemistries
Among the recommendations:
  • Men who consume more than 210 grams of alcohol per week and women who consume more than 140 grams of alcohol per week and have higher levels of serum aspartate aminotransferase (AST) than ALT  should be considered at risk for alcoholic liver disease and receive counseling for alcohol cessation.
  • Screening for alpha-1 anti trypsin deficient with alpha-1 anti-trypsin phenotype is highly recommended for patients with persistently elevated AST or ALT.
  • Patients with abnormal liver chemistries should be asked about prescribed and over-the-counter medications, non-prescribed complementary or alternative medicines, and dietary or herbal supplements that may be associated with drug induced liver injury.
  • Liver biopsy is recommendation if serologic testing and imaging fails to explain a diagnosis, to stage a condition, or if multiple diagnosis are possible.

For more information read the complete - ACG Clinical Guideline: Evaluation of Abnormal Liver Chemistries (CME) available @ nature.com.

Enjoy the weekend!
Tina

Tuesday, October 8, 2013

Hepatitis C Virus can affect your liver and your health

HEPATITIS C (HCV) by Dr. Robert Gish

In this mini lecture, Dr. Gish examines the Hepatitis C and how the Hepatitis C Virus can affect your liver and your health. 

Dr. Gish explains the importance of talking to your healthcare provider about starting treatment now or waiting, he urges patients to keep up with new therapies and data.  



Uploaded Oct 6 by Bob Gish

Sunday, April 21, 2013

Disease progression in chronic hepatitis C patients with normal alanine aminotransferase levels

World J Gastroenterol. 2013 Apr 14;19(14):2256-2261.

Disease progression in chronic hepatitis C patients with normal alanine aminotransferase levels

Sinn DH, Gwak GY, Shin JU, Choi MS, Lee JH, Koh KC, Paik SW, Yoo BC.


Source- World J Gastroenterol
April 14, 2013|Volume 19|Issue 14|

Download Full Text Here

Dong Hyun Sinn, Department of Internal Medicine, Sanggye Paik Hospital, Inje University School of Medicine, Seoul 139-707, South Korea.

Core tip: Recent studies have indicated that the upper limit of normal for the serum alanine aminotransferase (ALT) level should be lowered. However, outcome studies based on the development of adverse events during long-term follow-up are limited. In this present study, among patients infected with chronic hepatitis C virus who had normal ALT levels, the risk of disease progression differed between patients with “high-normal” and “low-normal” ALT levels, even within the currently accepted normal levels. This finding suggests that lowering the normal threshold of ALT levels may be necessary to better identify patients who are at increased risk for disease progression.

Abstract

AIM:
To investigate whether the disease progression of chronic hepatitis C patients with normal alanine aminotransferase (ALT) levels differs by ALT levels.

METHODS:
A total of 232 chronic hepatitis C patients with normal ALT (< 40 IU/L) were analyzed. The patients were divided into "high-normal" and "low-normal"ALT groups after determining the best predictive cutoff level associated with disease progression for each gender. The incidence of disease progression, as defined by the occurrence of an increase of ≥ 2 points in the Child-Pugh score, spontaneous bacterial peritonitis, bleeding gastric or esophageal varices, hepatic encephalopathy, the development of hepatocellular carcinoma, or death related to liver disease, were compared between the two groups.

RESULTS:
Baseline serum ALT levels were associated with disease progression for both genders. The best predictive cutoff baseline serum ALT level for disease progression was 26 IU/L in males and 23 IU/L in females. The mean annual disease progression rate was 1.2% and 3.9% for male patients with baseline ALT levels ≤ 25 IU/L (low-normal) and > 26 IU/L (high-normal), respectively (P = 0.043), and it was 1.4% and 4.8% for female patients with baseline ALT levels ≤ 22 IU/L (low-normal) and > 23 IU/L (high-normal), respectively (P = 0.023). ALT levels fluctuated during the follow-up period. During the follow-up, more patients with "high-normal" ALT levels at baseline experienced ALT elevation (> 41 IU/L) than did patients with "low-normal" ALT levels at baseline (47.7% vs 27.9%, P = 0.002). The 5 year cumulative incidence of disease progression was significantly lower in patients with persistently "low-normal" ALT levels than "high-normal" ALT levels or those who exhibited an ALT elevation > 41 U/L during the follow-up period (0%, 8.3% and 34.3%, P < 0.001).

CONCLUSION:
A "high normal" ALT level in chronic hepatitis C patients was associated with disease progression, suggesting that the currently accepted normal threshold of serum ALT should be lowered.

KEYWORDS:
Alanine aminotransferase, Disease progression, Hepatitis C virus, Hepatocellular carcinoma, Upper limits of normal

Follow link to full text article

Saturday, November 3, 2012

Acetaminophen: Effect on Drinkers' ALT Levels Appears Safe

Acetaminophen: Effect on Drinkers' ALT Levels Appears Safe

By: SHERRY BOSCHERT, IMNG Medical News

SAN DIEGO – Giving acetaminophen to patients who reported consuming ethanol did not adversely affect markers of liver damage in a meta-analysis of randomized, controlled trials.

"One of the questions we often get asked is the role of acetaminophen in patients with liver disease," according to Dr. Kennon J. Heard, who is an emergency medicine physician at the University of Colorado and director of the Medical Toxicology Fellowship at the Rocky Mountain Poison and Drug Center, Denver.

The findings of the meta-analysis suggest that "acetaminophen is safe in alcoholics," Dr. Heard said at the annual meeting of the Society of Hospital Medicine.

 The meta-analysis included five trials involving 901 subjects (including patients who reported drinking ethanol) who were randomized to receive acetaminophen or placebo.

Dr. Heard and his associates looked at daily ALT measurements out to a mean of 4 days, a time period for which most of the studies had data.

They also looked for any evidence of liver injury or dysfunction, hepatotoxicity, or death.
The alanine aminotransferase (ALT) levels changed by a mean of 0.04 IU/L after starting acetaminophen or placebo, "less than a tenth of a point in ALT," reported Dr. Heard.

"Essentially, in this group of patients who consume alcohol, if you give them acetaminophen for 4 days, you don’t see any change in their ALT," according to Dr. Heard.
The study is to be published in the journal Pharmacotherapy.
 
When acetaminophen consumption continued beyond 4 days, ALT levels increased in most patients who consumed alcohol but also increased in 60% of nondrinkers.
"The changes in the alcoholics look exactly like the changes in the nonalcoholics," he said.
The median increase in ALT was between 10-20 IU/L.
 
Among patients who drink alcohol, the highest ALT level in the acetaminophen group was 312 IU/L, "which is pretty impressive until you see that in the placebo group, somebody went up 288" IU/L, he said.
 
