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“The only thing necessary for these diseases to the triumph is for good people and governments to do nothing.”

Hepatitis: Treatment


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"Hepatitis C virus (Hepatitis C Virus) infection is the most common type of chronic viral hepatitis in the developed world. The prevalence of antibody to Hepatitis C Virus (anti-Hepatitis C Virus) is 1.8% among the US population, with 74% of antibody-positive individuals demonstrating chronic infection with viremia. These prevalence rates suggest that approximately 3.9 million Americans have been infected with Hepatitis C Virus, and 2.7 million are chronically infected.

Chronic hepatitis C impairs health- related quality of life,[5] with natural history studies indicating that progression to cirrhosis occurs in at least 25% of patients, generally over a 10- to 30-year period. After the development of cirrhosis, hepatocellular carcinoma occurs in 2% to 5% of these patients each year.[6] However, it is important to keep in mind that most patients with chronic hepatitis C have a relatively benign natural history without development of progressive disease.

Chronic hepatitis C is responsible for 8,000 to 10,000 deaths per year in the United States, and it is estimated that this death rate could increase to 38,000 per year by the year 2010. It is now the single most common indication for liver transplantation in the United States and Europe.

The high prevalence and potential morbidity of Hepatitis C Virus infection makes treatment of chronic hepatitis C one of the more urgent priorities in infectious disease control.

Future Antiviral, Immunomodulatory, and Combination Treatments

Although current interferon-based combination therapy can achieve sustained virologic response rates of up to 40%, the remaining 60% of treated patients do not experience significant long-term benefits. Clearly, better therapies are needed, especially for the interferon nonresponders. Hepatitis C: Current and Future Treatment.


Document Name & Link to Document Description

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99% Pegasys Respond The first study evaluating the long-term effectiveness of PEGASYSâ, peginterferon alfa-2a (40KD), a promising new hepatitis C treatment, has found that 99% of patients remain viral free when examined two to three years later.


Associated Health Costs - United States


Although few prospective long-term survival and health care cost studies are available for hepatitis C, it has been possible to estimate the life-long economic impact of the disease for both the individual patient and for the U.S. population with chronic hepatitis B. Lifetime health care costs for a patient with chronic hepatitis B has been estimated at $65,000 in the absence of liver transplantation. For the 150,000 HBV carriers with significant liver damage, the lifetime health care costs in the U.S. have been estimated to be $9 billion. Assuming an estimated survival of 25 years, the annual health care costs for the affected U.S. population with chronic hepatitis B is $360 million. Based on the same economic analysis, treatment of chronic hepatitis B with interferon is projected to increase life expectancy by about three years and reduce the aggregate health care costs.


Atlas of Liver Pathology: Vascular Alterations in the Liver Diseases Affecting the Vasculature of the Liver


Biopsychosocial Predictors of Health-Related Quality of Life in Patients With Chronic Hepatitis C

In 94 consecutive patients with chronic hepatitis C attending a liver center, HRQOL was assessed by the Medical Outcome Study Short Form Health Survey 36 (SF-36) and by the German version of the Chronic Liver Disease Questionnaire. The predictive effect on HRQOL of disease-related worries measured by the worry subscale of the Chronic Liver Disease Questionnaire, psychiatric comorbidity (defined by at least one Hospital Anxiety and Depression Scale German Version Score 11), the Child-Pugh score in case of cirrhosis, interferon therapy, and active medical comorbidities was assessed by a multiple regression analysis.


Britain says it will pay hepatitis C victims 

Thousands of Britons infected with the hepatitis C virus as a result of contaminated blood products and transfusions are to receive compensation, Health Secretary John Reid said on Friday.


Culprits identified in Hepatitis B Liver Damage Injecting antibodies to two rogue chemokines implicated in the chronic disease phase of Hepatitis B infection, which follows the initial acute response, blocks much of the secondary inflammation in the liver, claim US immunologists.


Diagnosis, management, and treatment of hepatitis C

Set of guidelines and methods of treatment for each of the various classifications of HCV


Difference between PEG and Pegasys The two pegylated versions of interferon alfa are not identical by RockyRacoon (WebMD), 6/2/00 09:48:35 The two pegylated versions of interferon alfa are not identical by Harvey S. Bartnof, MD FDA approval for two pegylated versions of interferon alfa * are expected this year.


