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Doctors' Answers to "Frequently Asked Questions" - Hepatitis

These comments are made for the purpose of discussion and should NOT be used as recommendations for or against therapies or other treatments. An individual patient is always advised to consult their own physician.

Hepatitis B [posted 1/14/99]
Question: I was diagnosed as a hepatitis b carrier. I was shown to be HBAge negative, and did not suffer from any liver damage. However, I suffer from lethargy easily. I often feel worn-out and run-down. Could this be due to my medical condition?

Answer: Yes, but get your blood counts done and check your thyroid looking for treatable causes.

Hepatitis C and Liver Transplant [posted 7/31/98]
Question: Can a person who has had Hepatitis C in excess of 8 years get a liver transplant? If so, would this be a possible cure?

Answer: Each transplant center has its own criteria for transplant. In general, Hepatitis C is not transplanted since the infection will continue in the transplanted liver. However, there are exceptions and I would correspond with individual transplant centers for their transplant criteria.

Question: Could you give me some info on Hepatitis B?

Answer: Hepatitis B is a virus that is transmitted by blood or blood products. Generally, it is transmitted by needles, blood, semen, etc. Although maternal, fetal transmission is also possible. The incubation period is about 30-180 days after infection. About 1% will have the initial infection be serious or fulminant-- usually leading to immediate death or liver failure. Most, however, will successfully fight off the initial infection. About 90% of patients will "kill" the virus and become hepatitis B antibody positive-antigen negative. About 5-10% will become chronic carriers and are at risk of transmitting the virus to others. Some of these will have chronic active hepatitis and proceed to liver failure. Prevention is the best cure, such as use of the vaccine(3 shots usually) and "safe" sex.

Hepatitis B Vaccine
Question: The blood test that was to precede my series of Vaccinations for Hepatitis B came back positive. I do not remember ever having Hepatitis. If I had it, am I contagious? Is there such a thing as a false positive?

Answer: False positives occur in any test but are rare with this test. I suspect you picked up the disease and never felt any symptoms. There are two major variations of people who have had Hepatitis B infections. 80-90% will be infected and the virus is killed by your immune system. This leads to Hepatitis B Antibody positive-Antigen negative. The Antigen is only present if the virus is still present and this occurs in about 10% or so. That is, HepBAntibody positive and HepBAntigen positive. These individuals still carry the virus and are potentially infectious. So, if you are Antibody positive and Antigen negative you are not positive. If you are Antibody positive and Antigen positive you are potentially infectious and may need treatment by one of several treatment regimens to prevent the virus from further damaging your liver and leading to cirrhosis or hepatitic carcinoma.

Hepatitis B
Question: Is any treatment for Hepatitis B?

Answer: Most patients with Hepatitis B will not need treatment. This is because their immune system has killed all the virus. This leads to Hepatitis B antibody positive and Antigen negative patients. The only ones who need consider treatment options are patients who are Hep B antibody positive and antigen positive. This indicates that there is active virus still in their system replicating. However, unlike Hepatitis C, many patients have very mild changes and usually need no ongoing treatment. The group that needs treatment are those who have chronic active hepatitis. These individuals will usually progress to cirrhosis and liver failure over many years. Treatment is generally reserved for this group, and this can only effectively be established by liver biopsy; however, there are some markers in the blood that are suggestive. Interferon alpha treatment over about 4-5 months is the current treatment.

Hepatitis C
Question: I was wondering if any dietary factors could contribute to or help control the progress of Hepatitis C?

Answer: None that I am aware of.

Question: I came into contact with a woman who had hepatitis. I don't know what type she had, but she had it. Is hepatitis an airborne pathogen? What are the chances of catching it?

Answer: Hepatitis is a viral illness that effects the liver, and it can lead to other complications, some of which can be serious. The severity of illness is to a large extent determined by the type of virus present. The known types of hepatitis include Hepatitis A and E both of which are known only to be transmitted to humans by fecal-oral route. That is, by ingestion of contaminated water or food products with fecal material containing the virus. The Remaining known types of Hepatitis viruses (B,C,D) can be more severe illnesses, are more likely to lead to chronic or more severe complications, and are known to be transmitted to humans only by direct exposure to infectious body fluids including blood, vaginal or seminal fluid contact, or from mother to fetus. Barring exposure to aerosolized infectious fluid particles, simple airborne exposure is not known to occur.

Hepatitis C
Question: I wanted to ask about the effects that Hepatitis C may produce in my mother?

Answer: Hepatitis C is a progressive viral disease of the liver. Untreated, it will progress to cirrhosis and liver failure. The time course is variable, but is usually 20-30 years after infection. There is treatment with interferon and other regimens. She needs to see a specialist in hepatitis or a GI specialist to begin treatment or at least have the regimens explained. They can be toxic, but do improve survival.