The biggest increase in ALT was in a healthy nondrinking patient on acetaminophen, whose ALT increased by 638 IU/L.
 
Most importantly, none of the 551 people who received acetaminophen in those trials developed an increase in International Normalized Ratio, bilirubin level, or symptomatic liver injury, Dr. Heard and his associates found.
 
Dr. Heard said that he and his associates are now in the process of finishing a separate study that appears to confirm that these are asymptomatic, self-limiting elevations in ALT that will go away even if people stay on acetaminophen.
 
Such information is valuable, he said. "It is worth knowing that if you have someone who has an ALT elevation while taking acetaminophen, it may be the cause, and it is reasonable to stop the acetaminophen and see if their ALT elevations go away rather than do an extensive work-up for hepatitis," Dr. Heard said.  


11/02/12 
 
More Clinical News »
 

Saturday, August 20, 2011

Hepatitis C ; liver function tests


Related; Lab Reports

Looking at Liver Function Bloodwork
By Nina L. Paul, PhD

When you go for a physical, your healthcare practitioner frequently orders blood tests. Many folks first find out they have hep C after undergoing a routine blood test and finding that one or more of the tests is abnormal.

Tests for the effects of hepatitis C on your liver include:

Liver enzyme tests: These tests measure current liver cell injury by the amount of enzymes that are "leaked" out of damaged or dying liver cells.


Liver function tests: These tests look at levels of proteins made by the liver. If your liver damage is such that your liver function is impaired, levels of these proteins will be low. If your bilirubin, clotting factors, or albumin levels are low, you may have cirrhosis or late-stage liver disease.

ALT
Small amounts of ALT (alanine aminotransferase) are normally found in blood. When the liver is damaged, ALT is released into the bloodstream. ALT is found in organs other than the liver (kidneys, heart, muscles, and pancreas), but most increases in ALT are from liver damage.

AST
AST (aspartate aminotransferase) is also called SGOT (serum glutamic-oxaloacetic transaminase). Like ALT, AST is found mainly in the liver but also in other parts of the body. AST and ALT are usually measured together and are good indicators of liver disease or damage. Sometimes, test results give AST/ALT ratios.

ALP
ALP (alkaline phosphatase) is found in all parts of the body, with particularly high concentrations in the liver, bone, and placenta (during pregnancy). Like ALT and AST, ALP might leak into the bloodstream when liver cells are damaged as a result of hepatitis C. Children (who have growing bones), pregnant women (especially in their last trimester), and people with bone disease also have higher levels of ALP.

GGT
GGT refers to gamma-glutamyl transferase, but it's also called gamma-glutamyl transpeptidase (GGTP) or Gamma-GT. High levels of GGT are found in the liver, bile ducts, and the kidney. Bloodstream GGT levels will be higher in people with diseases of the liver and bile ducts.

5'N'Tase
Higher levels of the enzyme 5'N'Tase (5'nucleotidase), also known as 5'NT, in your blood indicate a problem with bile secretion. Hepatitis or cirrhosis can cause a blockage of bile flow.

Albumin
Albumin is the major blood protein made by the liver. One function of albumin is to keep the blood from leaking through the blood vessels, which can cause fluid retention in the ankles (edema), lungs, or abdomen (ascites).Low levels of albumin may be due to liver or kidney disease, malnutrition, or even a low-protein diet.

Bilirubin
This pigmented (yellow) waste chemical comes from the normal process of red blood cells' dying after 90 to 120 days. A healthy liver converts bilirubin and sends it out of the body with the bile that goes to the intestine. Excreted bilirubin gives feces (stools) their characteristic brownish color.

When the liver is diseased, bilirubin isn't converted and excreted. Stools might, therefore, be light-colored. The bilirubin that's not properly excreted builds up in the body and gives a yellowish color to skin and eyes (a condition known as jaundice) and dark brown tea color to urine.

High levels of bilirubin are due to either too much production of bilirubin (from red blood cells dying) or because the liver isn't processing bilirubin, which happens when the liver is damaged. This is one of three tests used to determine wait time for a liver transplant.

In addition to using a blood test, urine can be tested for bilirubin.

PT test
The PT (prothrombin time) test measures how quickly your blood clots, which is dependent on clotting factors (proteins) that are made by the liver. The PT test is used as a marker of advanced liver disease and can indicate blood-clotting problems where it takes you longer to stop bleeding.

Your laboratory may also give PT results that have been converted to an internationally recognized and easily comparable value that's called the International Normalized Ratio (INR). The INR is one of the three factors used to determine wait time for a liver transplant.

Other blood tests
Additional tests that measure other markers in your blood give your doctor a clearer picture of any liver disease and also any effects from the combination peginterferon drug treatment.

Complete blood count (CBC)
A complete blood count (CBC) looks at the number and types of cells in your blood. Your doctor will look for problems such as

Reduced white blood cells or platelets: This may indicate portal hypertension, a complication of cirrhosis in which pressures are increased in the portal vein.
Indicators of anemia: This problem is very common during ribivarin treatment.

The complete blood count includes the following tests:

White blood cell (WBC) count: The total number of white blood cells. Changes can indicate problems of hepatitis C infection or side effects of interferon treatment. Interferon can cause neutropenia, which is a decrease in neutrophils, one type of white blood cell.

Red blood cell (RBC) count: The total number of red blood cells. Low levels can indicate anemia.

Hematocrit (HCT): Percentage of blood cells that are red blood cells. Low levels can indicate anemia.

Hemoglobin: The amount of this oxygen-carrying protein. Low levels can indicate anemia.

Platelet count: Number of platelets in your blood (may be altered in cirrhosis).

AFP
Tests for AFP (alpha-fetoprotein) are used to screen for liver cancer in people with cirrhosis. But not everyone with liver cancer has this marker. Pregnant women usually have higher levels of this protein, which is also used to look for problems in pregnancy. You may have slightly high levels of this protein if you have hepatitis or cirrhosis.

Iron
The liver stores iron, and an overabundance of iron (iron overload) can add to the damage caused by hepatitis C. Too much iron can be a problem during interferon treatment. See your physician to determine whether you should avoid supplements that include iron.

Creatinine
Creatinine is actually a breakdown product of creatine, which is made by the liver and transported to your muscles. The kidneys excrete the waste product creatinine, and when your kidneys are damaged, creatinine levels rise. When the liver stops functioning in end-stage liver disease, this can cause serious kidney problems as well. This test is one of the three used to determine your wait time for a liver transplant.

http://www.dummies.com/how-to/content/looking-at-liver-function-bloodwork.html

Sunday, April 17, 2011

Should Patients with Abnormal Liver Function Tests in Primary Care be Tested for Chronic Viral Hepatitis

Should Patients with Abnormal Liver Function Tests in Primary Care be Tested for Chronic Viral Hepatitis

David T Arnold; Louise M Bentham; Ruth P Jacob; Richard J Lilford; Alan J Girling
Of the 1,236 study patients with an abnormal LFT, 13 had chronic viral hepatitis (nine hepatitis B and four hepatitis C).

