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Guest ~Sammi~

Hepatitis C - The Facts On Contracting

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Over ten years ago I was an intravenous drug user, and around 15 years or a bit more ago I contracted Hep C after a very nasty person gave me a needle that had been used to inject someone with Hep C and HIV co-infection. I missed out on contracting HIV but was unfortunate enough to contract Hep C which 15years later I have literally this week begun treatments to clear this insidious virus from my body. I thought that this might be a good opportunity to begin a conversation on factual ways you can contract Hep C as a drug user and what treatments may consist of. Please feel free to ask any questions that come to mind.

How Hepatitis C Can Be Contracted

Hepatitis C is not contagious. It cannot be caught by any means other than blood to blood contact. The virus does not survive well outside the human body, which makes laboratory work difficult.

It is technically possible for the virus to spread by accidental contact with infected blood, but the chances are extremely small. A quantity of infected material has to be driven below the skin for the infection to transfer. Those with Hepatitis C are advised not to allow shaving items and toothbrushes to be used by others just in case. Spilt blood should be cleaned up with bleach or alcohol. Use of gloves during first aid is essential.

The virus is not transferred by heterosexual or oral sex. No additional precautions to prevent sexual transfer are recommended for couples in long term monogamous relationships. Whether the virus can transfer by anal sex is not clear, and almost impossible to research. Hence anal sex should be avoided, as should sex during menstruation.

The exception to the normal sexual transfer situation is where HIV/AIDS is also present, in which case Hepatitis C can transfer sexually. It is thought that the HIV switches off the body's local defences, and the Hepatitis C takes advantage.

The virus has been known to transfer across the placenta and infect babies in approximately 5% of cases where the mother has the virus.

In many cases (25%-40%), particularly where the quantity of infected material transferred is small, the virus is completely cleared by the body's immune system, leaving the person with antibodies to the disease but no active virus. Many infections do not develop into the full virus itself.

Nearly all current cases can be traced to infected blood transfusions, infected blood products, or intravenous drug abuse. A few can be traced to tattooing, piercing or electrolysis. There is a remote possibility that the virus could be transferred by shared cocaine straws.

Sammi

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Common Side Effects Of Treatment!

This is a big subject, and only covered very briefly here. More detail is available elsewhere on this site. Both Interferon and Ribavirin are very powerful drugs, and their use involves a variety of side effects which vary greatly in number and severity from patient to patient. Some fortunate patients experience very few side effects, and sail through treatment without problems. Others struggle, and in severe cases are unable to tolerate treatment and have to stop, usually without reaching a successful conclusion. There is no method of predicting the amount or severity of side effects for an individual patient prior to treatment.

Common side effects are:- Flu-like symptoms, fever, chills, joint pains, muscular pains, headaches, nausea, fatigue, mood/behavioral problems, depression, anemia (low red cell count), low white cell count, susceptability to infections, loss of libido.

Less common side effects are:- Shortness of breath, blurred vision, diarrhea, psoriasis, thyroid problems, heart problems, anorexia, abdominal pain, jaundice, rashes and skin problems, hair loss, sleep problems.

It should be stressed that the great majority of patients do not suffer severe side effects, but all the above (and more) have been attributed to this treatment.

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Thank you for sharing this with us, Sammi. I'm sure many will be following your progress.

MaryEllen

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Sammi,

Thank you for sharing that.

My brother-in-law was one of the rare ones who got Hep C from a tattoo. He and a friend had them done at the same time back to back and a few years later both were found to be infected. It was the only possible link. My brother-in-law did the treatment and is healthy and doing really well now. He almost quit the treatment a few times-it can be nasty-and his friend did quit. His friend is gone now. So please even when if it gets rough stay with it. It does pass and my brother-in -law says it was well worth it. A couple of times during treatment he said nothing was, but my sister wouldn't let him quit and those times passed.

All the best to you. You have a special strength and courage that inspires so many

John

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My father found out he had Hepatitis C a few years ago. It might have been from one of his tattoos or from the years he spent as a construction field mechanic, where quite a bit of blood mingling could occur imperceptibly. By the time of his diagnosis, his liver was so damaged that his legs were filling up with fluid.

Treatments seemed to have been helping until about a week ago, when he began to drift in and out of a dissociative state. One of his doctors thinks it's from ammonia in the blood, the other suspects hepatic encephalopathy. It's really scary.

It's a good idea to be careful to avoid Hep C and quick to look into it if you suspect you have it.

-Valerie

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Hi Valerie and JJ.

Thank you both for sharing your stories here with us, unfortunately there still isnt enough talk going on around Hep C and it's repercussions and so opening any kind of dialog about the issue is so important. The long term ramifications of Hep C can be intense to say the least, but can be avoided with treatments as we know. Treatments arent always successful and simply missing one injection over the six month period can completely null and void the entire treatment program. I am in contact with people who are on their third and fourth treatment cycles trying to eradicate this virus, but like me they remain positive about the long term treatment options.

Speaking of missing an injection, come monday morning depending on what the cardiology and liver clinics say to me I may just be forced to stop my treatment, at the moment it has been put on hold after finding an arrhythmic beat in my heart two nights ago. I had been feeling as though my heart was fluttering or palpitating two days before this and eventually it got to be painful and a little disconcerting so after seeking advice I fronted to the RPH emergency room. They hooked me up to an ECG and around two hours later I had a visit from the ER cardiology team to tell me that it seems that every fourth beat of my heart it's actually missing a beat and then fluttering to catch itself up which is what has been causing the constant feeling of having a racing heart etc.

They wanted to keep me in for the weekend to see cardiology and liver on monday, but after finding out that Im safe enough I decided to sign out with the understanding that come monday I'll be spending the entire day at the hospital for a barrage of tests to see if my treatments will actually go ahead or whether this is already the end of the road.

Things will work out right and in what direction the need to go one way or another, they always do. Im pretty confident that they will start my treatments again but maybe on a lower dose of ribaviron. Apparently consensus has it that for my measely under weight body I am on an exceptionally large dose of ribaviron, which indeed can cause this kind of side effect and by lowering the dose hopefully I'll be able to continue with treatments. I'll let you all know tomorrow how it all goes. It HAS to be decided upon tomorrow so that I am not missing an injection tomorrow night and stuffing up the entire treatment plan.

Sammi

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Thanks ME. Hope all is well with you

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Hepatitis: means Inflammation of the Liver. From ancient Greek hepar or hepato- meaning 'liver' and suffix -itis denoting 'inflammation'

Acute Hepatitis: Lasts less than 6 months

Chronic Hepatitis: Persists longer than 6 months

HCV Acronyms

HCV = Hepatitis C Virus

AHC = Acute Hepatitis C

CHC = Chronic Hepatitis C

G or GT = Genotype

RNA = RiboNucleic Acid

DNA = DeoxyriboNucleic Acid

Bx = Biopsy

Dx = Diagnosis

Hx = History

Rx = Prescription

Sx = Symptoms, Side Effects

Tx = Treatment, Therapy (can also mean Transplant)

SOC = Standard of Care

RVR = Rapid Virological Response (4 Week PCR - HCV negative)

EVR = Early Virological Response (12 Week PCR - >2 Log Drop)

EVC = Early Virological Clearance (Aviremic - HCV RNA Negative at Week 12)

PVR = Partial Virological Response (Viremic Response - >2 Log Drop still HCV+ at Week 12

SVR = Sustained Virological Response (UND 6 Months post EOT)

VR = Virological Response

VL = Viral Load

HVL = High Viral Load (≥400,000 IU) (≥600,000 IU) (≥800,000 IU)

LVL = Low Viral Load (<400,000 IU)

UND = Undetectable Viral Load

EOT = End of Treatment

ITT = Intent to Treat

DTT = Difficult to Treat

EIA = Enzyme ImmunoAssay

ELISA = Enzyme-Linked ImmunoSorbent Assay

RIBA = Recombinant ImmunoBlot Assay

PCR = Polymerase Chain Reaction

RT-PCR = Reverse Transcription-Polymerase Chain Reaction.

lakh = 100,000 (from Indian English)

TMA = Transcription Mediated Amplification

IU = International Unit 1 IU (2.5 VL Copies apx)

BMI = Body Mass Index

WHR = Waist to Hip Ratio

NAFLD = Non Alcoholic Fatty Liver Disease (Steatosis)

NASH = Non Alcoholic SteatoHepatitis

ESLD = End-Stage Liver Disease

HCC = HepatoCellular Carcinoma (Liver Cancer)

Drug Acronyms

PEG = PolyEthylene Glycol

IFN = Interferon (Alpha 2a/2b)

PegIFN = Pegylated Interferon Alpha (2a/2b)

CIFN = Consensus Interferon (Infergen/Alphacon)

NPIA = Non-Pegylated Interferon Alpha

S-IFN = Standard Interferon (same as NPIA)

