Coping With Hepatitis C

Like most viruses, there is no cure for hepatitis C. Four million Americans carry the virus that attacks the liver, but simple lifestyle changes can prevent hepatitis C from becoming deadly.

John Carrano enjoys a night with his family. However, he says life hasn’t always been fun and games. Three years ago, his nine-year-old daughter, Lauren, died of leukemia. That’s when John discovered his own health problem.

John explains, “We had all gone in to be tested to see if we would match to give her our blood, and when our results came back, they told me they had found hepatitis in my blood.”

Hepatitis C attacks the liver. The most immediate symptom is fatigue. Those with the virus are also prone to develop arthritis. Many patients take over-the-counter painkillers for relief.

Hepatologist Tom Riley, M.D., of the Hershey Medical Center in Pennsylvania, specializes in liver disease. After researching some over-the-counter drugs, he now recommends hepatitis C patients treat pain with Tylenol, a drug they were once told to avoid.

“Tylenol turns out to be the safest drug for patients with hepatitis C that have pain complaints or headache,” says Dr. Riley.

However, he says hepatitis C patients should not take medications containing ibuprofen or aspirin.

Dr. Riley says, “They commonly take these drugs over-the-counter not knowing that they may be injuring their liver while doing so.”

Patients should also avoid alcohol. Dr. Riley suggests taking multi-vitamins, but only those without iron to again protect the liver. Moreover he recommends a low-fat diet.

John is taking Dr. Riley’s advice seriously. He says, “Life’s too short.” Furthermore, the death of Lauren taught him and his family to be survivors.

Hepatitis C is most commonly transmitted through blood transfusions, I.V. drug use and contaminated tattoo needles. John believes he got the virus during a blood transfusion in 1975 following a serious car accident.

Doctor explains a combination of drugs that cuts down on the number of rejected liver transplants

What is the function of the liver?

Dr. Marino: The liver is actually the largest organ that is inside our abdomen, and it is so large that it basically occupies the right upper portion of the abdomen of any human being. It is extremely important because anything we eat or drink eventually goes through the liver. The liver metabolizes the food and makes all the proteins and other things that are essential for our life.

The liver, when it is healthy, its surface is very smooth and soft. When the liver becomes sick, the surface becomes bumpy and hard, and the liver is not able to metabolize the food that we eat. It is not able to deal with proteins or other things we need for our life.

What causes a liver to fail?

Dr. Marino: Mainly virus including infection with hepatitis B, hepatitis C, and then there are other diseases that are related to congenital problems that you may be born with. The liver may fail because the development of the liver during the fetal time is not perfect, but in the Western society, hepatitis C and hepatitis B are the most important causes of liver failure.

What are your options when your liver fails?

Dr. Marino: The liver is really a large organ, and because of that, in order to have a transplant, you must have a failure of almost 75 percent of the organ. If 25 percent of the liver is still capable to work, then you can have enough metabolism to sustain a relatively healthy life. When the liver fails completely, the only solution is to replace the organ because it is essential to our life, and you do that through the transplant.

What is the rate of transplant rejection?

Dr. Marino: Rejection is the most important problem from the time transplants started in the late 1950s because when you put an organ inside of a human being, the immune system has a tendency to reject it. It recognizes the new organ as a foreign body and reacts with rejection. Now we use different drugs, which are much more sophisticated from the drugs that were used in the early ’60s and ’70s, which were mainly steroids. Now we have very good drugs that have less side effects and are tolerated much better. Still, though, rejection happens in at least 30 percent of patients undergoing a liver transplant. So any strategy aimed to decrease the rate of rejection is very important.

What did this study try to accomplish?

Dr. Marino: We are actively involved in developing new strategies to control and actually to prevent rejection from happening. In this study, we used two drugs. One is called tacrolimus, and the other is called basiliximab. Basically these two drugs used in combination allowed us to have a significant decrease in the rejection. The drugs were given at the time you start the transplant operation, and then a second dose four days later. Through these drugs, which are very powerful, you contain much better control of rejection. Actually, you prevent rejection from happening. Comparing our patients to other patients transplanted with different anti-rejection treatment, we had only 12-percent rejection compared to about 40 percent, which is the usual incidence of rejection. So, it is a significant improvement.

How long did you follow the study participants?

Dr. Marino: We studied this new combination of drugs in 50 patients, and we followed them for three years. We were actually very pleased because the survival of these patients with very low incidence of rejection of three years is 88 percent. So almost 90 percent of the patients are alive and doing very well three years after the transplant. If you think about the fact that the average survival from liver transplantation is one year in the United States, I think that this is a significant improvement.

What is the status of the drugs now? Have they been FDA approved?