Abstract

Background: Liver function tests (LFTs) are ordered in large numbers in primary care, and the Birmingham and Lambeth Liver Evaluation Testing Strategies (BALLETS) study was set up to assess their usefulness in patients with no pre-existing or self-evident liver disease. All patients were tested for chronic viral hepatitis thereby providing an opportunity to compare various strategies for detection of this serious treatable disease.
Methods: This study uses data from the BALLETS cohort to compare various testing strategies for viral hepatitis in patients who had received an abnormal LFT result. The aim was to inform a strategy for identification of patients with chronic viral hepatitis. We used a cost-minimisation analysis to define a base case and then calculated the incremental cost per case detected to inform a strategy that could guide testing for chronic viral hepatitis.
Results: Of the 1,236 study patients with an abnormal LFT, 13 had chronic viral hepatitis (nine hepatitis B and four hepatitis C). The strategy advocated by the current guidelines (repeating the LFT with a view to testing for specific disease if it remained abnormal) was less efficient (more expensive per case detected) than a simple policy of testing all patients for viral hepatitis without repeating LFTs. A more selective strategy of viral testing all patients for viral hepatitis if they were born in countries where viral hepatitis was prevalent provided high efficiency with little loss of sensitivity. A notably high alanine aminotransferase (ALT) level (greater than twice the upper limit of normal) on the initial ALT test had high predictive value, but was insensitive, missing half the cases of viral infection.
Conclusions: Based on this analysis and on widely accepted clinical principles, a "fast and frugal" heuristic was produced to guide general practitioners with respect to diagnosing cases of viral hepatitis in asymptomatic patients with abnormal LFTs. It recommends testing all patients where a clear clinical indication of infection is present (e.g. evidence of intravenous drug use), followed by testing all patients who originated from countries where viral hepatitis is prevalent, and finally testing those who have a notably raised ALT level (more than twice the upper limit of normal). Patients not picked up by this efficient algorithm had a risk of chronic viral hepatitis that is lower than the general population.

Summary of Main Findings
The BALLETS study is the first GP based study where the entire cohort was comprehensively tested for additional diseases (such as viral hepatitis) after an abnormal LFT, using the full analyte panel and normal reference ranges. We have shown that an abnormal LFT alone does not select out a population where the prevalence rate approaches a threshold which would justify viral screening. We have assessed the validity of the various strategies a GP could adopt, at least as far as viral hepatitis is concerned, when faced with an abnormal LFT of uncertain provenance. The intuitive response for a GP in such a situation would be to repeat the LFT, an approach advocated by current literature. This study shows that this may not be the optimal policy. This strategy is the most expensive, even more so than viral testing all patients, as the costs incurred include repeating the LFT as well as viral testing the majority. The study also shows that if ALT is notably raised (greater than twice the upper limit of normal), then the probability of chronic viral hepatitis is high (nearly 8%), but sensitivity is low. The strategy of testing all people from prevalent countries is the second most efficient, in terms of cost per case detected, and detects almost twice as many cases as the most efficient strategy - testing for viral infection when two conditions (birth in a prevalent country and an ALT greater than twice the upper limit of normal) are satisfied. The relative financial disadvantages of the strategy of repeating the LFT would be even greater if patient costs were included, as the extra visit would have to be factored in.

Previous Literature on LFTs and Liver Diseases
We conducted a literature review using the search strategy shown in Table 8, with the aim of retrieving papers that studied a cohort of patients with abnormal LFT results to provide evidence on the probability of various liver diseases (including chronic viral hepatitis) given abnormal test results. Any such studies would enable the precision of our observations to be strengthened. The search strategy returned 1,448 papers, including a previous review by Dufour et al. (2000).[29]
Only eight studies matched our requirement of following up patients with an abnormal LFT result. Two additional articles were selected from the references of relevant studies. As a result, to the best of our knowledge, there are only ten studies where a cohort of asymptomatic patients with abnormal LFTs were followed up (Table 9). However, one article was written in Korean (only the abstract was translated), so was excluded from our analysis.
Two of the remaining nine English language papers described record linkage studies. One such study was based on the Korean insurance database that was linked with death certificates.[30] This study reported that increased ALT, even within the upper end of the normal range, was associated with eventual death from liver disease. A study carried out in Scotland linked general practice and hospital databases.[31,32] However, this was a retrospective study so a full liver screen was not conducted and follow-up was for a median of four years only, whereas many diseases, including chronic viral hepatitis, have much longer prodromal periods.[33]
The other seven studies were prospective cohort studies, based on testing asymptomatic members of the general population. The famous Dionysos study based on three analytes from the LFT analyte panel[34] is included among these. In this study an impressive 6,917 citizens from two communities in northern Italy were screened. Although they tested all those who had an abnormal LFT (n = 1473) for viral hepatitis, for which they found a prevalence rate of 2.4%, they did not describe the pattern of LFT results in infected patients. Another Italian study by Pendino and colleagues (2005) screened 1,645 inhabitants from a town in southern Italy, with both a LFT (ALT, AST and GGT) and viral screen.[35] The prevalence of viral hepatitis is much higher in this region because of a significant immigrant population, and they performed a more extensive analysis on the impact of viral hepatitis on LFTs. Of the 319 (19.4%) individuals who received an abnormal LFT, nearly 18% were infected with viral hepatitis. However, the LFT missed 34 (40%) of the 92 cases of viral hepatitis present in the community. Perhaps the most comprehensive prospective analysis looking at the effect of viral hepatitis on the individual analytes was carried out on a population of Japanese office workers.[16] The study used data from compulsory health checks, which included an ALT, AST and GGT panel along with certain additional tests, such as a viral screen, that were added for study purposes. They found that ALT was the most sensitive of the three analytes used, detecting nearly half the cases of viral hepatitis, whilst being abnormal in 14% of the cohort (278 abnormal results in 1,973 participants). The remaining four prospectively designed studies were carried out in general practices and were therefore closer in population terms to the BALLETS cohort. However, three of these were restricted to patients with persistently abnormal LFTs over a six month period[36–38] and one of these did not include a test for viral hepatitis. The final prospective study by Whitehead (1999) was small and based on only one analyte.[39]
After this review of the literature we concluded that there has been no published study that fully investigated a cohort of patients in primary care with an abnormal LFT result (from the full LFT analyte panel).