RBV = Ribavirin

RVN = Ribavirin

Riba = Ribavirin

WBR = Weight Based Ribavirin

WBD = Weight Based Dose

FDR = Fixed Dose Ribavirin

LDR = Low Dose Ribavirin (Same as FDR)

GCSF = Granulocyte Colony Stimulating Factor (Neupogen)

Neup = Neupogen

ESA = Erythropoiesis Stimulating Agent

EPO = Erythropoietin Epoetin alfa (Epogen/Procrit), Darbepoetin alfa (Aranesp)

TIW = Three Injections Weekly (Tri Weekly, Three Times a Week, Thrice Weekly)

BID = Twice Daily Dosage (from the Latin phrase “bis in die” which means twice-daily dosage)

SC = Subcutaneous (Beneath or Under the skin)

QW = Once a Week (from Latin quaque)

Blood Test Acronyms

LFT = Liver Function Test

ALT = Alanine Aminotransferase

SGPT = ALT was called Serum Glutamic Pyruvic Transaminase

AST = Aspartate Aminotransferase

SGOT = AST was called Serum Glutamic Oxaloacetic Transaminase

ALP = Alkaline Phosphatase (Alk Phos)

AFP = Alpha-FetoProtein

GGT = Gamma Glutamyl Transpeptidase

LDH = Lactate Dehydrogenase

FBC = Full Blood Count

CBC = Complete Blood Count (almost the same as FBC)

RCC = Red Cell Count

HGB = Hemoglobin

WCC = White Cell Count

MCV = Mean Corpuscular Volume

TSH = Thyroid stimulating hormone (Also called: Thyrotropin)

ULN = Upper Limit of Normal

LLN = Lower Limit of Normal

VLDL = Very Low Density Lipoproteins (Bad Cholesterol)

LDL = Low Density Lipoproteins (Bad Cholesterol)

HDL = High Density Lipoproteins (Good Cholesterol)

TG = Triglycerides (type of fat found in blood)

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A

Abdomen

largest body cavity that contains the stomach, small intestines, colon, rectum, liver, spleen, pancreas, gall bladder, bladder, kidneys and appendix

Abdominal

relating to the abdomen

Acetaminophen

pain reliever and aspirin substitute found in over-the-counter drugs like Tylenol

I

Acute

happening suddenly over a short period of time

Aflatoxin : a fungal toxin which is a powerful liver carcinogen (a substance that causes cancer).

ALCOHOLIC HEPATITIS - Hepatitis with unique pathologic liver injury varying widely in severity and caused by chronic, heavy alcohol ingestion

Alimentary canal

continuous tube that extends from the mouth to the anus in which food is processed and eliminated

Albumin : is the major plasma protein (approximately 60 per cent of the total). It is synthesized by liver. It have three main functions :

* maintain the osmotic pressure (it's a force that keep back plasma into blood vessel, opposing to blood (hydrostatic) pressure)

* transport of ions (e.g. calcium), bilirubin, fats, hormones and drugs

* store amino acids

Albumin decrease when production decreases (liver disease, malnutrition) or loss increases (kidney disease).

In more advanced liver disease, when serum albumin is reduced to less than 3.5 mg/dL (normal values 3.5-5 g/dL), plasmatic osmotic pressure become too low to maintain fluids into blood vessels and edema and ascites occur.

Alkaline phosphatase: protein found in bile duct cell membranes; blood levels may be increased in any liver disease, but more markedly with cholestasis.

Alpha-FetoProtein (AFP) : is a glycoprotein synthesized by the fetal liver and some cancers (mainly HCC and testicular germ cell cancer). It's elevated (normal value <15 ng/ml) in:

* HCC (useful for screening of high risk patient). Diagnostic if greater than 200 ng/ml

* testicular germ cell cancer (not in pure seminoma)

* liver diseases : cirrhosis and chronic hepatitis (< 200 ng/ml) and fulminant hepatitis.

* newborn and mother (decrease progressively after delivery)

* pancreatic, gastric and colonic cancer (less specific)

ALT : see transaminases.

Ammonia : is a toxic by-product of protein metabolism that is transformed in urea (non toxic) by liver cells. In advanced liver diseases there is a build-up of ammonia, due to liver dysfunction. (normal value <50 mg/dl).

Anemia

decrease in the normal level of red blood cells in the bloodstream

Antibodies (or Immuneglobulins, Ig) : are glycoproteins, produced by immune system, which bind to foreign proteins (antigen), causing their elimination. Specific antibodies are produced after an infection or after a vaccination and protect the body from further infections.Their presence can be assessed with blood test to estabilish if a infecious disease is occurred.

Antibodies can also be administered after exposure to an infectious agent to prevent the development of the disease (passive immunization).

Antigen : is a substance which is capable of inducing a specific immune response. Antigens are present on viruses, bacteria, toxins, but also on human cells and tissues (they cause auto immune diseases).

ANTI-NUCLEAR ANTIBODY TEST - ANA Laboratory test, when positive suggests the presence of some form of autoimmune illness.

Artery

a muscular tube that carries blood away from the heart and to all of the other organs of the body

Arthralgia : pain in one ore more joints.

Ascites : accumulation of fluid in the abdominal cavity, usually secondary to liver scarring and increased sinusoidal pressure. Intractable ascites is unresponsive to treatment and continually recurs.

AST : see transaminases.

Asymptomatic : without obvious signs or symptoms of disease.

AZATHIOPRINE - Drug marketed with trade name Imuran. Used to treat a number of diseases of unknown or autoimmune cause. Also used to treat organ transplant recipients to help prevent graft rejection.

B

Basophils : are a type of granulocytes with large basophilic granules that contain histamine. They are not phagocytic.

Benign

not cancerous; does not spread to other parts of the body; the opposite of malignant

Bile : a greenish-yellow fluid secreted by the liver and stored in the gallbladder. Bile contains cholesterol, lecithin, water, bile salts and waste products such as bilirubin and some drugs. Bile salts allow the digestion and the intestinal absorption of fats and then of fat-soluble vitamins (A, D, E and K).

Bile duct

tube that carries bile from the gallbladder to the duodenum

Bilirubin : is a pigment produced when haemoglobin and cytochromes are destroyed. The liver trasforms it into a soluble compound (direct bilirubin) that is elimined with urine and bile. A high level of bilirubin causes yellowing of the eyes and skin, called jaundice.

Biopsy : a procedure used to obtain a small amount of tissue from a organ for microscopic analysis. Biopsy can be accomplished with a biopsy needle, passed through the skin into the organ in question, or by an open surgical incision.

Board Certified

certification from the American Board of Surgery that the surgeon has the skills necessary to specialize in surgery

Blood Cell : there are three main types of cell in the blood stream :

1. erythrocytes (red cell) : carrie oxygen

2. leukocytes (white cell) : fight infections. There are three types of leukocytes :

1. granulocytes

2. lymphocytes

3. monocytes

3. platelets : prevent bleeding

B-Lymphocytes (or B Cells) : are a type of white blood cells involved in the production of antibodies (humoral immunity). When stimulated by an antigen, they evolve into plasma cells, that produce specific antibodies against that antigen.

Budd-Chiari Syndrome : it's a rare disease characterized by occlusion of hepatic veins, usually accompanied by ascites, hepatomegaly, and pain in abdomen.

C

Cancer : a mass of abnormal cells that have lost their functions and grows out of control, invading and destroying the surrounding healthy tissues.

Capsid : the proteic coat that covers the genome (DNA or RNA) of a virus. The capsid is built up of subunits that self assemble in a pattern typical of a particular virus.

Capillaries

smallest blood vessels of the circulatory system that connect arteries and veins; also referred to as capillary beds and network of capillaries

Caput medusae: literally "Medusa's head"; dilated, varicose veins around the umbilicus, which may be seen in patients with cirrhosis of the liver.

Carrier : an individual who hosts a virus or has a gene (or the genes) that cause a disease, withouth displaing its symptoms. A carrier however can transmit the viral disease to other person and genetic disorders to his/her offspring.

Centers for Disease Control and Prevention (CDC) : is an USA agency, responsible for estimating prevalence rates and making epidemiological studies (http://www.cdc.gov/).

Ceruloplasmin: copper transporter protein; blood levels are usually decreased in Wilson's disease.

Chemotherapy

treatment of cancer with anti-cancer drugs

Cholangitis : is an inflammation of bile ducts.

Cholestasis : it 's a stoppage or suppression of the flow of bile.

Chronic : a disease or a symptom that persists for a long period of time without recovers.

CHRONIC HEPATITIS - Prolonged inflammation and death of liver cells persisting for six months or more caused by hepatitis viruses, autoimmune factors, and on occasion, unknown conditions.

Cirrhosis : pathologically-defined disease characterized by diffuse, irreversible fibrosis of the liver surrounding regenerative nodules.

Clotting Factors:

proteins made in the liver that are important in maintaining normal blood clotting. Disruption in the blood's ability to clot may indicate that the liver is not creating enough clotting factors. A severe shortage in clotting factors may indicate that a liver transplant is needed.