Disruption of Plasma Melatonin in Liver Cirrhosis To assess the 24 hr plasma melatonin profile as a marker of the output rhythm from the circadian clock and to study sleep diaries as reflection of subjective sleep quality in patients with liver cirrhosis


Do You Think It's Related?

Over the past six years, similar questions have been posed to me by hepatitis C patients thousands of times. Too often, their doctors tell them their symptoms and other medical conditions are not related to hepatitis C, which causes frustration and confusion for patients. The fact that so many patients report similar symptoms and that a multitude of research has shown a remarkable number of Hepatitis C Virus patients with other conditions, makes it clear that there is more to the relation between these conditions than just coincidence.


Evidence-Based Management of Hepatitis C: A Clinician’s Guide to Pegylated Interferons

The hepatitis C story is an ongoing tale of discovery, with the chapters on viral pathogenesis, patient risk stratification, and treatment constantly in need of revision.  This brief symposium review highlights several key areas of current interest in the diagnosis and management of chronic hepatitis C infection

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Experimental drugs block Hepatitis C Virus New experimental compounds may help the body fight off hepatitis C, researchers said Thursday. The research, done by separate teams in the United States and Canada, also led to new discoveries about how the body fights off infection. 


Exploring the Liver This through-the-skin biopsy method makes it possible to get tissue via the laparoscope (intra-abdominal telescope), or from the inside of the liver via a guided catheter threaded through the jugular vein, or through the skin with added accuracy using ultrasound or MRI guidance. A recent article from Harvard in the New England Journal of Medicine retraces these liver biopsy historical steps that I have lived through


Gastroenterology & Hepatology Description of Liver Disease



Gene Therapy may hold key to Hepatitis B Gene therapy that targets liver cells can halt hepatitis B infection in mice, a new study shows.


HCV On-Treatment Virologic Monitoring: Impact on Treatment Decisions

PowerPoint Presentation

Pdf 382v kb

HCV-To Treat or Not to Treat? That is the Question...

The difficult question of if and when to treat those infected with Hepatitis C Virus (HCV) can be evaluated from a myriad of perspectives, including public health concerns, risk/benefit in corrections, legal issues, ethical issues, and personal physician-patient responsibility


Hepatitis B Virus infection: A comprehensive immunization strategy to eliminate transmission in the US-Draft  (Large paper-increase download time)

This document updates the immunization strategy to eliminate hepatitis B virus transmission in the US, which was published in 1991 and expanded in 1995.  The document also updates technical information on HBV vaccination of infants, children, adolescents, and adults.

2209 kb pdf

Hepatitis C: Epidemiology, Diagnosis and Treatment

PowerPoint Presentation

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Hepatitis C: Facts for Today, hope for tomorrow

PowerPoint Presentation


Hepatitis C infection and injection drug use: The role of hepatologists in evolving treatment efforts

The majority of incident infections with the hepatitis C virus (HCV) are acquired through injection drug use practices. For most injection drug users, drug use occurred in the past. However, drug addiction is a chronic disease with a continuing possibility of former drug users' relapsing back to drug use. Injection drug users, both current and reformed, are at risk for HCV and other infectious diseases, and they commonly display co-morbidities associated with drug use, such as psychiatric illnesses.


Hepatitis C Management

Effective treatment rests importantly on recognition of the attributes that influence disease progression; they include host factors such as age, obesity, comorbidities (eg, chronic renal failure, coinfection with human immunodeficiency virus [HIV]), and others. Viral properties such as genotype play an important role in treatment choices and outcomes. A thorough understanding of the pharmacology and pharmacodynamics of the agents used in treatment and management of side effects is also important.


Hepatitis C-new Test A study presented at this year's 51st American Association for the Study of Liver Disease (AASLD) meeting reported on results using a new Hepatitis C (Hepatitis C Virus) test which utilizes a cutting-edge molecular diagnostics technology called transcription mediated amplification (TMA).


Hepatitis C vs. TRADITIONAL MEDICINE So-called "traditional medicine" did not exist as we know it before the early1920's. Also known as "allopathic" medicine, it is adversary based. It "wages war" on bacteria, viruses and misunderstood processes in the body, and sometimes even the body itself


Hepatitis C-Post-exposure Treatment Report on post-exposure management


Hepatitis C Symptoms-Imagined or Real

What is it about hepatitis C that makes so many of us complain about symptoms such as fatigue, nausea, body aches and pains, loss of appetite, and mood swings?  Are they real or imagined?