Strengths and Limitations of the Study
The main strength lies in the unique nature of the BALLETS cohort, being the only prospective study that has looked at the consequences of an abnormal LFT from a full analyte panel in primary care. The main limitation of our study relates to the rather small number of cases of chronic viral hepatitis (n = 13) and hence wide confidence limits on the results. That said the results are plausible, in the sense that they are consistent with the pathophysiology of hepatitis and in line with what was found in non-practice settings (see literature review above). They are available for meta-analysis with potential future studies.
We deliberately selected multi-cultural inner city populations in order to provide a sizable sub-group of people from countries where chronic viral hepatitis is common, as a result of infection during infancy (hepatitis B),[40] and iatrogenic infection (hepatitis C).
Our study considers only one disease type, chronic viral hepatitis, while GP decision making must take into account other diseases, such as haemochromatosis, as well as other behavioural and social motivations for testing.[41,42] That said, our conclusion that repeating the LFT "offers more than it delivers," may well apply to diseases such as PBC and haemochromatosis.
Lastly we have presented an analysis for cost minimisation and incremental cost per case detected. This is not a full cost-effectiveness or decision analysis. Donnan et al. did attempt a decision analysis.[32] However this decision analysis was intended to find the most cost-effective strategy in the short term and used a limited time horizon of one year. LFTs are often ordered to prevent poor outcome in the long term, with many serious liver diseases, viral hepatitis included, manifesting over decades. Anxiety resulting from a false positive result was included in the model while long term health gains as a result of successful case finding and treatment were not captured.
Neither our decision analysis, nor that in Donnan's HTA report,[32] considered cost-effectiveness. We tackle this limitation by considering our results in the context of published cost-effectiveness analyses for screening for viral hepatitis (i.e. studies that found screening was cost-effective in populations with high prevalence rates e.g. migrants) and attempt to produce a "fast and frugal heuristic"[28] to guide practice.

Implications for Practice: A Fast & Frugal Heuristic
The intuitively appealing practice of repeating abnormal LFTs (strategy A) gets little support from our analysis. It is the most expensive option, both in absolute terms and in terms of cost per case detected, compared to all five alternative strategies (Table 7) - including that of simply testing everyone for viral infection.
The most important question a doctor can ask a patient with abnormal LFTs is their country of origin. This holds good whether the person settles in an area of high or low ethnic mix, since infections are acquired in infancy (hepatitis B), or as a result of sub-standard medical practices, such as needle sharing (hepatitis C). Once infected, people "take their risk with them" - less people will need to be tested in a low ethnic mix area, but those from prevalent countries still need testing. The strategy of testing people from prevalent countries promises good value for money. In this study, 11 of the 13 cases originated in medium or high risk countries. Thus the prevalence of chronic hepatitis viral infection (positive predictive value) among people with an abnormal LFT who were born in a prevalent country was 6.5% (11/170, 95% CI: 3.7%-11.2%, see table 5), while the prevalence among the home born population (of all ethnic groups) was less than 0.2% (2/1038, CI: 0.05%-0.7%). Our findings support viral testing only in the former group, consistent with the threshold prevalence for both HBV and HCV, of approximately 3% at which population screening becomes cost-effective.[21,43,44]
Four of the strategies, C, D, E and F, entail viral testing in a population where the rate of hepatitis exceeds the 3% threshold for which testing has proven cost-effective in screening programs (Table 5). The cost-effective threshold is probably a little lower in a diagnostic population than in a screening population (costs of inviting people to attend are lower and cases detected might be a slightly higher risk) but no other strategy yields a population with a hepatitis rate exceeding even 2%.
Strategy D (test immigrants from prevalent countries) has a better (lower) incremental cost-effective ratio than C and detects twice as many cases as E. However, the strategy F, testing immigrants from prevalent countries or any people with a very high ALT, is our preferred strategy, being both sensitive and efficient. We therefore recommend the "fast and frugal" heuristic described in Figure 3. This combines strategy F with normal judgement of clinical indications. For example a patient who is an intravenous drug user, or who has recently returned from a trip abroad where they had an attack of hepatitis, would be tested notwithstanding the result of the LFTs. Otherwise we recommend testing all patients with an abnormal LFT who were born in a country of intermediate or high prevalence and all patients for whom the ALT exceeds twice the limit of normal.



The probability of chronic viral hepatitis is low even when the ALT exceeds this limit and the patient does not originate from a medium or high-risk country (1.6%). Nevertheless we advocate testing in these patients for the following reasons:
1. It is hard to ignore a level this high, and the wide confidence levels from our data suggest the need for flexibility.[45]
2. The progression for undetected chronic viral hepatitis is worse for patients with ALT greater than twice the upper limit of normal, and this level has been used as a threshold for treatment in guidelines.
3. If chronic viral hepatitis is not present at this level a more in-depth search for other causes of hepato-cellular damage is indicated.
We draw the line on further viral testing after this algorithm has been followed, unless of course further clinical indicators emerge. The likelihood of a case of viral hepatitis being present following the exclusions in this algorithm is approximately 0.1% in our study. This is considerably below the UK population prevalence.

Conclusions
This analysis indicates that the strategy of repeating LFTs in asymptomatic patients, advocated by current guidelines, is less sensitive and far more expensive than viral testing those patients born in countries where viral hepatitis is prevalent. Despite few cases of viral hepatitis the data on costs of the various strategies is strong and the results of prevalence rates within the cohort are consistent with other literature. The finding that a notably raised ALT level was also effective at identifying infected patients inspired the construction of a "fast and frugal" heuristic that might aid GPs who are faced with abnormal LFTs in asymptomatic patients, with regards to viral hepatitis. Our proposal addresses the diagnostic problem by identifying a clear high-risk population originating in prevalent countries. The residual population who are not immigrants from such countries are at low risk. However, this should not override clinical judgement. Its overall cost in other settings will depend on the relative proportions of patients in these risk-strata, but our results suggest that the cost of automatic testing of high-risk individuals will be repaid in terms of additional cases detected.
Clearly the situation might change as vaccination catches on in developing countries and needle hygiene improves. The key points to emerge are that:
1) it is more efficient to determine country of origin with a view to viral testing, than to simply repeat the LFT;
2) it is more cost-effective to test the whole LFT positive population for viral hepatitis, than to repeat the LFT with a view to viral testing if it remains positive.
References


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    Thursday, January 13, 2011

    Video/Healthy liver in comparison to a diseased liver














    ,
    Pediatrician Dr. Jim Sears demonstrates how the liver functions in the body, and E.R. physician Dr. Travis Stork shows what a healthy liver looks like in comparison to a diseased liver.