Dr. Marino: The first drug tacrolimus was FDA approved in 1994, after it was used for several years in Pittsburgh. The other drug basiliximab was mainly studied in kidney transplantation, and this is the first study that uses this drug with tacrolimus in liver transplantation. So any patient can be treated with this combination of drugs, because both drugs are FDA approved and are commercially available in this country and in Europe.

Why is this combination of drugs a medical breakthrough?

Dr. Marino: This new combination of drugs is really a breakthrough in transplantation because it allows a significant reduction in rejection and also excellent outcomes with almost 90 percent of liver transplant recipients doing well after three years. I believe that the most important area of research nowadays is aimed to allow excellent quality of life years after a transplant to our patients. A transplant is now not any longer a treatment to save a life momentarily, it is now a treatment to give an excellent quality of life back to our patients for many, many years to come.

Are there risks or side effects associated with this drug combination?

Dr. Marino: We did not identify any important side effects. Actually, none of the patients who received this combination of drugs were suffering from a side effect that resulted in stopping the drugs. Obviously, there will probably be patients who will have less tolerance to these drugs than other patients, but in general, it’s a very safe and well-tolerated combination of drugs.

Is there anyone who cannot take this drug because of a condition, or is it safe for everyone?

Dr. Marino: A result of our study shows that the combination of these two drugs is very safe for everybody. Currently, we use these drugs in combination with a very low dose of steroids, and we think it is possible to eliminate the steroids and use only these two drugs. But, this is what we are studying in the next few years so we cannot really comment on this at the present time.

This article was reported by Ivanhoe.com, who offers Medical Alerts by e-mail every day of the week. To subscribe, go to: http://www.ivanhoe.com/newsalert/.

Doctor explains the importance for high-risk people to screen for liver cancer

What motivated you to do this study on liver cancer?

Dr. Thuluvath: Liver cancer is increasing in this country because of what we call the silent epidemic of hepatitis C. It is also due to what we call cryptogenic cirrhosis, which we presume is due to non-alcoholic fatty liver disease. This is secondary to obesity, hyperlipidemia and diabetes. So, there is an increase in liver cancer due to these diseases in the community. Two million people die from liver cancer every year.

What did you look at in your study?

Dr. Thuluvath: The question of our study is what is the best form of treatment for liver cancer in someone with cirrhosis of liver. In this country, most of the liver cancer patients have cirrhosis at one point. In our own transplant circle, we know liver transplantation is perhaps the best treatment modality, because it not only removes the cancer but also the diseased liver. So, we decided to look at the nationwide database of about 1,000 patients transplanted for this condition. We divided the last 20 years into three time periods to look at the trends. Over the last 10 years, we have learned a lot about who got transplants, how to pick the right patients, the selection, and how to get the best results.

The study looked at data nationwide and found there has been a major improvement in the outcome of liver cancer in this country. In the early part, 1987-1991, the survival was around 25 people, and the next period it was up to 96 people, and then in the most recent period up to 2001, it has gone up to almost 260 people. That’s pretty good for cancer. When you say five years, it is almost like a cure for this patient because if liver cancer were to recur it would happen within one or two years. So, that’s what prompted us to do the study, and we were quite pleased to see we can cure liver cancer in somebody with cirrhotic liver, an advanced cirrhosis, and 60 percent or more can live for five years or more.

Have there been many studies looking at trends in liver cancer?

Dr. Thuluvath: There was a major paper published in The New England Journal of Medicine in 1996, which gave recommendations about how to get the best results for liver transplant, and it is since known as Milan criteria. Since then there have been many small papers on the subject.

What’s the message you want to send to patients?

Dr. Thuluvath: Liver cancer, if it is detected early, is curable. The key here is to make that diagnosis early. For that, the patients and doctors have to work together. We have different ways to do surveillance. We can do blood tests, ultrasounds, computed tomography (CT) scans or magnetic resonance imaging (MRI). But, the majority of patients with cirrhosis don’t get any of these tests.

The commonly available techniques, whether we use MRI, blood test or a combination, still miss a third of liver cancer. We, myself and some of my colleagues, are focusing on finding ways to diagnose cancer at an earlier stage. Then, we can offer them many more options, including a liver transplant, and we can probably improve the survival of patients with liver cancer in this country. This may not apply to every country in the world, where they don’t have the access to liver transplantation, but at least in the United States, we can improve the survival by early detection and the offering of the best modality of treatment.

Do you feel like liver cancer does not receive as much attention as it should to be able to properly prevent it?

