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Hepatitis Info Sheet

October 1997

Hepatitis Chart

Hepatitis AHepatitis BHepatitis C
How do you get it?Hep A is passed between people through rimming (anal-oral sex), dirty plates, and glasses. "Employees must wash hands before returning to work", or outbreaks in the water supply. Most people get Hep A from contaminated water, which can happen anywhere.You can get Hep B through sexual contact via semen and/or vaginal fluid, blood (syringe, needlesticks or transfusions), or breast milk (mother to child). You can't get it from dirty plates or glasses, or from someone's spit.Transmission of Hep C is mostly through blood, via syringes, transfusions, or needlesticks, but sexual contact has been reported (case studies of vaginal sex), as has mother-to-child transmission during birth.
What does it do?The way Hep A works in the body is not well understood. Virtually all people get better on their own. You can only get it once.Hep B infects liver cells, causing swelling and the tissue to die. Your own immune system response causes some of the symptoms associated with Hep B infection.Hep C infects your liver, causing swelling and the death of cells and tissue. Hep C works similarly to Hep B, but not much is understood about how Hep C causes harm.
What are the symptoms?Although virtually all people get better, the symptoms from Hep A can be severe, even deadly: high liver enzymes, high fever, loss of appetite, nausea, vomiting, and tell-tale jaundice. Jaundice is a yellow discoloration of skin and eyes, caused by an increase in liver enzymes. The symptoms usually last 1 to 4 weeks.Symptoms, if you have any, will show up 10-12 weeks after infection. The symptoms are high liver enzymes, fever, appetite loss, nausea, diarrhea, vomiting, exhaustion, and jaundice. Most chronic Hep B carriers don't have any symptoms, but they have a good chance of developing cirrhosis of the liver , which can kill you.The symptoms of Hep C are: high liver enzymes, fever, loss of appetite, nausea, diarrhea, vomiting, exhaustion, and jaundice. However, many Hep C patients never have symptoms. Chronic Hep C infection is associated with cirrhosis of t he liver, which is scar formation in the tissue, and related to an increased risk of liver cancer.
What are the treatments?There is no antiviral treatment for Hep A infection. If you have specific symptoms you should treat each one individually.Alpha-interferon injections are the standard treatment for chronic Hep B. The injections, usually daily or three times a week, are self-administered, and taken for four months. 3TC, Thymosin-Alpha, and famcyclovir look promising, alone and in combination with interferon. 3TC may suppress Hep B replication, but might not get rid of the infection.Alpha-interferon three times a week for six to twelve months, is the standard treatment for Hep C. The combination of ribavirin and interferon has been shown to be more effective than interferon or ribavirin alone. Amantadine, a common flu drug, was effective in one study when used with and without ribavirin.
How do you avoid getting it?Be careful about water, fruits, and vegetables when you travel. Drinking bottled water is usually sager. Use barriers for rimming and intercourse. There is a vaccine, which can be given in combination with the vaccine for Hep B.Use condoms and clean needles. There is a vaccine that can protect you against Hep B, run to the doctor and get it. It's a series of three shots given over six months. It's so easy! Remember, practicing safer sex and using clean needles will protect you from more than just Hep B.There is no vaccine for Hep C yet, so to avoid infection, have safer sex and use clean needles.



New Dirt on Hepatitis

There is some exciting data about treating Hepatitis B (Hep B) and Hepatitis C (Hep C). These illnesses are similar, but are caused by structurally different viruses. The word hepatitis, like so much medical language, comes from Greek, and means simply "liver inflammation". All hepatitis can cause painful swelling and cirrhosis, liver damage, sometimes bad enough to cause the liver to stop working. We've carried both of the promising drugs, Ribavirin and Thymosin-Alpha-1, for years, so we're happy to see some results.

