This and That From Hepc.bull newsletter

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This and That From Hepc.bull newsletter

This and That

From hepc.bull -monthly newsletter (.pdf)March 2010

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RIBAVIRIN PRIMINGLess than 50% of genotype 1 infectionsrespond to standard therapy, and retreatingthose non-responders is effective in only15% of the patients. The preliminary datafrom this study shows that priming, or takingribavirin before standard treatment, improvesresponse rates. This small studytreated 10 non-responder, genotype 1 patients,who were first given 1000-1200 mgof ribavirin alone for 1 month, followed bystandard treatment for 12 months. 5 of the10 patients had a sustained viral response(SVR) after this study, and the treatmentwas well tolerated. The ribavirin seem to actas an interferon “sensitizer.â€Source: http://www.natap.org/ from AASLD Oct 31-Nov3 2009, Boston, MA

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Did You KnowA low immune system (for instance, fromHIV or from cancer treatment) can allow thehepatitis C antibodies to hide. If you...:• have a low immune system• have had a risk for hepatitis exposure in thelast three months but your HCV antibodytest was negative (non-reactive)…then, ask for the PCR test to see if theHCV virus is present in your blood.Having the HCV antibodies doesn’t protectyou from getting the virus again.You will always have the HCV antibodieseven if you clear the virus, either on yourown or through successful treatment.Source: Hepatitis C Council of BC’s ResourceDirectory

CANCER SURVIVORSUNAWARESurvivors of childhood cancer who weretreated before 1992 may be at risk for transfusion-acquired HCV. A questionnaire wassent out to 9242 such patients who weretreated between 1970 and 1986. Over 41%reported having had no HCV testing, 31%were unsure, and only 29% had undergonetesting. 50% remembered having a bloodtransfusion. Those who had no testing wereusually older and had received no care at acancer centre in the past two years. Thesepatients could benefit from programs thatincrease awareness and knowledge, andpromote screening.Source: www.ncbi.nlm.nih.gov/pubmed

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What Is Alpha-Fetoprotein?The blood test called alpha-fetoproteinor AFP is recommended by many specialistsat least once a year for those with Hep C,and more often if you have cirrhosis.The AFP is a protein and is most oftenused in pregnancy to detect birth defects, butis also used in liver disease as warning ofpossible liver cancer or other tumours(tumour marker). Levels of AFP over 500nanograms per millilitre of blood are foundonly in patients with hepatocellular carcinoma(HCC—a type of liver cancer), germcell tumours, and cancer in the liver comingfrom tumours in another part of the body.Like a PCR, the AFP can be qualitativeor quantitative. It can indicate normal or notnormal (less expensive), or it can say howmuch. This is the test usually used for uswith Hep C. The report should state themethod and

equipment used, and if it’s aquantitative test, it should give a normalrange, because it can vary from lab to lab.Keep a record and notice if the resultsare changing from your baseline, or originaltest. An elevated AFP only suggests theremay be a problem.Some research indicates that AFP is notuseful for screening patients with cirrhosisor hepatitis C, since the levels can be elevateddue to chronic liver disease alone. Butthe test may indicate a problem if the levelsare increasing, and if other tests, such as anultrasound, show a possible problem, aswell.So let’s say you have a high level ofAFP. Your doctor orders other tests, andyour CAT scan shows that your liver is fine.What then? As we’ve seen above, it may bethat your liver disease is causing the elevatedAFP. There are other possibilities.HCC is just one possible cause of an elevatedAFP. There are other

conditions thatcan produce AFP but they are rare.(endodermal sinus tumor, mixed Mülleriantumor (females only), Sertoli-Leydig celltumor, Wilms tumor, teratoma (usually benign),nonseminomatous germ cell tumors,Citrullinemia, Argininosuccinate synthetasedeficiency, etc.).Source: http://en.wikipedia.org/wiki/Alphafetoprotein

HEP C & CHILDRENfrom Peppermint Patti’s FAQ http://www.hepcbc.ca/

PREGNANCYIf a baby is born to an HCV+ motherand its blood is tested at birth for hepatitisC antibodies, the test would come backpositive. This is because the baby has someof its mother’s antibodies. The antibodiesclear naturally over time. A test at 12months usually confirms whether or not atoddler has the virus.About one third of babies test positivefor the virus when tested at the age of 3days. Method of delivery made little or nodifference. The rate of fetal infections inHCV+ can be zero and up to 10%. The rategoes up if the mother is co-infected withHIV. Present information shows that transmissionmay be more likely in infants bornto mothers with genotype 1. (Obstet GynecolSurv. 2005 Sep;60(9):572-574)Any woman, or partner of a

man, whohas taken ribavirin must wait 6 monthsafter the end of treatment before becomingpregnant to avoid birth defects.