Coagulopathy: increased bleeding tendency due to decreased hepatic synthesis of clotting factors.

Colorectal

relating to the colon and the rectum

Complete Blood Count (CBC) : is a blood test that determines the number of red blood cells, white blood cells and platelets present in the patients. (FBC) Full Blood Count (UK)

Cryoglobulins : abnormal plasma immunoglobulins (IgG or IgM) that precipitates when serum is cooled. They cause damage to blood vessels (vasculitis) and therefore to the tissues that they fed.

Cryoglobulinemia : is a condition characterized by the presence of cryoglobulins in the blood.

CT Scan COMPUTERIZED TOMOGRAPHY - A specialized x-ray procedure utilizing multiple radiographic films of the liver to construct with computer technology, a 2-dimensional picture of the liver.

CYCLOSPORINE A - Drug marketed with trade names Sandimmune and Neoral. Given to organ transplant recipients to prevent the body from rejecting the graft. Inhibits immune system from rejecting foreign tissue.

D

Decompensation : is the failure of the compensation of a disease (e.g. decompensated cirrhosis). The decompensation causes the occurrence of symptoms of the disease.

Decompensated Cirrhosis:

a late-stage cirrhosis accompanied by abnormal blood tests and other complications. At this stage of the disease, evaluation for liver transplant becomes an option.

DNA : Deoxyribo-Nucleic Acid (see genome).

Diagnosis : the determination of the nature of a case of disease.

Diuretic : a medication that promotes the excretion of salts and water from the kidney, increasing the volume of urine produced.

Drug : any animal, vegetable, or mineral substance used in the composition of medicines.

E

Edema (Oedema) : the presence of abnormally large amounts of fluid in the intercellular tissue spaces of the body.

Endemic : a disease or an agent present or usually prevalent in a population or geographical area at all times.

Encephalopathy : alteration in sleep patterns and mental status, ranging from forgetfulness and mild confusion to coma; may be caused by circulating gut-derived brain-toxic proteins not cleared by a dysfunctional liver.

Endoscope : a flexible viewing instrument used for inspection of any cavity of the body. It has diagnostic (e.g. biopsy) and therapeutic capabilities (e.g. esophageal varices sclerotherapy) through special channels.

Envelope : is the outer layer of some viruses (e.g. HBV). It derives from plasma membrane of the host cell.

Eosinophils : are a type of granulocytes. They destroy parasitic organisms and play a major role in allergic reactions (hypersensitivity). They also secrete chemical mediators that can cause bronchoconstriction in asthma.

Erythrocytes : see red blood cells.

Esophageal Varices : is an abnormal dilatation of the veins in the esophagus, that occurs as the result of portl hypertension due to liver cirrhosis. Varices are prone to rupture, causing a serious bleeding.

Exacerbation : an increase in the severity of a disease or of its symptoms.

F

Falciform ligament

band of strong fibrous tissue that connects the right lobe and the left lobe of the liver

Fatty liver (steatosis) : abnormal lipid increase in the liver.

Ferritin : is an iron storage protein found mainly in liver. It's released in blood, where it can be dosed, giving information on iron body storage. Higher than normal values can be seen in haemochromatosis.

Fibrosis : is the deposition of collagen, that forms a fibrose (scar) tissue, poor of blood vessels and of cells and that therefore impair liver function. Liver fibrosis represents the wound healing response of the liver to a long term disease that damage it. Liver fibrosis leads to cirrhosis.

False negative:

Test result that indicates that an abnormality or disease is not present when, in fact, it is.

False positive:

Test result that indicates that an abnormality or disease is present when, in fact, it is not.

Fecal-oral:

Mode of transmission of an infectious agent from person toperson by putting something in the mouth that has been contaminated with the stool of an infected person.

Fibrosis:

scar tissue developed as a result of chronic infection and inflammation. The presence of fibrosis usually means several years of active infection have taken place. Fulminant - Occurring suddenly, with lightning-like rapidity, and with great intensity or severity.

Food and Drug Administration (FDA) : the U.S. Agency responsible for regulation of biotechnology food products. The major laws under which the agency has regulatory powers include the Food, Drug, and Cosmetic act, and the Public Health Service Act.

Fulminant hepatitis : a severe and rapidly progressive form of hepatitis accompanied by hepatocellular death and hepatic failure.

G

Gallbladder : a digestive organ which stores bile (produced in the liver), used in the digestion and absorption of fats in the duodenum.

Genome : one or more molecules of nucleid acid, called chromosomes, that encode the genetic informations (genes) required to determinate the structure, function and behavior of a cell or of a virus. Human genome has 46 chromosomes of DNA. Viruses can have a DNA (e.g. HBV) or a RNA (e.g. HCV) genome.

Genotype:

Genetic makeup of the virus that describes the ³family² to which the specific virus belongs; there are at least 6 distinct HCV genotypes identified genotype 1 is the most common genotype seen in the United States

GGT (gamma-gutamyl transferase):

a liver enzyme that may be elevated in patients with hepatitis. Guillain-Barre syndrome - An inflammation of the nerves of unknown cause characterized especially by muscle weakness and paralysis.

Glycogen : is a branched polymer of D glucose and represents the major short term storage of glucose of animal cells and is particularly abundant in the liver and to a lesser extent in muscle.

Glycolysis : is the conversion of glucose to pyruvate, with production of energy (2 molecule of ATP). The glycolytic pathway takes place in the cytosol of cells.

Granulocytes : are a type of white blood cells with numerous cytoplasmic granules. They are subdivided, according to the staining properties of the granules, into eosinophils, basophils and neutrophils.

H

Hemophilia:

A sex-linked hereditary blood defect that occurs almost exclusively in males and is characterized by delayed clotting of the blood and consequent difficulty in controlling hemorrhage even after minor injuries.

Hemodialysis:

The use of a machine to clean wastes from the blood after the kidneys have failed; the blood travels through tubes to a dialyzer, a machine that removes wastes and extra fluid; the cleaned blood then goes back into the body.

Hemochromatosis : a rare genetic (inherited) disease that results in the over abundance of iron in the body tissues. Iron, when present in excessive amount, becomes toxic for cells, damaging them. The liver and the heart are the most important organs involved.

Hemoglobin (or haemoglobin) : is the oxygen carrying protein found in red blood cells. A low concentration of hemoglobin in blood is called anemia.

Hepatic : pertaining to the liver.

Hepatic artery

blood vessel that carries oxygen-rich blood to the liver from the heart

Hepatic portal vein

blood vessel that carries oxygen-poor blood from the liver back to the heart

Hepatic Stellate Cells (or Ito cells) : reside in the space of Disse and in normal liver are the major storage site of vitamin A. When a chronic liver injury occurs (e.g. a chronic hepatitis), these cells start produce collagen and other extracellular matrix proteins, that lead to liver fibrosis and then to cirrhosis.

Hepatitis : is an inflammation of the liver, that can be caused by viruses, bacteria, drugs or toxins. If persist for more than 6 months is called chronic hepatitis.

HEPATITIS A ANTIBODY (Anti HA) - Main laboratory test used to detect hepatitis A. Detects antibody produced by patient's immune system in response to hepatitis A virus.

HEPATITIS A - Hepatitis caused by hepatitis A virus. Most common in children and adolescents. Usually resolves in a few weeks. Almost never fatal. Transmitted by contaminated food and water.

HEPATITIS B CORE ANTIBODY (Anti-HBc) - Laboratory test that detects antibody produced by patient's immune system in response to internal components of the hepatitis B virus.

HEPATITIS B SURFACE ANTIBODY (Anti-HBs) - Laboratory test that detects antibody produced by patient's immune system in response to surface component of the hepatitis B virus.

HEPATITIS B SURFACE ANTIGEN (HBsAg) - Main laboratory test used to establish a diagnosis of hepatitis B. Detects component of hepatitis B virus circulating in patient's serum.

HEPATITIS B VIRUS DNA (HBV DNA) - Laboratory test that detects internal component of hepatitis B virus.Reflects degree of activity or rate of multiplication of the virus.

HEPATITIS Be ANTIGEN (HBeAg) - Laboratory test that helps to determine degree of activity, or rate of multiplication, of hepatitis B virus.

HEPATITIS B - Hepatitis caused by the hepatitis B virus, transmitted by infected serum. Full recovery in more than 90% of infected individuals in a few days to a few weeks. Five to ten percent of individuals may develop chronic hepatitis, cirrhosis, or severe liver failure requiring transplantation.

HEPATITIS C ANTIBODY (Anti-HC) - Laboratory test that detects antibodies produced by patient's immune system in response to presence of the hepatitis C virus. Laboratory test methods include enzyme immunoassay (EIA) and radioimmunoblot assay (RIBA).

HEPATITIS C RNA (HC RNA) - Laboratory test that measures the levels of components of the hepatitis C virus in the patient's serum.

HEPATITIS C - Hepatitis caused by the hepatitis C virus. Transmitted by infected serum. Less than half the patients recover with disappearance of the virus. Individuals may develop chronic hepatitis, cirrhosis and severe liver failure, usually after many years of infection.