Hep B and Hep C can be latent(very low level), active (initial infection), or chronic(life-long high level). A doctor will tell how well your liver is working by measuring your liver enzymes. If they're high, your liver is working overtime to deal with your infection. But if you've had hepatitis a long time, and have sever liver damage, your enzymes might be low because the liver can't produce them. This can trick you and your doctors into thinking that everything is really all right. Something new are viral load measurements (PCR) of Hep B DNA and Hep C RNA, which gives you an actual count of viral activity. The count will be high or low depending on how active your Hepatitis virus is. Your doctor might also do a biopsy of your liver to see if the infection has caused cirrhosis, or physical damage to your liver.

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Antigen tests for Hep B tell if you have the B virus, and antibody tests tell if you have immune system things to fight the virus. If you have antibodies, but no antigen, your immune system has beaten the infection. There is no Hep C antigen test, but they can find antibodies and do a PCR (a viral load test).

Both Hep B and C are treated with alpha-interferon. It can cause awful flu-like side effects, and has been shown to be only marginally effective. People with specific types of Hep C (genotypes 1a and 1b) seem to have less chance of getting a good response from alpha-interferon. These new studies suggest that Hep B and C are best treated with a combo of drugs, especially after alpha-interferon failure.

The chart above lays out Hep A, B, and C to show their similarities and differences. There's very little information about Hep D, E, F, or G, nor is there much information about how to prevent or treat them. They've been recently discovered and are not well understood.


More on Hepatitis C

A study of the combination of ribavirin and alpha-interferon, conducted in 60 patients in Taiwan who had chronic Hep C infection, but no cirrhosis, showed that the combo was more than twice as effective as interferon alone. At the end of 6 months of treatment, 76 percent of the people on the combo versus 32 percent of the people on interferon alone had complete responses (define as normal liver enzymes and no Hep C by PCR). After 2 years of follow-up (96 weeks of no treatment), 43 percent of the responders still had a complete response. There are US trials of this combination.

Two controlled Hep C studies in the US of ribavirin vs. alpha-interferon showed ribavirin works better. In one study, 25 percent of the participants had normal liver enzymes, and half had improved enzymes. In the other study, 33 percent got normal liver enzymes while on treatment, but their numbers quickly shot up after stopping treatment. These and other studies have showed no change in Hep C viral load levels as measured by PCR.

Two recent studies report favorably on the combination of thymosin-alpha plus alpha-interferon. In a controlled study of 103 people with chronic Hep C, the complete response rates will increase over time and treatment was not stopped at the six month point. A second study of 15 people with severe Hep C, 13 with the infamous 1b genotype, took thymosin-alpha (high loading dose) with alpha-interferon. After a year of treatment, and six months of follow-up, 40 percent had a complete response, defined as a negative Hep C PCR. 39 percent of those with the 1b genotype had a complete sustained response. Like ribavirin, thymosin-alpha-1 is notable for its lack of side effects, and unclear mechanism of action.

Finally, a recent study of 105 people with Hep C it was suggested that one cause of alpha-interferon treatment failure may be low glutathione levels. The author of this study cautiously suggests glutathione replacement and /or taking antioxidants like NAC that replace intracellular glutathione to help treatments work.


More on Hepatitis B

In a study in France, 333 people who had failed alpha-interferon therapy took 500mg Famvir (famcyclovir) 3 times a day. Famvir is approved in the US for herpes. Viral levels of Hep B were reduced and liver enzymes became normal in half of the people after 16 weeks. There were no significant side effects reported. We don't know yet if Hep B and enzymes levels will rebound after you're off the drug, which often happens in hepatitis, or what will happen over the long term, especially in terms of resistance.

Combination studies of thymosin-alpha and alpha-interferon for Hep B continue to tumble in. A randomized study of 33 people in Italy finally had good results, reporting a complete response in 41 percent of the combo arm six months after stopping treatment. Earlier studies have not been statistically significant, with oddly high response rates in the placebo arms.



  
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This article was provided by PWA Health Group.
 
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