    Friday, January 7, 2011

    Hepatitis C: Understanding Those Liver Tests

    Looking at Liver Function Bloodwork
    By Nina L. Paul, PhD

    When you go for a physical, your healthcare practitioner frequently orders blood tests. Many folks first find out they have hep C after undergoing a routine blood test and finding that one or more of the tests is abnormal.
    .
    Tests for the effects of hepatitis C on your liver include:

    Liver enzyme tests: These tests measure current liver cell injury by the amount of enzymes that are "leaked" out of damaged or dying liver cells.
    .
    Liver function tests: These tests look at levels of proteins made by the liver. If your liver damage is such that your liver function is impaired, levels of these proteins will be low. If your bilirubin, clotting factors, or albumin levels are low, you may have cirrhosis or late-stage liver disease.


    ALT
    Small amounts of ALT (alanine aminotransferase) are normally found in blood. When the liver is damaged, ALT is released into the bloodstream. ALT is found in organs other than the liver (kidneys, heart, muscles, and pancreas), but most increases in ALT are from liver damage.

    AST
    AST (aspartate aminotransferase) is also called SGOT (serum glutamic-oxaloacetic transaminase). Like ALT, AST is found mainly in the liver but also in other parts of the body. AST and ALT are usually measured together and are good indicators of liver disease or damage. Sometimes, test results give AST/ALT ratios.

    ALP
    ALP (alkaline phosphatase) is found in all parts of the body, with particularly high concentrations in the liver, bone, and placenta (during pregnancy). Like ALT and AST, ALP might leak into the bloodstream when liver cells are damaged as a result of hepatitis C. Children (who have growing bones), pregnant women (especially in their last trimester), and people with bone disease also have higher levels of ALP.

    GGT
    GGT refers to gamma-glutamyl transferase, but it's also called gamma-glutamyl transpeptidase (GGTP) or Gamma-GT. High levels of GGT are found in the liver, bile ducts, and the kidney. Bloodstream GGT levels will be higher in people with diseases of the liver and bile ducts.

    5'N'Tase
    Higher levels of the enzyme 5'N'Tase (5'nucleotidase), also known as 5'NT, in your blood indicate a problem with bile secretion. Hepatitis or cirrhosis can cause a blockage of bile flow.

    Albumin
    Albumin is the major blood protein made by the liver. One function of albumin is to keep the blood from leaking through the blood vessels, which can cause fluid retention in the ankles (edema), lungs, or abdomen (ascites).Low levels of albumin may be due to liver or kidney disease, malnutrition, or even a low-protein diet.

    Bilirubin
    This pigmented (yellow) waste chemical comes from the normal process of red blood cells' dying after 90 to 120 days. A healthy liver converts bilirubin and sends it out of the body with the bile that goes to the intestine. Excreted bilirubin gives feces (stools) their characteristic brownish color.

    When the liver is diseased, bilirubin isn't converted and excreted. Stools might, therefore, be light-colored. The bilirubin that's not properly excreted builds up in the body and gives a yellowish color to skin and eyes (a condition known as jaundice) and dark brown tea color to urine.

    High levels of bilirubin are due to either too much production of bilirubin (from red blood cells dying) or because the liver isn't processing bilirubin, which happens when the liver is damaged. This is one of three tests used to determine wait time for a liver transplant.

    In addition to using a blood test, urine can be tested for bilirubin.

    PT test
    The PT (prothrombin time) test measures how quickly your blood clots, which is dependent on clotting factors (proteins) that are made by the liver. The PT test is used as a marker of advanced liver disease and can indicate blood-clotting problems where it takes you longer to stop bleeding.

    Your laboratory may also give PT results that have been converted to an internationally recognized and easily comparable value that's called the International Normalized Ratio (INR). The INR is one of the three factors used to determine wait time for a liver transplant.

    Other blood tests
    Additional tests that measure other markers in your blood give your doctor a clearer picture of any liver disease and also any effects from the combination peginterferon drug treatment.

    Complete blood count (CBC)
    A complete blood count (CBC) looks at the number and types of cells in your blood. Your doctor will look for problems such as

    Reduced white blood cells or platelets: This may indicate portal hypertension, a complication of cirrhosis in which pressures are increased in the portal vein.
    Indicators of anemia: This problem is very common during ribivarin treatment.
    The complete blood count includes the following tests:

    White blood cell (WBC) count: The total number of white blood cells. Changes can indicate problems of hepatitis C infection or side effects of interferon treatment. Interferon can cause neutropenia, which is a decrease in neutrophils, one type of white blood cell.

    Red blood cell (RBC) count: The total number of red blood cells. Low levels can indicate anemia.

    Hematocrit (HCT): Percentage of blood cells that are red blood cells. Low levels can indicate anemia.


    Hemoglobin: The amount of this oxygen-carrying protein. Low levels can indicate anemia.
    Platelet count: Number of platelets in your blood (may be altered in cirrhosis).

    AFP
    Tests for AFP (alpha-fetoprotein) are used to screen for liver cancer in people with cirrhosis. But not everyone with liver cancer has this marker. Pregnant women usually have higher levels of this protein, which is also used to look for problems in pregnancy. You may have slightly high levels of this protein if you have hepatitis or cirrhosis.

    Iron
    The liver stores iron, and an overabundance of iron (iron overload) can add to the damage caused by hepatitis C. Too much iron can be a problem during interferon treatment. See your physician to determine whether you should avoid supplements that include iron.

    Creatinine
    Creatinine is actually a breakdown product of creatine, which is made by the liver and transported to your muscles. The kidneys excrete the waste product creatinine, and when your kidneys are damaged, creatinine levels rise. When the liver stops functioning in end-stage liver disease, this can cause serious kidney problems as well. This test is one of the three used to determine your wait time for a liver transplant.