HEPATITIS D ANTIBODY (Anti-HD) - Laboratory test that detects antibodies in serum produced by patient's immune system in response to the presence of hepatitis D virus.

HEPATITIS D - A unique viral particle that infects individuals only when there is concommitent hepatitis B infection. Increases the likelihood of severe liver damage and cirrhosis.

HEPATITIS E - Hepatitis caused by the hepatitis E virus. Transmitted by infected food and water and more common in tropical and subtropical regions of the world than in the United States. Substantial fatality in pregnant women.

Hepatic encephalopathy: is a serious complication of advanced liver disease caused by toxins, that the liver is no more able to remove from the bloodstream. It is clinically manifested by personality changes and impaired intellectual ability, awareness, and neuromuscular functioning.

Hepatologist : is a physican who specializes in the liver and its diseases.

Hepatocellular necrosis: localized tissue death of hepatic cells.

Hepatocellular carcinoma (HCC): a primary liver tumor more common in patients with cirrhosis.

Hepatocytes: liver cells.

Hepatorenal syndrome: poorly understood terminal kidney failure in the setting of hepatic disease.

Histology : the study of cells and tissue structure on the microscopic level. The study is performed on small amount of tissue obtained with a biopsy.

Homeostasis : tendency of the body to maintain a stable internal environment, using a variety of counterbalancing control systems.

Human Leukocyte Antigen (HLA) : is the human Major Histocompatibility Complex (MHC).

Hyperbilirubinemia : abnormally high levels of bilirubin in the blood.

I

Immunoglobulin (or Ig) : see antibodies.

Immune System:

The complex system in the body responsible for fighting disease. Its primary function is to identify foreign substances in the body (bacteria, viruses, fungi or parasites) and develop a defense against them. This defense is known as the immune response. It involves production of protein molecules called antibodies to eliminate foreign organisms that invade the body.

Immunity:

Protection against a disease. There are two types of immunity, passive and active. Immunity is indicated by the presence of antibodies in the blood and can usually be determined with a laboratory test. See active and passive immunity.

Immunity, Active:

Resistance developed in response to an antigen (infecting agent or vaccine) and usually characterized by the presence of antibody produced by the host. Immunity, Passive: Immunity conferred by an antibody produced in another host. This type of immunity can be acquired naturally by an infant from its mother or artificially by administration of an antibody-containing preparation (antiserum or immune globulin).

Immunization:

The process by which a person or animal becomes protected against a disease.

Immunocompromised:

Any condition in which the immune system functions in an abnormal or incomplete manner; such conditions are more frequent in the young, the elderly, and individuals undergoing extensive drug or radiation therapy.

Immunogenic:

Producing immunity; capable of inducing an immune response; for example, hepatitis B vaccine produces a protective immune response in 90%-95% of young healthy adults.

Immunoprophylaxis:

Preventing the spread of disease by providing physiological immunity.

Immunosupression:

When the immune system is unable toprotect the body from disease. This condition can be caused by disease (like AIDS) or by certain drugs (like those used in chemotherapy). Individuals whose immune systems are compromised should not receive live, attenuated vaccines.

Incubation period : is the amount of time that elapses between infection and the development of symptoms. It varies for the different hepatitis viruses.

Inflammation : a localized protective response induced by injury or destruction of tissues. It is characterised in the acute form by the classical signs of pain, heat, redness, swelling and loss of function. Histologically, it's characterized by dilatation of arterioles, capillaries and venules, with increased permeability and blood flow (cause heat and redness), exudation of fluids, including plasma proteins and leucocytic migration into the inflammatory focus (cause pain, swelling and loss of function).

Intrahepatic : within the liver.

Infection : is the invasion and multiplication of microorganisms in body tissues, which may be clinically unapparent or result in the development of a disease.

INTERFERON - Drug produced by several companies with brand names: Intron, Roferon, and Infragen for the treatment of hepatitis B and C. Interferons are natural substances produced by the body that help to strengthen the immune system and display anti-viral activity against infections such as hepatitis C.

INFERGEN® (interferon alfacon-1), also known as consensus interferon, is marketed for the treatment of adults with chronic hepatitis C virus (HCV) infections. It is currently the only FDA approved, bio-optimized interferon developed through rational drug design and the only interferon with data in the label specifically for non-responding or refractory patients. InterMune's sales force re-launched Infergen in January 2002 with an active campaign to educate U.S. hepatologists about the safe and appropriate use of Infergen, which represents new hope for the more than 50 percent of HCV patients who fail other currently available therapies.

IVDU : Intravenous drug use.

J

Jaundice : is a yellow coloration of eyes and skin. It's due to the build-up of a yellow pigment called bilirubin (see bilirubin). Jaundice occurs when too much bilirubin is produced (e.g. haemolitic anemia), or when there is a liver disfunction (e.g. hepatitis) or when there is a bile ducts obstruction (e.g. gallstones).

K

Kuppfer Cells : are specialised macrophage of the liver sinusoids. They are part of the reticuloendothelial system.

L

Lesion : any pathological or traumatic discontinuity of tissue or loss of function of a part.

Lethargy : abnormal drowsiness or stupor, a condition of indifference.

Leukocytes (or white blood cells) : blood cells that fight infections and other diseases. They can be found in blood and lymphatic system. There are three types of leukocytes : granulocytes, lymphocytes and monocytes.

Limiting plate: layer of hepatocytes surrounding each portal triad and separating it from the surrounding sheets of hepatocytes.

LIVER BIOPSY - Procedure used to take a sample of the liver to study under a microscope to determine the degree of liver damage or the type of liver injury. Can be performed by passing a needle between the ribs on the right side or at the time of surgical procedure where the abdomen is opened.

LIVER FAILURE - A term used to refer to the clinical picture produced by end-stage cirrhosis manifested by esophageal variceal hemorrhage, ascites, and/or hepatic encephalopathy.

Lymph nodes

small glands located throughout the lymphatic system that store cells that help fight infection and disease

Lymphocytes : are a type of white blood cells that fight infection with high specificity. There are 2 types of these cells (see B-Lymphocytes and T-Lymphocytes).

M

Macrophages : are phagocytic ("eating") cells of mammalian tissues, derived from blood monocytes (a type of white blood cells). Macrophages play an important role in immune response. In fact, in response to foreign materials, they become activated and can kill some bacteria, protozoa and tumour cells; release substances that stimulate other cells of the immune system and present antigens to T-Lymphocytes, activating them (they are Antigen Presenting Cells or APC).

Macrophages may further differentiate within chronic inflammatory lesions (granulomas) to epithelioid cells or may fuse together to form the foreign body giant cells or the Langhans giant cells.

Major Histocompatibility Complex (MHC) : is a complex family of genetically inherited proteins that play a critical role in immune response to foreign organisms. It is also involved in autoimmune disease and in transplant rejection. MHC are located on cell surface and work like receptors, that interact with immune cells. In mammals there are 2 classes of MHC :

* Class I : is present on the surface of all cells. T-lymphocytes use it to recognize infected cells.

* Class II : is present only on Antigen Presenting Cells (APC) and is involved in the activation of immune response.

Human MHC is called Human Leukocyte Antigen (HLA).

Malaise

vague feeling of discomfort like the onset of an illness

Malignant

cancerous; cancer cells that may spread to other parts of the body

MITOCHONDRIAL ANTIBODY - Laboratory test used to help establish a diagnosis of primary biliary cirrhosis.

MYCOPHENOLATE MOFETIL - Drug marketed with trade name Cellcept. Given to organ transplant recipients to prevent the body from rejecting the graft. Inhibits immune system from rejecting foreign tissue.

Monocytes : one of three types of white blood cells. Monocytes can exit from blood vessels and reach the tissues, where they evolve into macrophages.

Myalgia : pain in one or more muscles.

Myoglobin : is a oxygen store protein found in muscles.

N

Necrosis : is the cell death. It may affect groups of cells or part of a structure or an organ.

Needlestick Injury : penetrating stab wounds caused by a needle. It can cause the transmission of blood-borne pathogens.

Neutrophils : are a type of granulocytes. They are phagocyte and are increased when a bacterial infection occurs.

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) : are commonly used drugs with anti-inflammatory, fever-reducing, and pain-relieving properties. They works by inhibiting cyclooxygenase, an enzyme responsible for making prostaglandins.

Nucleus : is the major organelle of eukaryotic cells. It contains the cell genome (chromosomes), that is separated from the cytoplasm by the nuclear envelope.

Nuclear Envelope : a membrane system that surrounds the nucleus of eukaryotic cells. Consists of inner and outer membranes, separated by perinuclear space and perforated by nuclear pores.

O

OLT : Orthotopic Liver Transplantation.

Oncogene : a gene that induces cancer. It can be a gene of a normal cell that becomes alterated (see proto-oncogene), or derives from a virus (viral oncogene) that infects a normal cell.