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Hepatitis B report Hepatitis B is a global health concern despite the availability of a vaccine. Although vaccines for hepatitis B and hepatitis A are available, they are often not administered to at-risk individuals


Hepatitis C Informational

Critical issues in the treatment and management of Chronic Hepatitis C

1,114 kb pdf

Hepatitis C-Who should get treated When Fran Kee learned he had been infected with the hepatitis C virus, he decided to start the grueling, yearlong treatment process, even though doctors said he could wait. His blood tests showed extremely low levels of the virus, and all but one of his liver enzyme readings were normal.


Hepatitis C-Current & Future Treatment Interferon alfa-2b, 3 million units tiw, plus ribavirin, 1000 to 1200 mg daily for 6 to 12 months, has shown an improvement of 2-fold or more for all measures of efficacy when compared with interferon monotherapy. In the next year, treatment of chronic hepatitis C will involve pegylated interferons, either alone or in combination with ribavirin. Therapy in 3 to 5 years will likely be multidrug combinations, including inhibitors of the hepatitis C virus (Hepatitis C Virus) protease, helicase, or polymerase, with the aim of reducing serum levels or eradicating Hepatitis C Virus RNA.


 Hepatitis Report: The patient who has a liver disease wants (or needs) to know about the natural history of the disorder so as to plan for the future. The patient should be informed regarding the likely consequences, important milestones, major complications, and available therapies, all given with a large measure of compassion and sensitivity.


Hepatofugal Flow in the Portal Venous System: Pathophysiology, Imaging Findings, and Diagnostic Pitfalls

Hepatofugal flow (ie, flow directed away from the liver) is abnormal in any segment of the portal venous system and is more common than previously believed. Hepatofugal flow can be demonstrated at angiography, Doppler ultrasonography (US), magnetic resonance imaging, and computed tomography (CT). The current understanding of hepatofugal flow recognizes the role of the hepatic artery and the complementary phenomena of arterioportal and portosystemic venovenous shunting. Detection of hepatofugal flow is clinically important for diagnosis of portal hypertension, for determination of portosystemic shunt patency and overall prognosis in patients with cirrhosis, as a potential pitfall at invasive arteriography performed to evaluate the patency of the portal vein, and as a contraindication to specialized imaging procedures (ie, transarterial hepatic chemoembolization and CT during arterial portography). Hepatofugal flow is generally diagnosed at Doppler US without much difficulty, but radiologists should beware of pitfalls that can impede correct determination of flow direction in the portal venous system.


High-Dose Interferon Alpha-2b Prevents Chronic Hepatitis C Early treatment of acute hepatitis C with a relatively short, high-dose regimen of interferon alpha-2b prevents the development of chronic infection in most patients,



HIV and Hepatitis C-Coinfection Information Brochure

Complications from hepatitis C are becoming one of the most important medical issues facing HIV positive individuals

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How to Enroll in a Drug Study There are several ways in which patients and their physicians can learn of clinical trials in which they may want to take part


In a first, USC scientists show how Hepatitis C dodges medicinal firepower

“Hepatitis C is a ticking time bomb…It creates tremendous social and health pressure, and is one of the most important infectious diseases in this country.”

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Incidence of seroconversion to hepatitis C To estimate the rate of seroconversion to positivity for hepatitis C antibody in repeat blood donors in England and to describe the probable routes of infection in these donors.


Overcoming Barriers to Prevention, Care, and Treatment of hepatitis C in Illicit Drug Users

Injection drug users constitute the largest group of persons infected with the hepatitis C virus in the united States, and most new infections occur in IDUs.  The prevalence of HCV antibody in most studies of older IDUs is 80%-90%, and uninfected IDUs generally become infected at rates of 10%-20%/year

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Physicians in the Management of Patients With Hepatitis C Approximately 4 million Americans are infected with the hepatitis C virus (Hepatitis C Virus). Most patients with hepatitis C have no symptoms until cirrhosis is established. Thus, initial diagnosis and management of hepatitis C rely on primary care physicians identifying and screening high-risk individuals.


Patients paying larger percentage for Medical Costs Faced with "rapidly rising" prescription drug spending, which is climbing at about 15% per year, employers and insurers have increasingly shifted the costs to patients, who "may soon pay even more,"


Quick Treatment for Hepatitis C cured if caught early Quick treatment after infection can almost always cure hepatitis C, a condition that causes between 8,000 and 10,000 deaths in the United States each year, according to a study released Monday.