Dr. Thuluvath: I think you get a lot of publicity for prostate cancer and to some extent breast cancer. But liver cancer, because it’s not as common as these cancers, has not come to that attention of the public. Liver cancer is the sixth most common cancer in the world, but it seems to affect the part of the world where there is a lot of hepatitis B and poverty. In Africa and parts of Asia, this is like an epidemic. Now, it looks like liver cancer has come to the United States and Western Europe. I think there is now more attention being given to liver cancer.

One cancer we think we can prevent early is colon cancer. Early detection is key there. I think in a way that is the best example for early detection and cure of all cancers. Simple tests can prevent or cut down a significant proportion of this cancer.

Are there specific reasons why liver cancer is more aggressive now?

Dr. Thuluvath: That’s a very interesting question. We addressed this in a small study we did in Maryland. Worldwide, Africans and Asians seem to have a higher incidence. That is perhaps due to hepatitis B. If you go to the Western part of this country, you see a lot of cancers in Asians because they had what we call transmission of hepatitis B from their parents. But, the difference between the races has decreased significantly in the last 10 years in this country. When we looked at the reason they differ Maryland, we actually found Caucasians and blacks have the same incidence of liver cancer. There was a big gap that seems to have closed significantly. It could affect anybody.

What are the risk factors for liver cancer?

Dr. Thuluvath: The risk factors are important. Hepatitis C, B, hemochromatosis, and cirrhosis for many reasons could predispose someone to liver cancer. This patient should be carefully monitored. Once they develop cirrhosis, the risk increases significantly. They need close monitoring at least every six to 12 months with some sort of scanning. They can have either an ultrasound, CT scan or MRI; it depends on the expertise of the local hospital. And, they should have regular blood work to look for this cancer. This is a treatable cancer, and the early detection is the most important aspect of the management.

Are transplants given early after diagnosis, or does the disease have to develop extensively before a transplant is approved?

Dr. Thuluvath: I think the important part of our studies tells us the faster the transplantation the better the outcome will be. You don’t want the liver cancer to advance because there is a high probability that cancer may spread elsewhere, like to the blood vessels or lymph nodes. The earlier the better.

Now that you have this exciting new information, are you still dealing with the shortage of organs?

Dr. Thuluvath: That is something we have not been able to solve. The organ donation in this country, unfortunately, has not gone up in the past 10 years. It’s almost plateaued. I think a shortage of this nature may help people to learn more about liver transplantation. Many of these patients would have died within a year if they were not transplanted, and many of them may have contributed significantly to the community and the families.

In the future, we may be able to find ways to use organs from other species, and the research has to develop in that field. Hopefully, maybe 10 or 20 years later, we will be thinking of stem cell research to help us to develop these organs. But, I think in the immediate future, the focus should be to increase the organ donation and also to perfect the technique of live donor liver transplant. That can save many people.

What do you see as the impact of this study?

Dr. Thuluvath: I’m excited about the possibilities. I think the public needs to know all these things because unless they’re educated, they’re not going to go to their physician and say, “Time for me to have a screening test.” Once the patient is educated, he or she can remind the physicians too. Also, they need to learn that cancer, if you diagnose it early, is a curable disease

Who should be talking to their doctors about screening?

Dr. Thuluvath: Anyone with cirrhosis of liver should talk to their doctors about screening for liver cancer, and this is more important for those with hepatitis C, hepatitis B, and a condition called hemochromatosis, where there is too much iron in the body. These are the three major risk factors. But, we have recently seen increased incidence of cancer in people with cryptogenic cirrhosis, which means we really don’t know what caused cirrhosis, but we assume most of them may have progressed from fatty liver disease. This population is going to increase substantially because of obesity in this country. Two out of three people we see in this country are obese now, and the significant number will have fatty liver disease. A small proportion will progress to cirrhosis, which is a substantial number of patients, and many of them may end up with cancer of the liver. So, they should also get the early screening. I think that is the most important thing.

What do you hope to see in the immediate future of this field of study?

Dr. Thuluvath: From my point of view, I think we need to develop better techniques to detect this cancer. We don’t have very good tests yet. I would sense the detection rate is still around 60 percent to 65 percent. That means one out of three cancers could be missed even if you do all this screening. The screening has to be something that is easily applicable to a majority of patients, like a blood test, which has a very high sensitivity and specificity.

This article was reported by Ivanhoe.com, who offers Medical Alerts by e-mail every day of the week. To subscribe, go to: http://www.ivanhoe.com/newsalert/.

Hepatitis C

Hepatitis C is a blood-borne infectious disease of the liver caused by the hepatitis C virus. It is the leading cause of liver transplants in the United States.