Oncogenic : an event or a cause that induces cancer.

Opportunistic infections: are infections that occur in persons with weak immune systems due to AIDS, cancer or immunosuppressive drugs such as corticosteroids or chemotherapy.

P

Pathogenesis : the origin and development of a disease.

PCR (Polymerase Chain Reaction) : it's a technique used to amplificate DNA. Also RNA can be amplificate, but it must be first transformed into RNA. A test based on PCR is very sensitive and is used to detect the presence and the amount of DNA or RNA of a specific organism (e.g. a virus) in the blood or tissue.

Pathogens:

Bacteria, viruses, parasites, or fungi that can cause disease.

Pegylated interferon:

FDA approved antiviral drug for treatment of chronic hepatitis C in persons 18 years and older; pegylated interferon remains active in the bloodstream longer and at a more constant level than standard interferon and can be given less often than standard interferon; combination therapy using pegylated interferon and ribavirin is the treatment of choice for chronic hepatitis C.

Percutaneous:

Passed through the skin. Permucosal:

Passed through the mucosa, which is a lining of various organs (e.g., mucosal lining of the mouth).

Pharmaceutical clinical trial:

A carefully designed and executed investigation of the effects of a drug administered to human subjects; the goal is to define the clinical efficacy and pharmacological effects (toxicity, side effects, incompatibilities or interactions); the federal government requires strict testing of all new drugs before their approval for use as therapeutic agents.

Phagocyte : a cell that is capable of phagocytosis (eat foreign particles or other cells). The main mammalian phagocytes are neutrophils and macrophages.

Pharmacocynetic : is the study of the time courses of absorption, distribution and elimination of drugs.

Plasma Cells : are specialized white blood cells that produce antibodies. They derives from B-lymphocytes.

Platelets

special blood cells that cause blood to clot and stop bleeding

Portal hypertension: abnormal increase in portal blood pressure, usually due to obstruction of, or increased resistance to, portal blood flow.

Portosystemic shunting: development of blood vessels that connect the portal and systemic circulation while bypassing the liver.

Portal system: includes all the veins that drain the small and large intestines, stomach, and spleen and that converge into the portal vein to drain into the liver.

Portal triad (or tract): consists of three components: branch of the hepatic artery, branch of the portal vein, and a biliary duct, all held tightly together by a limiting plate of hepatocytes at the periphery of the lobule.

Portal Vein : is a large vein that carries blood from the spleen, pancreas, stomach and intestines to the liver.

PORTAL-SYSTEMIC ENCEPHALOPATHY - Refers to a condition of mental status changes, ranging from mild confusion to a coma-state resulting from increased ammonia transferred to the brain because of the inability of the liver to remove this toxic compound from the circulation.

PREDNISONE - Drug used to treat a number of autoimmune diseases. Broken down by body into a product normally produced by the adrenal gland. Has broad immunosuppressive effects and is often used for management of organ transplant recipients.

PRIMARY BILIARY CIRRHOSIS - Chronic liver disease, most common in women, caused by inflammation of bile ductules leading to a raised serum alkaline phosphatase and serum bilirubin. Course may be prolonged over many years or may proceed to liver failure in 3-5 years.

PRIMARY SCLEROSING CHOLANGITIS - A liver disorder that most commonly occurs in patients with inflammatory bowel disease resulting in destruction of the bile ductules in the liver leading to a marked increase in the serum alkaline phosphatase and serum bilirubin. Ultimately leads to cirrhosis and liver failure.

Protease Inhibitors : these drugs block the ability of the viral protease to cleave the finished viral polypeptide sequence into the smaller functional enzymes, thus interfering with further production of viruses. This is the newest group of HIV drugs available on the market (saquinavir and ritonavir). Protease inhibitors specific for HCV are under study.

Prothrombin time (PT): laboratory test that measures the clotting of blood in seconds; abnormally increased PT signifies bleeding risk due to deficient synthesis of clotting proteins.

Proto-oncogene : a normal cellular gene that is activated to become an oncogene by mutation, deletion, rearrangement over expression or inappropriate expression.

Prodromal phase:

Pertaining to the initial stage of a disease; the interval between the earliest symptoms and the appearance symptoms.

Prophylaxis:

Measures designed topreserve health (as of an individual or of society) and prevent the spread of disease (e.g., HBIG and hepatitis B vaccine given to a baby born to an HBV infected mother is a prophylactic treatment toprevent perinatal HBV transmission).

Protein:

A large molecule composed of one or more chains of amino acids in a specific order; the order is determined by the base sequence of nucleotides in the gene that codes for the protein. Proteins are required for the structure, function, and regulation of the body's cells, tissues, and organs; and each protein has unique functions. Examples are hormones, enzymes, and antibodies.

Pruritus: itching.

Q

Quasispecies : the genetic heterogeneity of viral population within an infected individual.

Red Blood Cells (RBC or erythrocytes) : are cells specialized for oxygen transport, that is binded to hemoglobin, present in large amount in these cells.

Resection : removal of a portion or all of an organ or other structure.

Ribavirin : is an antiviral drug (is a nucleoside analogue) active against respiratory syncytial virus and hepatitis C virus (HCV).

RIBA:

Recombinant immunoblot assay; FDA licensed and approved supplemental laboratory test that detects antibodies against HCV and is used to verify a positive anti-HCV by EIA.

Risk factors : are an aspect of personal behaviour or lifestyle, environmental exposure, or inborn or inherited characteristic, which, on the basis of epidemiologic evidence, is known to be associated with a health-related condition.

RNA : Ribo-Nucleic Acid. Plays a role in transferring information from DNA to the protein-forming system of the cell. Some viruses, like HCV, have a genome of RNA.

Serologic Test : a blood test that detects the presence of antibodies to a particular antigen (e.g. anti-HCV test).

SGOT : see transaminases.

SGPT : see transaminases.

Sign : is the objective evidence of a disease, perceptible to the examining physician.

Spider angiomas: red capillary tufts in the skin that blanch on pressure; often found in patients with cirrhosis.

Splenomegaly : enlargement of the spleen. It's a sign of portal hypertension.

Spontaneous bacterial peritonitis (SBP): bacterial infection of ascitic fluid.

S

Sonographer

technician who specializes in the operation of ultrasound equipment

Steatorrhea : decreased absorption of dietary fats, resulting in their passage to the distal bowel which causes foul-smelling diarrhea; can be caused by deficiency of bile salts.

Steatosis (fatty liver) : abnormal lipid increase in the liver.

Subcutaneous Injection : the delivery of a medication into the subcutaneous tissues via injection.

Symptom : is the subjective evidence of disease perceived by the patient (symptom).

T

TACROLIMUS (FK506) - Drug marketed with trade name Prograf. Given to organ transplant recipients to prevent the body from rejecting the graft. Inhibits immune system from rejecting foreign tissue.

Thrombocytopenia : a decrease in the number of platelets in the blood, resulting in the potential for increased bleeding and decreased ability for clotting. It can occur in cirrhotic patients, when splenomegaly is present.

Tissue : a group of similar cells united to perform a specific function.

T-Lymphocytes (or T-Cell) : are a type of white blood cells responsible for cell-mediated immunity. They originate from lymphoid stem cells that migrate from the bone marrow to the thymus, where differentiate under the influence of the thymic hormones.There are three subpopulations of T-lymphocytes :

* T cytotoxic (or Tc) : kills cells infected by viruses.

* T helper (or Th) : stimulates immune response. It's infected and destroyed by HIV, leading to AIDS.

* T suppressor (or Ts) : inhibits immune response.

TOXIC HEPATITIS - Hepatitis caused by an industrial chemical such as carbon tetrachloride or phosphorus.

Toxin : any chemical that interferes with normal cell function.

Transaminases (SGOT or AST, SGPT or ALT) : are enzymes present in liver cells. They are released in bloodstream when a liver damage occurs.

Transmission : the passage or transfer, as of a disease from one individual to another.

U

Ultrasonography : a technique in which high-frequency sound waves are used to create bidimensional pictures of internal organs (Ultrasound Imaging).

Ultrasound Guided Biopsy : is the use of ultrasound imaging to guide a biopsy needle to obtain a sample of tissue for analysis by a pathologist.

ULTRASOUND EXAMINATION - A test that utilizes ultrasound waves to bounce off internal organs of the body to construct a picture used by physicians as a non-invasive study of the liver.

V

Vaccine : a preparations used for the prevention of an infectious disease. It stimulates an immune response in the body (active immunization) in order to prevent future infection with similar microorganism.

Varices : small protruded vessels. Varices in esophagogastric region are one of the major complications of cirrhosis.

Viral Hepatitis : a liver inflammation caused by viruses. There are seven specific hepatitis viruses (HAV, HBV, HCV, HDV, HEV, HGV and TTV). Other viruses, like cytomegalovirus (CMV) and Epstein-Barr virus (EBV), can also cause hepatitis, but their primary target is not the liver.