Researcher Says Disease Will Strain the State's Hospitals and Transplant Units

While new cases of infection will decline in the future, Dr. Davis and colleagues predict that more people who already have HCV infection will experience progression of liver disease -- to cirrhosis and hepatocellular carcinoma, for example. Chronic HCV is the most common indication for liver transplantation in the U.S., affecting 50 percent of all patients receiving liver transplants. And, the disease frequently recurs following liver transplantation, sometimes leading to cirrhosis and liver failure a second time.


Recommendations for Prevention and Control of Hepatitis C Virus (HCV) Infection and HCV-Related Chronic Disease

These recommendations are an expansion of previous recommendations for the prevention of hepatitis C virus (HCV) infection that focused on screening and follow-up of blood, plasma, organ, tissue, and semen donors (CDC, Public Health Service inter-agency guidelines for screening donors of blood, plasma, organs, tissues, and semen for evidence of hepatitis B and hepatitis C. MMWR 1991; 40 (No.RR-41); 1-17). The recommendations in this report provide broader guidelines for a) preventing transmission of HCV; b) identifying, counseling, and testing persons at risk for HCV infection; and c) providing, appropriate medical evaluation and management of HCV-infected persons. Based on currently available knowledge, these recommendations were developed by CDC staff members after consultation with experts who met in Atlanta during July 15-17, 1998. This report is intended to serve as a resource for health-care professionals, public health officials, and organizations involved in the development, delivery, and evaluation of prevention and clinical services.


Sharing of Drug Preparation Equipment as a Risk Factor for Hepatitis C This study investigated the sharing of drug preparation equipment as a possible route of hepatitis C virus (Hepatitis C Virus) transmission.


Statistics and meaning of normal ALTs with Hepatitis C Virus+ This article contains discussion of several published studies which look at Hepatitis C Virus positive individuals with normal ALTs (liver function test) and the relationship between ALT levels and Hepatitis C Virus disease progression. Whether or not such individuals should initiate Hepatitis C Virus treatment is discussed.


Subject Effectiveness of Hepatitis C Drug Patients being treated for the hepatitis C virus -- a blood-borne disease that attacks the liver -- now can learn earlier than ever before if they are likely to benefit from an investigational drug therapy.



Deciding when to undergo treatment for Hepatitis C through an assessment of the benefits and detriments


Transjugular Intrahepatic Portosystemic Shunt: Current Status

The Transjugular Intrahepatic Portosystemic Shunt (TIPS) was developed in the 1980s for treatment of complications of portal hypertension.  Once it was shown that the shunt could be place with relative ease, TIPS was rapidly applied to the treatment of many of the complications of portal hypertension.

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Treatment options for Hepatitis B non-responders Thus, a large number of untreated patients with HBeAg-positive CHB are left with severe liver necroinflammation which persists for several years and results in an increased likelihood of progression of liver damage to advanced stages of fibrosis, cirrhosis and even development of hepatocellular carcinoma (HCC), the most dire consequence in the natural history of CHB.


Treatment denied to inmates In mid September, 1998 I became ill: fatigued and weak, I thought I'd caught a bug. By late January, 1999 I'd been diagnosed as suffering from chronic hepatitis C and was taken out of the prison to see a gastroenterologist at a local hospital.


Treatment of Chronic Hepatitis C Chronic infection with the hepatitis C virus is extremely prevalent, averaging 1% to 2% of the world population. Fortunately, recognition of potential risk factors, changes in patterns of using injected drugs, and improved safety of the blood supply have led to a dramatic decline in the incidence of new hepatitis C virus infections in recent years.


Treatment of Hepatitis after Kidney Transplant This patient is the classic patient with acute hepatitis due to Hepatitis C Virus infection. The most important thing we need to know is the timing. It looks as if she clearly was negative before transplantation and now is positive by both virologic and enzymatic evaluation; therefore, she meets the criteria for acute hepatitis


Treatment of Hepatitis B Hepatitis B remains a major worldwide public health problem. Globally, there are 350 million carriers of the hepatitis B virus (HBV) vs 370 million carriers of the hepatitis C virus (Hepatitis C Virus). In the United States, 4.0 million persons are positive for Hepatitis C Virus antibodies and 2.7 million of these individuals are chronic carriers