    Read more: http://www.dummies.com/how-to/content/looking-at-liver-function-bloodwork.html#ixzz1APvqmvgY

    Saturday, January 1, 2011

    Morning Hep C News and Letters


    Lifesaving change for transplant checklist
    TRANSPLANT patients are being given the healthy organs of pack-a-day smokers, heavy drinkers and the elderly to give more people on the waiting list a chance of survival.
    Surgeons are also transplanting the unaffected body parts of cancer patients and have begun a new registry for donors with hepatitis C.
    While donor rates in NSW have risen by a quarter this year - due to reforms and a public awareness campaign - Australia still lags behind many countries, leading doctors to extend the criteria for acceptable donors.
    .
    Thelma Thiel, CEO of the Hepatitis Foundation International explains the functions of the liver and risk behaviors that can cause liver disease on CBS 6 - Good Morning Virginia program. Check out the video of the interview entitled "Hepatitis Awareness"
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    ,
    .
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    January 2011 HEPC Bull Newsletter

    Read the hepc.bull -our online monthly newsletter (.pdf)
    .
    .
    IN This Issue:

    More AASLD 2010 News
    My Story (Daryl) / PHCN Conference Report
    Hep C & Me
    Hep C on the Internet
    Conferences
    PegCARE/PegAssist/Neupogen/Compensation
    .
    HEPATITIS C NUTRITION: Foods that Bite, Foods that Fight
    .
    Inside Look
    .
    More AASLD 2010 News

    SVR 20 YEARS LATER

    We often think our goal is an SVR(Sustained Viral Response), but the long term goal is to prevent Hep-C related deathor disability. This study looked at 103 successfully-treated patients treated beginning in 1984. Biopsies and blood tests were compared before and after. Patients seen since 2007 were evaluated by elastography, a type of liver scan. Three of the original patients had relapsed between just over a half a year up to 6 ½ years after treatment. Of the other100, 45% had GT1, and 53% had GT2 or 3.2% had other genotypes. There was no liver failure or liver cancer. ALTs were 27 U/Land ASTs were 24 U/L, average. All other markers remained good, as well. There were no liver-related deaths, and 97% had maintained their SVR. The study concluded that “SVR is associated with both short term and long-term benefits.”
    Source:
    www.natap.org/2010/AASLD/AASLD_25.htm
    .

    BMS-790052 + BMS-650032
    Bristol-Myers presented results from their protease + NS5A inhibitor trial. The drugs were tested with and without standard therapy, on GT1 null-responders. At 12weeks of therapy, 6 out of 11 patients experienced breakthrough. All were GT-1a. However, the other 5 patients remained undetectable with the two oral drugs alone. It appears that the patients with breakthrough............
    .

    .

    HEPATITIS C NUTRITION:
    At one point scientific studies stated that there was no notable harm in taking milk thistle but also did not see any benefit. However new work has demonstrated that at the very least milk thistle is a powerful antioxidant providing benefits to cell health. While milk thistle has more therapeuticpotential than first imagined when refined and administered intravenously, there are some new indications that taking it orally likely reduces fibrosis as well as raising QoL.

    Any improvement in QoL is going to increase your chances of fighting HCV. However if there is a potential for negative health consequences from a food or drug it is said to be a contraindication. For example when you take interferon and eat high fat food, fat is going to be a contraindication for the interferon since fat temporarily fertilizes the virus we are trying to fight. Also fat deposits in the liver have been shown to hamper treatment success and it is especially harmful to those with HIV coinfection.......

    ,
    From NATAP
    (12/30/10)

    New York Magazine Top Infectious Disease Doctors in NYC 2010 List -

    More Hep C Articles...

    __________________________

    Ten Neglected Points
    by Articleman

    12/31/2010
    The Silent Hepatitis C Crisis. Hepatitis C is rampant among American prison inmates. While the general population has it at an incidence of roughly 2%, prison populations have it at rates ranging from 28% to 30% to 40%, depending on who you ask or read. To be sure, the percentage of inmates who enter prison with it is substantially higher than the percentage of infections among the general public. But many are infected in prison, and given the lack of treatment in prison, we are seeing long-term catastrophic liver failures and illnesses among persons late in their prison terms and after they are released back into society. While treatment on the front end is expensive, it is more expensive on the back end, when livers and lives are destroyed, and when the ill person can go on to infect others as well. This is a huge public health problem that no one can be bothered to discuss.

    Last update 01/01/2011 11:00:00 AM (GMT+7)


    Vietnam successfully conducts second liver transplantation for adult

    VietNamNet Bridge – Hanoi-based Vietnam-Germany Hospital has successfully performed liver transplantation for a 44-year-old man from the central city of Da Nang in a 13-hour surgery.

    The liver donor is the patient’s cousin, who is 34 years old.

    Vietnam has carried out many liver transplantations but all of them were on children. This is the second liver transplantation on an adult in Vietnam, according to Dr. Nguyen Tien Quyet, director of the Vietnam-Germany Hospital.

    Liver transplantation for adults is much more complicated and risky than for children because doctors have to take up at least half of the liver of the donor while it is only one third for children.

    The first adult liver transplantation was in late 2007, also conducted at the Vietnam-Germany Hospital

    “Besides the harmony of indexes between the donor and the recipient, the weight of liver is very important. In some case, the weight of liver of the donor is not enough for the recipient,” Quyet said.

    The patient has recovered after the operation.

    In May 2010, this hospital successfully performed liver, kidney and heart valve transplantations, using donated organs of a dead person.

    Quyet said that Vietnam’s viscera transplantation technique is not behind any country in the world. Notably, the cost for viscera transplantation in Vietnam is very cheap, equivalent to one third of the region and the world.

    However, the common problem is the scarcity of viscera for transplantation. In the world, up to 90 percent of viscera come from dead people while 90 percent of viscera for transplantation in Vietnam come from the living people.

    Vietnam is about to build a centre to coordinate viscera transplantation.

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    .
    Stem Cells
    .
    Scripps Scientists home in on chemicals to reprogramme cells news
    Breaking new groundScientists have known for at least 50 years that a cell's identity is reversible if given the right signal - cells go forward to become mature, functional cells or they can go backward to become primitive cells. In order for cellular reprogramming to be safe and practical enough to use in cell therapy, researchers have sought an efficient, reliable way to trigger the reprogramming process


    What Are Stem Cells ?
    Yesterday, December 31, 2010, 7:35:06 PM


    • All stem cells can divide many times without turning into specialized cells. In a laboratory, a small batch of stem cells can multiply over many months and yield millions of cells.

    • Embryonic stem cells can develop into any of the more than 200 types of cells found in the human body.

    • Embryonic stem cells can be produced fairly easily in the laboratory, by cell division.

    • Adult stem cells (also called somatic stem cells) are found in specific tissues of the body. Usually, they develop only into the type of cells needed in those tissues. Adult stem cells have been found in the brain, bone marrow, blood, skeletal muscle, skin, teeth, heart, and liver.

    • Adult stem cells are difficult to isolate from the surrounding specialized cells, and scientists haven’t yet learned how to grow them in the laboratory. This makes them less promising for therapies that would involve replacing damaged tissues with tissues grown from stem cells. However, certain adult stem cells are already being used in medical therapy: for example, in bone marrow transplants for leukemia patients. (Bone marrow contains stem cells that produce blood cells.)