Viral load : is the number of viral particles in a sample of blood plasma. It is measured by PCR and bDNA tests and is expressed in number of copies or equivalents per millilitre.

Viremia : the presence of virus particles in the blood. It can be detecteted and dosed with a test called PCR.

Virion : a single virus particle, complete with coat.

W

Wilson's disease: inherited metabolic disorder in which copper accumulates in the liver and in the central nervous system, causing hepatitis, cirrhosis, and neuropsychiatric symptoms

White Blood Cells (WBCs) : see leukocytes.

Wild Type : the naturally-occuring, normal, non-mutated version of a gene or of an organism.

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Things that Increase your Chances of Treatment Success

1. Younger Age....younger people have a higher SVR.

2. Female Sex.... Females clear the virus more than males.

3. Having Genotype 2 or 3 which are the easier ones to get rid of.

4. Amount of liver damage....it is more difficult to clear the virus if you have cirrhosis (Stage 4).

5. Viral load.....it's easier to clear if you have a low viral load. High viral load is associated with having insulin resistance.

http://www.hepcaustralia.com.au/index2.php?option=com_content&do_pdf=1&id=575

6. Compliance....Taking at least 80% of the meds, 80% of the time increases your chances of treatment success. Obviously, it's better never to miss any doses. So you must be careful not to forget to take your meds and always get refills early so you won't run out.

7. Right Dose.....

Pegasys has only one dose 180mcg weekly, plus Copegus (capsules) 800mg daily for Genotype 2/3. The dose of Copegus for genotype 1 is either 1000mg daily if you weigh <165 lbs or 1200mg daily if you weigh more.

PegIntron is based on body weight. Plus Ribavirin (capsules) 800g daily for Genotype 2/3 For Genotype 1, the dose of Ribavirin is 1000mg if you weigh <165lbs and 1200mg daily if you weigh >165lbs. However, if you weigh more than 300lbs, ask your doctor if you need a higher dose of Ribavirin.

8. Hormones....For women, being post-menopausal (or having had a total hysterectomy) decreases the chances of treatment success. An option for post-menopausal women would be to start taking hormones before starting the treatment but this should be discussed with their doctor since hormones can increase the risk of breast and cervical cancer ....especially if you have a family history of these types of cancer.

For men....low testosterone can increase insulin resistance and having insulin resistance decreases SVR. So having your doctor check your testosterone may be an option, especially if you're diabetic. Diabetes is associated with having low testosterone.

http://natap.org/2008/HIV/030508_05.htm

9. Lowering Insulin Resistance.

http://scholar.google.com.au/scholar?q=lowering+insulin+resistance+and+HCV&hl=en&as_sdt=0&as_vis=1&oi=scholart

10. Weight Loss before starting treatment if you're obese. It decreases insulin resistance.

11. Exercise.....it decreases insulin resistance. Also, the Hepatitis C virus damages the mitochondria (the power plant ) of liver cells and aerobic exercise creates more mitochondria.

http://www.ncbi.nlm.nih.gov/pubmed/18325973?ordinalpos=19&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

12. Protein.....increases energy, promotes healing, and a Protein-rich diet boosts the benefit of exercise.

13. Treating Anemia with Procrit, Aranesp.

14. Having low Alphafetoprotein (AFP).....blood test for liver cancer.

http://www.ncbi.nlm.nih.gov/pubmed/17713163?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA&linkpos=2&log$=relatedarticles&logdbfrom=pubmed

15. Milk Thistle....it's good for the liver and it also may help treat diabetes.

http://diabetes.webmd.com/news/20061031/milk-thistle-help-treat-diabetes

16. Green Tea.....improves immunity.

Also, the Hepatitis C virus causes the liver to disgorge large amounts of glucose. Epigallocatechin Gallate, a constituent of Green Tea, represses hepatic glucose production.

http://www.jbc.org/cgi/content/abstract/277/38/34933

17. Anti-oxidants

http://www.sciencedaily.com/releases/2008/01/080110190902.htm

18. Omega 3

www.omega-3centre.com/

19. Zinc..... Zinc supplementation has been shown to contribute to inhibition of liver fibrosis, it decreases insulin resistance and it exerts an anti-inflammatory effect on the liver.

http://www.ncbi.nlm.nih.gov/pubmed/17710674?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

20. Statins.....Cholesterol Medications....because of their anti-oxidant properties.

http://www.tulsaworld.com/scene/?articleID=20080411_1_A5_hAnOk02858

21. Grapefruit juice.....naringenin, a compound in grapefruit, has been shown to decrease viral load.

http://www.sciencedaily.com/releases/2008/02/080204124110.htm

(Warning: Grapefruit juice can increase the effect of many medications, including many blood pressure meds. DO NOT drink grapefruit juice without checking with your doctor to make sure it does not interfere with any meds you take).

22. Bitter Melon

http://www.ncbi.nlm.nih.gov/pubmed/17942003?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA

23. Stevia.....inhibits HCV replication. (Also lowers insulin resistance).

http://www.medhelp.org/posts/Hepatitis-C/Stevia-curcumin--INTERESTING/show/556671

24. Taking Vitamin D (if you had a blood test and the result was low).

25. Vitamin B12.

(Warning: Always check with your doctor before taking any supplements).

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Sammi, been thinking about you. How is it going? Were you able to continue the injections?

Great information you are posting

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heya JJ.

Thank you. Its nice to hear someone say that the info Ive been posting is good and also thank you for your interest and desire to know how my treatments are going.

I spent monday at the hospital at both the liver and cardiology clinics. They have discovered as mentioned that I have an irregular heartbeat but they don't think that the treatments have caused it and they reinstated them again. I spent Monday afternoon with Cardiology who are going to be doing a heap of stress tests and what not tomorrow. I also see the liver clinic again tomorrow to fill them in on what has been happening. Since monday the side effects have been around the same as last week, fever, chills, joint pain, lethargy, headaches, although this 2nd injection has also brought with it the (ahem) poops, and last night even a manic period. Sleep has been almost non existant and the heart palpitations are still there but def not as bad as last week.

Im quite stoked that the treatments continued despite the Sx (side effects), mind you I probably wont be saying that in a month or so when the anemia hits or the bleeding gums and a number of other serious side effect, not to mention the chronically dry skin, eczema, and skin rashes. But you know me, chin up...soldier on and no matter what stay positive.

Its going to be a long and weary road thats for sure, these treatments are very hard hitting, but worth every moment of it when at the end you are given the SVR (Sustained Viral Response). I'll keep you updated as things progress and treatments are continued, In approx two weeks we should know if the treatments are starting to work with PCR (polymer chain reaction) and viral load blood tests indicating any kind of large drop.

hugs JJ

Sammi

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.

Sammi.......

I have a friend that just finished his Interferon treatments....

His HEP C came on from his actions as a much younger person...

They were to be one year long (all of 2010) but had to stop a month early when other health problems were found..

But, now he tests negative and his cell counts are good.

And he is getting his strength back...

I'm hoping that it all turns out as well for you!

Huggs

Donna Jean

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Whoa! Sammi. That's a lot of info to take in at one setting. It'll take me a day or to to memorize all of that. :lol: I hope you're doing ok, my friend.

ME

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So glad to hear that the treatment is continuing Sammi even though it means so much misery for you in the short term.

You are so courageous and your story inspires many people to keep fighting in their own lives.

I'm proud to know you

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:groupwavereversed: (god I love the emotes on the forums - yea yeah I know small things amuse small minds......ooohhhh look Shinies :o )

DJ: Please congratulate your friend for me. 48 weeks is a long treatment program, but just recently I have met someone who is on a 74 week treatment which made my jaw drop. Thankfully mine is only 6 months. I assume your friend would have had genotype 1a or b. I have genotype 3 which has shown to respond better with treatments. Im really happy to hear that he has hit a SVR. Ive been told it can take up to and over about 6 month to start getting back to some kind of normality after Tx's (normality? am I making up words again?)

Thank you for your well wishes and hopes DJ, and yep its going to be just fine. It will all turn out the way it's supposed to in the end, it ALWAYS does, you just have to ask the universe to provide ;) Im going to moan and whine and complain along the way but it'll work out fine :)

ME: Sorry for the over load, but I kinda figured everyone could indeed take their time with it all and at least have an idea of what some of the things Im going to be talking about, but I'll slow up ;) How am I feeling? Hmmm right at this minute absolutely fantastic, Ive just had the best sleep Ive had for weeks, Ive managed to make a really good healthy meal, I'm smiling so much my cheeks hurt, Im just in a really good mood. Hows things with with you? I hope your well and smiling also :)

JJ: You nearly made me cry. What a wonderful thing to say to someone, thank you. It does mean a lot to know that you are all there behind me and supporting. Having that support from everyone is so important along this treatment journey and to know you are there and following that journey means a lot to me. Thank you :)

Hugs everyone

Sammi

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ME: Sorry for the over load, but I kinda figured everyone could indeed take their time with it all and at least have an idea of what some of the things Im going to be talking about, but I'll slow up How am I feeling? Hmmm right at this minute absolutely fantastic, Ive just had the best sleep Ive had for weeks, Ive managed to make a really good healthy meal, I'm smiling so much my cheeks hurt, Im just in a really good mood. Hows things with with you? I hope your well and smiling also

I'm glad to hear that you're having a good day and hope you have many many more. Hepatitis C must be a very complicated disease. I've learned a lot from the info you've supplied. I wasn't aware that it's not contagious for example.