In the first six months of infection with the virus – the period referred to as acute hepatitis C – 60 to 70 percent of the people infected have no symptoms at all, while others experience decreased appetite, fatigue, abdominal pain, jaundice, itching, or flu-like symptoms. When infection with the virus continues for more than six months – a condition called chronic hepatitis C – again, there may be no symptoms at all. Some patients, though, experience weight loss, flu-like symptoms, low-grade fever, muscle pain, joint pain, itching, abdominal pain, nausea, diarrhea, and more. If left untreated, this disorder can progress and cause inflammation of the liver, liver scarring, and cirrhosis. It should be noted, though, that the majority of those infected with hepatitis C experience either no symptoms or such milk symptoms that they do not seek treatment.

Hepatitis C is spread through contact with infected blood, and may be contracted through IV drug use; transfusions with unscreened blood; occupational exposure to blood; recreational exposure to drugs, as in sports; and even shared personal items such as razors. The condition has also been known to spread through sex with an infectious person, and from mother to infant during childbirth.

While prompt medical treatment of hepatitis C is important to avoid progression of the disease, a number of supplements can also be useful in the treatment of this disorder. At the same time, avoid high doses of vitamin A and beta carotene, and niacin supplementation greater than 100 milligrams.

Supplements to treat Hepatitis C

• Alpha-lipoic acid – USANA combined alpha-lipoic acid with coenzyme Q10 to create CoQuinone 30, a fantastic supplement of these energy-supporting nutrients. USANA Vitamins supplements CoQuinone 30 contains a full 30 mg of CoQ10 and 12.5 mg of alpha lipoic acid per soft gel capsule.
• Astragalus
• B-complex vitamins
• Carnitine
• Coenzyme Q10
• Lysine – Taking for more than six months can cause an imbalance of arginine. Do not take if you have diabetes or are allergic to eggs, milk, or wheat.
• N-acetylcysteien (NAC)
• Olive leaf extract
• Phosphatidyl-choline (Lecithin)
• Probiotics
• Selenium
• Silymarin – Found in milk thistle
• Taurine
• Vitamin B9 (folic acid)
• Vitamin B12 (cobalamin)
• Vitamin C
• Vitamin E

USANA Vitamins supplements Hepasil DTX is the comprehensive liver support formula that promotes and balances the body’s detoxification processes. Milk-thistle extract which provides dual action, stimulating liver enzymes and protecting against oxidative stress. USANA Hepasil DTX provides additional antioxidants from green-tea extract, olives, and turmeric provide further antioxidant protection.

Hepatitis

A viral infection of the liver. There are a number of different viruses whose names are identified by a different letter. Hepatitis A is caught through eating or drinking food with viral faecal contamination. Most other types of hepatitis such as B, C, D, E, F and G are transmitted by blood or blood products through needles, cuts or sometimes unprotected sexual intercourse. Acute hepatitis is a very serious disease with liver failure of varying degrees. After the patient has recovered, chronic hepatic disease can lead on to cirrhosis or even liver cancer. Excess alcohol can also cause hepatitis and cirrhosis.

Doctors can
• Provide you with a protective hepatitis vaccine before going into countries where hepatitis is a risk.
• In acute hepatitis there is no effective treatment, but in time most patients recover.
• Chronic hepatitis may be helped by a number of drugs such as interferon alpha, lamivudine or steroids. These may reduce the inflammation and may lower the risk of subsequent cirrhosis or cancer.

Avoiding hepatitis is by far the best option, so make sure you are vaccinated if going to at risk areas. Only drink bottle water and do not use any ice; eat only freshly cooked vegetables and avoid salads. Demand non reusable needles and intravenous tubing sets. Always use a condom during sexual intercourse.

If you have contracted hepatitis, don’t overstress the liver. Avoid alcohol and toxins, poisons and preservatives which rely on the liver for their detoxification before they can be excreted. Eat organic, non-fatty and simple food.

Some people believe that high doses of intravenous vitamin C (30-45 grams) can damage the virus and be beneficial in both the acute and chronic phases of the disease.

Nutritional supplements

Because the liver may not be functioning well, these are especially important:

• A good multivitamin/multimineral makes sure that the liver and the immune system have all the nutrients and minerals required to function perfectly. These contain the nutrients the liver needs to detoxify and also to change potentially damaging materials in the body to less harmful ones.
• Grape seed extract (proanthocyanidins) is a powerful antioxidant and anti-inflammatory agent. In the detoxification process many free radicals are produced, and proanthocyanidins help neutralize these before they cause damage.
• Co-enzyme Q10 is an anti-inflammatory supplement; it also provides additional energy. Dosages of 30-100mg/day help the liver cells to work.
• Specific compounds can also help the liver work and also heal, in addition to those found in a good multi-tablet: tri methyl glycine (Betane), selenium, glutathione, dietary flavanoids – green tea extract, curcumin, indole 3 carbinol, sulfapyrone, milk thistle.