    Liver: Stem Cells Updates and News 2011
    Yesterday, December 31, 2010, 7:21:52 PM
    Patients who are displaying symptoms of liver cirrhosis are involved in the trial Once harvested, the cells are purified, so that a high concentration of the right type of stem cells can be injected back into the patient's blood stream. The Repeated Autologous Infusions of Stem Cells in Cirrhosis, or 'Realistic' trial, will compare the current standard treatment to both the effect of giving GCSF injections on their own and giving the injections, collecting the stem cells and putting them back into the bloodstream. Dr Philip Newsome, from the Centre for Liver Research at Birmingham University, is the clinical leader for the trial.

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    Pharmaceutical News

    Roche acquires Marcadia Biotech
    Roche beat the end of year holiday rush yesterday by acquring Marcadia Biotech - probably the last pharma deal of 2010. Marcadia is located in Carmel, IN and was founded by former Lilly executives.
    Roche acquires Marcadia Biotech Indianapolis Business Journal IBJ.com.

    ,

    New Drugs 2010 - Fewest FDA Approvals since 2007
    Here's a piece republished in its entirety from Bloomberg.
    Twenty-one new drugs were approved in the U.S. this year, the fewest since 2007, as the Food and Drug Administration showed more willingness to delay or reject medicines with potential safety risks.
    The tally, compiled by Bloomberg from an FDA database, compares with 25 approvals last year and 24 in 2008, according to the FDA’s website. Nineteen new drugs were cleared in 2007, the fewest in 24 years.

    __________________________

    New Year !

    The List: Top New Year's resolutions

    Telaprevir Makes The List: New year, new science

    2011: Good News For Hepatitis C Patients

    Scripps Research scientists identify key interaction in hepatitis C virus

    http://hepatitiscnewdrugs.blogspot.com/2010/12/getting-ready-for-2011-hepatitis-c-new.html

    __________________________

    Infectious Disease

    Who Knew ?

    Deer-Associated Parapoxvirus Infection Identified
    ,
    Parapoxvirus infection, attributable to a unique strain, diagnosed in two deer hunters
    THURSDAY, Dec. 30 (HealthDay News) --
    Parapoxvirus infections were identified in two deer hunters in 2009 and, with deer populations on the rise, the potential for deer-associated parapoxvirus infections may also be increasing, according to a report published in the Dec. 30 issue of the New England Journal of Medicine. Amira A. Roess, Ph.D., of the U.S. Centers for Disease Control and Prevention in Atlanta, and colleagues describe the clinical and pathological features of parapoxvirus infection and the phylogenetic relationship of a unique strain of parapoxvirus diagnosed in two deer hunters to other parapoxviruses. Both hunters had cut their fingers while field-dressing deer. DNA sequence analysis revealed that the parapoxvirus infections identified in these deer hunters were likely due to a unique strain of the virus. Individuals with parapoxvirus infection typically present three to seven days after exposure with erythematous maculopapular lesions on the hands that progress over four to eight weeks. The histopathological appearance of the lesions is characterized predominantly by epidermal hyperplasia, with occasional cytoplasmic inclusions, prominent vascular proliferation and dilatation, and mixed inflammatory-cell infiltrates. The authors note that, because the deer population is increasing in the United States, the potential for parapoxvirus infection may be increasing as well. "Anecdotal data suggest that imiquimod may be effective in the treatment of parapoxvirus infection in patients with underlying health conditions, to prevent the spread of virus, autoinoculation, and the need for surgical d├ębridement," the authors write. One author disclosed financial relationships with pharmaceutical and medical companies.
    Full Text (subscription or payment may be required)

    Upcoming Events:

    4th Paris Hepatitis ConferenceParis, France Jan. 17 – Jan. 18, 2011

    http://www.colloquium.eu/site/-Homepage,1724-


    EASLBerlin, GermanyMarch 30 – April 3, 2011

    http://www.easl.eu/


    DDWChicago, ILMay 7 – May 10, 2011

    http://www.ddw.org/wmspage.cfm?parm1=679


    HCV 2011 SymposiumSeattle, WA Sept. 8 – 11, 2011

    http://www.hcv2011.org/


    AASLDSan Francisco, CA Nov. 4 – 8, 2011

    http://www.aasld.org/lm/Pages/default.aspx

    Friday, November 26, 2010

    Blood tests predict mortality following liver resection

    Simple blood tests predict mortality following liver resection

    Last Updated: 2010-11-23 13:35:26 -0400 (Reuters Health)

    By Gabriel Miller

    NEW YORK (Reuters Health) - A set of three simple preoperative tests may predict in-hospital death following hepatectomy, according to a study published in the November issue of Archives of Surgery.

    Many previous studies have identified factors postoperatively that contribute to death after liver resection, the investigators say. However, their study has identified a set of tests done before surgery that predict mortality and can be used to decide who should -- and should not -- have the operation immediately.

    "Our experience showed that preoperative liver function tests and coagulation as well as evaluation of liver capacity predict the mortality rate in patients requiring right-sided major or an extended major liver resection with extra-hepatic bile duct resection," lead author Dr. Elie Housseau-Oussoultzoglou at Hautepierre University Hospital in Strasburg, France told Reuters Health in an email. "All these biological parameters are easily available and measurable preoperatively in a simple blood sample."

    Though the study found several pre-operative measures that were predictive of mortality, hepatic resections are extremely complicated procedures in a widely varying patient population. Considering the high mortality rate already established with these operations, it 's not surprising that a retrospective review would uncover a few significant measures, said Dr. William Jarnagin, chief of the Hepatopancreatobiliary Service at Memorial Sloan-Kettering Cancer Center in New York City.

    "These are big operations and they're performed on patients with advanced cancers so there is a lot of morbidity," said Dr. Jarnagin, who was not involved in the study. "It's complicated to analyze (and) there are a lot of factors, so to pick one or two things, even though they might be significant, is not a simple thing at all."

    Dr. Jarnagin added that several of the pre-operative tests the authors suggest are already done on a routine basis by many clinicians.

    The study retrospectively reviewed the preoperative evaluation of 67 patients without cirrhosis undergoing liver resection of at least four contiguous liver segments.

    More than half of the patients (n=35) had co-morbidities prior to their operation, most commonly hypertension and cardiovascular disease.

    The main outcome measure was postoperative mortality, which included intraoperative death, death within 90 days after surgery and in-hospital death.

    In the series, all of the postoperative deaths (7%) were related to liver failure, which was mainly associated with the extent of liver resection and the inability of the liver to regenerate, the investigators report`.

    On univariate analysis, five factors were associated with higher postoperative mortality: serum alanine aminotransferase (ALT) level > 40 U/L, preoperative prothrombin (PT) ratio less than 70%, a preoperative indocyanine green retention rate at 15 minutes (ICGR-15) greater than 15%, preoperative biliary drainage, and extrahepatic bile duct resection.