As for me, I'm well. Got to shovel some snow today for exercise. :lol:

ME

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shovelling snow :goodjob: that;ll keep you fit and active. One of my close friends was across the road today digging a trench round a tree stump getting it ready to be removed. I wanted to help soooo much but even just watching him exhausted me :hairpull:

Today has been a really quiet day thankfully. Ive needed one after the last few days. Ive spent the day eating while I had an appetite and just resting after my shift in chat. I unfortunately had to leave my shift about 20 min's early because I did a fantastic impression of stu's new pup. I went from 100mph to zero in 1.04 seconds I was literally passing out where I sat in a split second. so I excused myself and headed to bed. I got 6 or 7 hours sleep, completely wiped out uninterupted sleep. I still feel exhausted upon waking, but atm that seems to be the only ongoing Sx. The others seem to come and go at differing times. But I know it's still only early days.

Stu seems to think that the interferon is changing my DNA coz Ive gone from drinking 20 or more cups of coffee a day to maybe one AND doing what I swore I'd never do......actually enjoy a cuppa tea :doh1: Hell really has frozen over :thumbsup:

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Sammi you just made me go get a cuppa myself. But then I've always liked a good tea anytime but morning. Morning is coffee.

I am glad to hear that the sx aren't too bad right now. I hope it continues to be that way.

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:dunno: all I could do was sleep today. trying to stay away has been a nightmare. My entire body is just screaming at me to sleeeep!

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:harhar: Hiya's

So a little HCV biology

HCV is a enveloped positive sense RNA virus and is a member of the Flaviviridae family

Flaviviridae is a family of viruses that gets its name from Yellow Fever virus; flavus means yellow in Latin. (Yellow fever in turn was named because of its propensity to cause jaundice in victims.).

The family includes the following members:

Flavivirus

• Yellow Fever

• West Nile Virus

• Dengue FeverGenus

Hepacivirus

• Hepatitis C Virus (the single member although GBV has been added recently)

Pestivirus (contains viruses that do not infect humans

• Bovine virus diarrhea

• Classical Swine Fever or hog cholera

So now we know HCV is an RNA virus and what family of viruses it belongs to.

Now for its size. HCV is approximately 50nm. Nm=nanometer or 1 billionth of a meter.

Not very big in other words. Several hundred thousand would fit on a .

The HCV genome is approximately 9600 bp in length.

You may see this written as 9600 neuclotides or 9.6 kb. But it is all the same thing.

A Neucleotide is the basic structural unit of DNA or RNA.

Kb = kilobase and bp = base pair

Base pair and neucleotide is the same thing

A kilobase is 1000 base pairs or neucleotides.

You may also find in some studies that HCV is 9.4 kb, probably because the genotypes are a slightly different size.

The HCV genome consists of approxinmately 3000 amino acids that encode 10 proteins.

These proteins are either structural of non structural.

The structural proteins are

Core, E1, E2 & P7

The non structural proteins are

NS2, NS3, NS4a, NS4b, NS5a,NS5b

NS3 is a protease and NS5 is a polymerase.

NS3/4 is also a helicase.

Both Telaprevir and bocepeprivir are protease inhibitors and target the NS3 protein

They are other drugs being studied (polymerase inhibitors that target the NS5b protein.

HCV replicates at between 100 billion and 1 trillion copies per day, without any error checking as RNA doesn not have any proof reading unlike DNA.

This high replication rate has produced a high degree of genetic diversity within the HCV genome.

HCV is divided into 6 genotypes numbered 1 thru 6.

Originally there were genotypes 7,8,9,10 & 11 but these have been reclassified as subtypes of Genotype 6 except G10 which became a subtype of G3.

Each genotype has subtypes numbered a thru z. e.g.; 1a,1b/2a,b,c etc.

Over 100 different subtypes have been identified.

The Genotypes differ for each other by 30–35% of nucleotide sites, with more variability concentrated in regions such as the E1 and E2 glycoproteins and less variability in the non structural proteins.

Each HCV Genotype contains a series of more closely related subtypes that typically differ from each other by 20–25% in nucleotide sequences, compared with the >30% divergence between genotypes

Lastly Quasi-species develop in each individual and this sequence diversity is generated continually during virus replication, as RNA copying by the virally encoded RNA polymerase (NS5B) is error-prone and the replicating population is so large.

For example, ongoing error rates of between 1 in 10 000 and 1 in 100 000 bp copied, which are typically found for RNA polymerases, combined with a rate of virus production of up to 1012 virions per day, would produce a highly genetically diverse population of variants, containing mutants that differed at every nucleotide position and every combination of paired differences from the population mean or consensus.

So now we know that HCV produces up to 1,000,000,000,000,000 copies of itself per day with no error checking. This leads to a diverse population some of which when placed under pressure will become resistant to a given drug.

But even worse there maybe pre-existent mutations already resistant to NS3 protease inhibitors.

This is the reason why even when taking the directly acting anti-virals we still need to take interferon as interferon will kill the mutant quasi species off.

Hope all this helped explain things for you

HCV is one tough arse virus

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13/04/11

How to Prevent Side Effects During Hep C Treatment.

One of the most common side effects of hepatitis C treatment is FLU-LIKE symptoms which can include: Fever, chills, body aches, sweating, headaches, runny nose, watery eyes...I think you get the picture...it feels like you have the flu....but having these symptoms is not a bad reaction...it's a GOOD reaction. When the Interferon starts to work, it activates your immune system . This creates a reaction....fever!...But since it doesn't feel so good, there are things you can do to minimize the discomfort.

Hepatologists say 6 regular Tylenol/Acetaminophen(325mg each) per day are okay but because I'm not a doctor, please check with your own doctor before taking anything. That's 2 tablets of Regular Tylenol half hour before the injection and the injection should be given at bedtime (at about the same time every week) so that you can hopefully sleep and not feel some of the discomfort. Let's say that in the m]orning you have a headache...you can take 2 more Tylenol but NEVER exceed more than 6 per day. Remember check with your doctor to see if this is okay. Aspirin or Ibuprofen are not recommended because they can lower the platelets and the treatment meds can do the same.

The most important thing to do to prevent side effects is to drink WATER. The recommended amount is half your body weight in ounces (that means if you weigh 160 lbs, the amount of water should be 80 ounces of water daily). You can also have juice (unsweetened), broth, jello, popsicles, lemonade, crystal light, and soda without caffeine. Start drinking since the morning of the first injection.

Avoid caffeine because it dehydrates you and you want to be well hydrated. To me it's like working against the treatment and we must use whatever we can to beat this virus...even if sometimes it may appear like a very small detail...whatever I can use, I'll use. Caffeine also causes a rapid increase in blood pressure and for those of you who have esophageal varices, this may be a problem. For diabetics, caffeine can increase the blood sugar ALL DAY LONG.

I once met somebody who was so scared of treatment that he only injected half the dose and went to bed. He didn't drink water because he didn't want to have to get up in the middle of the night....guess what happened?...yes, he got very sick....and quit. Months later he tried it again...this time he drank the water....and he sat up all night waiting for the side effects that never came.

Interferon is a protein that your own body produces. It activates your immune system to fight viruses but your body doesn't produce enough to get rid of the Hepatitis C virus. You will be getting weekly injections of a long-acting Interferon called either PegIntron or Pegasys. It is recommended that the injection be given at bedtime (whatever your bedtime is) AT THE SAME TIME EVERY WEEK or as close as you can. If you wait longer, especially with the Peg Intron, there may be gaps where the blood level may not be high enough to stop the virus from multiplying. I suggest you taking the first shot when you have a couple of days off from work.

The Ribavirin or Copegus capsules are to be taken TWICE A DAY and the doses should be 12 HOURS APART....you choose the times but try to always do it at the same times. So if you choose 8 am, the second dose should be at 8 pm. Start taking the capsules the morning of the day you will be taking your first injection. If your doctor orders 5 capsules daily...take 3 in am and 2 in pm. If he orders 6 per day...take 3 in am and 3 in pm. Taking the capsules with food improves absorption and decreases the risk of getting nausea. However, do NOT take the capsules at the same time as antacids like Maalox because that interferes with absorption.

THIS IS CRUCIAL!....DO NOT MISS ANY DOSES UNLESS YOUR DOCTOR TELLS YOU TO. Studies have shown that to expect success, you must take AT LEAST 80% of the meds, 80% of the time. If you become very anemic, the dose of capsules may need to be decreased. If on top of that you miss some doses, your chances of success decrease greatly. Be careful not to run out of medication. Get refills early.