..BREASTFEEDINGThere has been no documented case ofHCV being transmitted by breastfeeding,and the rates of infant infection are identicalin both breastfed and bottle-fed infants.There are many advantages to breastfeeding.Breastfeeding mothers should checktheir nipples before each feed and avoidbreastfeeding if they are cracked or bleeding.They may want to consider usingbreast shields.It is not known if interferon or ribavirinis passed on to the baby through breastmilk.Circulating HCV RNA does not increasepregnancy complications.A substantial proportion of pregnantwomen with hepatitis C virus infectionhave circulating HCV RNA, even whenthey are asymptomatic, however thesewomen do not have an increased risk ofobstetric complications and pregnancydoes not appear to induce symptomaticliver

disease. “There is no risk to the outcomeof pregnancy in an anti-HCV positivepregnant mother. The majority of pregnantwomen have normal transaminaselevels during the course of pregnancy, althougha substantial proportion has circulatingHCV RNA. Pregnancy does not inducedeterioration of liver disease, andHCV infection does not increase the risk ofobstetric complications.†(“HCV Infectionin Pregnancy,†British Journal of Obstetricsand Gynecology, 1996;103:325-329)

There is a high mortality rate among pregnantpatients infected with hepatitis E, which sometimesaccompanies hepatitis C. There havebeen no studies on pregnant women takinginterferon.

HOW DOES HCVAFFECT CHILDREN?Children with chronic hepatitis cannot betreated simply like miniature adults. Specificissues and questions need to be addressedwhen dealing with the pediatric age group.Pediatric patients are less likely than adults tohave symptoms of infection with hepatitis C,leaving the viruses undetected and possiblyunknowingly spread. According to informationavailable on the natural history of HCV, childrenhave a higher rate of spontaneous viralclearance than adults, and generally a slowerprogression rate during the first 20 years ofinfection. Children who are chronic carriers ofHCV have normal growth patterns.In 16 HCV children followed for up to 14years, encephalopathy (mental confusion),ascites (swollen stomach), or bleeding did notdevelop. The lack of cirrhosis in children withHCV

is consistent with the fact that a timeperiod of 10 to 20 years or more is required forcirrhosis to occur. Hepatocellular carcinomaoccurs very rarely in the pediatric group.A recent study (2005) conducted by HELIOSChildren's Hospital Wuppertal in Germanydemonstrated that treatment withpeginterferon-alfa-2b and ribavirin is a welltoleratedand effective therapy for childrenwith HCV genotype 2 or 3. The level of sustainedviral response among patients varied,dependent upon the HCV genotype, liver enzymelevels, and the mode of infection.While receiving the therapy, 64 percent ofpatients had no detectable level of HCV RNA,and only five percent of patients relapsed duringthe follow-up period. The study also demonstratedthe following:• All children infected with genotype 2 or 3achieved a sustained viral response; however,less than half of patients infected with genotype1 had

similar success• Children infected by their mothers did notrespond as well as non-vertically infected children• Patients with normal liver enzyme levelsbefore treatment responded better that thosewith above normal levels.(Hepatology Volume 41, Issue 5, Date: May2005, Pages: 1013-1018 Peginterferon alfa-2bplus ribavirin treatment in children and adolescentswith chronic hepatitis C,)

Children have surprisingly few sideeffectsfrom treatment, compared to adults

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RECOMMENDATIONS1. Diagnosis, testing, and liver biopsy ofchildren thought to have HCV.2. Because of the high spontaneous clearancerate during the first year of life, testingfor children of HCV-infected mothers isrecommended at 18 months or later.3. Otherwise healthy children aged 3-17may receive therapy with interferon alfa-2band ribavirin, administered by specialists intreating children4. Children under the age of 3 should not betreated.(Doris B. Strader, DB, et al, HEPATOLOGY,April 2004 AASLD PRACTICE GUIDELINE,Diagnosis, Management

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Note from this J & F blogger... I have a friend whom is 20 and born

with HCV. She went on treatment at 17 years of age and

cleared the virus SVR.

I also am a mother of three and

had HCV while I was pregnant, (didn't know it at the time)

All of my three children were not born with HCV.

I myself reached SVR back in 2000, still SVR

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From hepc.bull -monthly newsletter

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