    Based on the results of their multivariate analysis, the authors propose that patients who have two or more risk factors based on ICGR-15, PT ratio, and ALT level should not have surgery. Surgery can proceed in patients with one risk factor, they suggest, although mortality rates will be higher than 5%.

    "In patients with altered preoperative liver tests and function, the initially planned surgery should be postponed, until full recovery of the biological parameters," Dr. Elie Housseau-Oussoultzoglou said. "During this interval a palliative anti-tumoral therapy is administered to avoid disease progression.

    "Considering the high expected risk of lethal liver failure it would be preferable to survive few months with a chronic disease instead (of dying) within a thirty-day hospital stay," Dr. Housseau-Oussoultzoglou added.

    SOURCE: http://link.reuters.com/tab86q

    Arch Surg 2010;145:1075-1081

    HIV Video: Possible Method to Preventing HIV, Statin Therapy in Those With Abnormal Liver Function

    http://www.insidermedicine.com

    (November 23, 2010 - Insidermedicine)
    From Chicago - Researchers may have found a way to prevent HIV transmission, according to a report published in the New England Journal of Medicine. Randomizing over 2400 HIV-negative gay men to either daily intake of antiretroviral treatment or placebo, researchers found that those who received the therapy (known as oral pre-exposure prophylaxis) had a 44% reduction of new HIV transmissions.

    From Greece - A new report published in The Lancet examines the benefits of statin therapy in people with abnormal liver function. Randomizing over 400 patients with abnormal liver tests to either statin therapy or no therapy at all, researchers found that those on the statins had a 68% relative reduced risk of suffering a cardiovascular event.

    Wednesday, November 24, 2010

    Reluctance to start statins in patients with out-of-range (ALT)

    Statins less dangerous than thought for liver patients
    Thursday, 25 November 2010

    Long-term use of statins, a drug widely prescribed to prevent artery-blocking cholesterol, is less risky than thought for patients with a common form of liver disease, according to a study published on Wednesday by The Lancet.
    Statins work by blocking a liver enzyme that makes fatty molecules which line arterial walls and boost the danger of heart disease and strokes.


    Doctors commonly choose not to prescribe these drugs to people with high levels of a type of liver enzyme which is often a telltale of non-alcoholic fatty
    liver disease, or NAFLD.
    Few studies have until now been carried out into the benefits or risks of this policy, and the probes have been small and short-term.


    In the biggest and longest investigation of its kind, doctors in Greece enrolled 437 patients who had abnormal
    liver function tests and were believed to have NAFLD.
    Of these, 227 of whom were treated with a statin, while the others were not treated.
    Over the three-year duration of the study, 10 percent of patients in the statin group had a heart attack or a stroke, while in the non-statin group, this was 20 percent. The benefit for the statin group was a relative risk reduction of more than two-thirds.


    Bouts of liver-related sickness were equal in both groups, indicating no adverse affects on the liver from taking statins.
    The study was led by Vasilis Athyros from the Hippokration University Hospital in Thessaloniki, Greece and Dimitri Mikhailidis from University College London, London.
    Commenting on the study, Ted Bader from the University of Oklahoma Health Sciences Center said the findings demonstrated emphatically that many patients with liver disease had been wrongly denied statins for high cholesterol for too long.
    "Most
    physicians believe that statins cause liver disease because of the language of package inserts. Drug companies should be encouraged to request the deletion of this point from the insert," he said.

    Statins have been dubbed "the aspirin of the 21st century" for their perceived benefits in cardiovascular health and relatively few side effects. Worldwide sales total more than 20 billion dollars annually.
    A study published last week cautioned against over-prescribing, saying that among healthy adults, only those with measurable buildup of artery-hardening
    calcium would significantly benefit.

    The six-year study found that 75 percent of all heart attacks, strokes or heart-related deaths occurred in the 25 percent of participants who had the highest calcium buildup in their blood vessels.

    The 47 percent of participants who had no detectable levels of calcium buildup meanwhile suffered just five percent of heart disease-related events, meaning the therapy would have offered little protection.
    ri/co




    Friday, November 12, 2010

    Hepatitis:Common Blood Tests/Liver Function

    Click To Enlarge

    Liver Function Tests (or Liver Enzymes) - Includes blood tests that assess the general health of the liver. When elevated above normal values, the ALT (alanine aminotransferase) and AST (aspartate aminotransferase) tests indicate liver damage. They are enzymes located in liver cells that can leak out into the bloodstream when liver cells are injured.

    ALT (alanine aminotransferase)—ALT is an enzyme that is normally found in the liver cells and in the blood. When liver cells become damaged, they leak into the bloodstream, causing levels of liver enzymes to be raised. An increase in ALT levels can indicate acute liver damage. However, a single ALT test cannot usually reveal the severity of liver damage. Many people with chronic hepatitis C have normal ALT levels, so this test is not considered a completely accurate marker of disease progression.

    AST is found in other organs besides the liver. High AST levels in the bloodstream can be a sign of liver trouble. AST testing measures the level of AST in a person's bloodstream at a given time. Like ALT levels, AST levels in people with HCV often vary over time and can't be used to forecast disease progression or specifically measure liver damage.

    Bilirubin
    When red blood cells complete their lifecycle and break down naturally, they produce bilirubin, a yellow pigment that's passed on to the liver and excreted in the bile. Most of the time, the body produces as many red blood cells as it breaks down. However, if the red blood cells break down more rapidly or if liver function becomes impaired, bilirubin levels in the blood rise. In patients with hepatitis, bilirubin levels tend to fluctuate. A prolonged persistent rise in bilirubin for a patient with chronic hepatitis C usually indicates severe liver dysfunction.

    Albumin
    Albumin is a protein manufactured by the liver. A decrease in albumin may reflect a reduction in the liver's ability to synthesize this protein, and a significant sustained decrease in this protein may mean poor liver function. However, decreases in albumin levels may also occur for reasons not related to the liver. Your doctor will take this into account when interpreting test results.

    Prothrombin time
    This test measures blood clotting ability. When the liver is damaged, it may fail to produce enough blood clotting factors.
    Complete blood count—A complete blood count analysis can be used to help detect liver scarring. If the liver becomes scarred, blood may back up into the spleen. This causes the spleen to enlarge and to trap blood elements, removing them from circulation and lowering blood counts.

    Ferritin
    Iron is stored in the liver in the form of ferritin. Increased levels of ferritin means a high level of iron is being stored. This could result from an increased iron intake in the diet (vitamin supplements, food cooked in iron pots, etc.), but it can also occur from a destruction of liver cells causing leakage of ferritin. More research is needed to understand the relationship between elevated ferritin and liver cancer.