FATIGUE--Can happen because of lack of protein..Studies have shown that people that have liver disease have a higher caloric need and as cirrhosis advances, they become malnourished. Also, nausea can cause long periods of not being able to eat. When this happens, your body uses your MUSCLE for energy, making your muscles weak and you feel tired.

Protein is only restricted when people are decompensated (liver no longer working) but if you're unsure, check with your doctor. The Schering "Be in Charge" book recommends half your body weight in grams of protein. To work out the amount for you...DIVIDE your weight by 2. The result will be the amount of grams of protein recommended for you based on your body weight. For example, if you weigh 160 lbs, your daily protein intake should be 80 grams.

Foods considered Protein-- All meats, however I DO NOT recommend red meat (it's tougher on the liver), or liver (it has large amount of iron which can accumulate in the liver and FEED THE VIRUS), Beans, cheese, tofu, soy, eggs (or egg whites), peanut butter and all nuts. There is also protein in many vegetables.

Since having the right amount of protein may mean having to eat more food, using POWDER PROTEIN (WITHOUT IRON) is a good alternative. Get something that has 30-50 grams of protein per scoop. That way you can have a protein shake in the morning and the rest you can get from food. Having the protein shake in the morning will help give you energy during the day.

I also recommend NOT cooking your food in iron skillets. Some of the iron can be absorbed by the food. Please don't even think about eating raw seafood. If contaminated it can cause fulminant hepatitis.

To prevent fatigue ask your doctor if you can take a daily multi-vitamin WITHOUT IRON (very important). Vitamins for "mature" people (like Centrum Silver) don't contain iron. Again, check this with your doctor. A study done by Schering Pharmaceuticals showed that using an anti-oxidant vitamin daily, helped to prevent anemia ONLY in the first 12 weeks of treatment...I say, better than nothing.

AVOID taking herbal meds without your doctor's okay. If your doctor says it's okay to take Milk Thistle, it should have 70-80 % Sylimarin, the active ingredient, to be beneficial. Milk Thistle has protective and anti-inflammatory properties.

AVOID Gingko, Kava, Ginger in large amounts, Garlic capsules (garlic in food is okay), Valerian Root, Comfrey, Germander, Chaparral, Gordolobo. They can all be toxic to the liver. St John's Wort (an over-the-counter anti-depressant) can interfere with the Peg and make your treatment ineffective!!!

EXERCISE WILL HELP NOT JUST PREVENT FATIGUE BUT ALSO DEPRESSION.

Depression--The Peg injection alters certain chemicals in your brain causing depression. It can happen to anybody at any time and can be severe enough to cause suicidal or homicidal thoughts. Waiting for depression to go away or telling yourself to be strong won't work. The only thing that will help is anti-depressants. It is critical that you recognize the symptoms of depression early since anti-depressants take about 2 weeks to start to work. Symptoms can include: Sadness, crying, alienating yourself from others, not enjoying the things you usually enjoy, innability to sleep (or waking up after only a couple of hours), severe anxiety at night, palpitations, severe irritability (anger).

If any of this things happen, notify your doctor immediately so he can prescribe an anti-depressant. Anti-depressants can take a couple of weeks to start to work so don't wait to tell your doctor.

***Remember that most anti-depressants, like Paxil, Zoloft, and Celexa can cause impotence in men while taking them. Wellbutrin does not.

LOSS OF APETITE, NAUSEA, VOMITING-- When we are dehydrated we crave water, but during treatment, when we lack protein, instead of craving protein we get LOSS OF APETITE and NAUSEA. To prevent this, eat the proper amount of protein for your body weight...push yourself. You can also use Ginger ale, 7-up, saltines, jello, and keep drinking the water. If the nausea is severe, ask your doctor for medication to make it stop.

DIARRHEA--Next time you see your doctor, ask him, "If I get diarrhea, what can I take?" They usually let you have over-the-counter meds like Immodium and of course, you would increase the amount of water you are drinking.

HAIR LOSS--You may notice more hair on your brush and your hair thinning but you won't go bald. Things that can help: Nioxin shampoo/conditioner, soft brush, not shampooing daily, silk pillowcase to prevent pulling your hair when you turn, avoid jells, harsh chemicals, blow driers, curling irons and rubber bands that pull our hair. Use hats, wigs or get a short haircut.

RASH-- A rash caused by Interferon is usually mild, can come and go and it's not itchy. Try using lotions or Aveno soap. The rash caused by Ribavirin capsules can be severe, anywhere on your body, it's very itchy and can get worse when you take more capsules. If it happens, notify your doctor. Severe reactions are very rare. If you feel like your throat is closing, get help immediately!

SUN SENSITIVITY-- Did I hear someone say tanning bed? Absolutely not! Interferon can cause you to burn easily and get skin cancer. It also causes increased sweating. Avoid very hot showers and jaccuzis. It remainds me of hard boiled eggs tee, hee....and I've seen people pass out after. Your eyes can also be affacted by the sun and since Interferon can cause them to get very dry, this would only make it worse. For dry eyes you can use natural tears to lubricate them, DO NOT USE Visine which dehydrates. If you are going to be out in the sun for prolonged periods of time, use sunblock, hats and long sleeves.

RETINAL BLEEDING-- For diabetics, it's recommended they get an eye exam, done by an opthalmologist, before starting treatment. Your doctor should check your eyes at EVERY VISIT. This is done by shining a light and looking inside the eye. Notify your physician immediately if you experience vision changes like: Blurry vision, black spots, floaters, blind spots, tunnel vision or eye pain.

The RIBAVIRIN or COPEGUS capsules can cause multiple blood abnormalities.-- Anemia (iron won't help since this is caused by the capsules and not by iron defficiency). Low white cells which defend you against infections, Low platelets (responsible for clotting), Low Neutrophils (white cells that defend you against bacterial infections), increased bilirubin (causes yellow in eyes and skin), increased uric acid (too high causes gout), high blood sugar even if you are not a diabetic, and low or high thyroid (which may or may not resolve after treatment).

ANEMIA.....caused by the Ribavirin/Copegus capsules. Symptoms can include fatigue, weakness, shortness of breath, and in some cases, chest pain which can lead to a heart attack (especially if you have a history of cardiac problems). Report all episodes of chest pain to your doctor right away!!!

Dose reductions are to be avoided if at all possible. If the hemoglobin drops to 10 or below (or you are having severe anemia symptoms), your doctor can prescribe a medication to help the anemia called Procrit or Aranesp (same as Procrit but long-acting).

Since Procrit is not yet approved by the FDA for the treatment of anemia caused by the Hepatitis C treatment, your insurance company may deny it.....this can be avoided by using a chemotherapy CODE. That's why some doctors send their patients to see a Hematologist so they can prescribe the Procrit (which is unnecesary and time consumming. Procrit takes 2-4 weeks to START to work).

If your doctor prescribes Procrit, make sure he CHECKS YOUR IRON. If you don't have enough IRON STORES, Procrit WILL NOT WORK!!!! Even though some Hepatitis C patients have too much iron, not everybody does.

LOW NEUTROPHILS-- Neutrophils are white cells that protect you against bacterial infections (throat, sinus, urinary, skin infections, etc). If the neutrophils are too low, your doctor may ask you to skip a Peg injection or cut the dose in half. Sometimes that's all it takes for the neutrophils to go back up to normal. However, if they remain low, your doctor can prescribe NEUPOGEN.

Remember that the goal is to avoid Peg/Riba dose reductions or interruptions....and the use of Procrit and Neupogen may be needed to be able to maintain the dose that will give you a better chance at clearing the virus.

It is extremely important that you have your blood tests done on time so blood abnormalities can be taken care of quickly and your treatment not be interrupted. Ask your doctor for copies of your blood tests results so you can keep track. After all, this is YOUR treatment.

I have tried to cover everything I could think of...but you are the one that knows your body best. If you think something is wrong...tell your doctor. Only your physician knows the exact condition of your liver and nobody's advice should replace that of your physician's.

Sources:

AdvancMed Speaker's Program.

Schering Speaker's Program.

Schering's "Be in Charge" book.

Projects in Knowledge, Side Effect Management Handbook.

http://www.projectsinknowledge.com/Init ... ndbook.pdf

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Not too sure if anybody was aware of this. The FDA was to make a decision on Wednesday of this week on a new med for Hep C. And a second new med for Hep C on Thursday as well.

The current regime for Hep C treatment is only effective in approximately 40% of patients with the Hep C genotype 1 virus. This treatment takes up to a year and only raises the autoimmune system's response to the virus.

Both of the new drugs, Manufactured by Merck and Vetrex, are actual inhibitors to the virus itself. These are to be taken in addition to the older meds (Peginterferon alpha 2a and Ribaviron).

In addition to the increased success rate, the length of treatment as submitted to the FDA is only 26 weeks instead of 52 weeks as currently indicated for the older immune systemic treatment.

Just thought that I'd pass that along...

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