Hepatitis C nutritional information
Question: Can nutritional aspects control or contribute to the disease Hepatitis C?

Answer: Hepatitis C is transmitted by blood and blood products. It is a virus and no nutritional limits or controls will affect it. You cannot contact this through contaminated food products as you can Hepatitis A.

Hepatitis B
Question: My family just found out that my brother has been diagnosed with Hepatitis B. Could you please send me any information on this disease. I am aware of it's symptom to liver failure which could lead to death. I would like to know any survival rate or treatments today to help prolong liver failure.

Answer: Anything that produces inflammation to the liver is called hepatitis. Many chemicals, such as alcohol will cause hepatitis as will many infectious agents. Viruses are the most usual form of infectious hepatitis and it is very common to see elevated liver enzymes following a cold or other non-specific viral infection. However, there are several viruses that have a predilection for the liver. The first of these was Hepatitis A. This is a virus transmitted by oral/fecal transmission. The hepatitis is limited and does not chronically inflame the liver. Second was Hepatitis B. This is transmitted by blood. semen and body products. Transmission by oral/fecal route is thought to be rare to not existent. This in about 5-10 % of cases will not be "cured" by the body and proceed to chronic inflammation of the liver. This can lead to liver failure and death and is the leading cause of liver cancer worldwide. There is a vaccine for Hepatitis B aimed at prevention in high risk individuals. Third was Hepatitis C. This was initially called non-A non-B, but is not referred to as Hepatitis C. This virus is transmitted like Hepatitis B - by blood products, semen, etc. The risk for transmission for Hepatitis B and C is the same as for the spread of the AIDS virus. Hepatitis C can also proceed to chronic hepatitis. This occurs in about 50 % of patients. It does not proceed as rapidly as Hepatitis B to liver failure, but occurs much more frequently. Fourth is Hepatitis D. This virus is spread mainly through semen/blood route and is usually seen in together with either Hepatitis B or C. Fifth is Hepatitis E. This is similar to Hepatitis A and is spread mainly by oral/fecal route. This virus is seen mainly in India, Asia, and Africa. There are several more rare types of viral hepatitis and the list now extends to G. Unprotected sex may spread Hepatitis B, C, or D. Oral routes will spread A and E. Chronic hepatitis refers to the chronic longs term infection with B, C, and D.

Hepatitis C
Question: My ex-husband has been diagnosed with Hepatitis C. Is my daughter in any danger of contracting this from him? Also how could he have contracted it? He claims he got it from the chemotherapy and radiation treatments he just went through for testicular cancer. Is Hepatitis a disease common with HIV patients?

Answer: Hepatitis C cannot be spread by chemotherapy and radiation. Your husband is a mild risk for transmitting Hepatitis C to your daughter, but only if she comes in contact with his blood or semen. You are at higher risk if there is unprotected intercourse. Hepatitis B, C, and D are common in HIV patients since it is transmitted in a similar manner as the HIV virus. Unprotected sex may spread Hepatitis B, C, and D. Oral routes will spread A and E. Chronic hepatitis refers to the chronic long term infection with B, C, and D.

Hepatitis B
Question: My father recently died of Hepatitis B complications. It has been acknowledged by the government that he was very likely to have contracted it in the sixties when he was an army medic in Vietnam. It recently occurred to me that I was conceived after he returned. Should I be concerned for my own health, or is it even possible that he could have passed it on to me or even my mother some twenty five years ago?

Answer: You should probably be checked. However, the risk of vertical transmission is fairly low. If your mother is checked and is negative, the risk for you is even lower since the most likely mode of transmission is from your father to your mother and your mother to you. Only about 5-10% of patients with Hepatitis B become chronically infectious, but these are the patients who proceed to liver failure.

Hepatitis C
Question: My girlfriend has hepatitis C and she is taking interferon. What is the risk of my getting the disease with unprotected sex? What is the risk of her passing the disease to my children (ages 7 and 9) by kissing them?

Answer: Your children are at little risk of Hepatitis C trom kissing.

Immune Hepatitis
Question: I'm trying to find out some side effects of prednisone. A nine year old girl has auto immune hepatitis and is very ill. She is concerned about side effects and would like information on alternative treatments.

Answer: Hepatitis is an inflammation of the liver. There are several types of hepatitis ranging from infectious to drug induced. Immune hepatitis is an uncommon cause of hepatitis; but, like any type, liver inflammation will progress to liver failure if unchecked. Unfortunately, the liver is an organ that is not duplicated like the kidneys or that any mechanical intervention will replicate. Consequently, liver failure will rapidly progress to death unless a transplant is available. There are several drugs used to treat the immune system when is becomes overactive. Steroids like prednisone (pregna-1, 4, diene-3, 11, 20-trione, 17, 21-dihydroxy) are potenent moderators of the bodies immune function. These are used in the early stages to treat disorders of immune function. However, long term these drugs have potentially severe side effects. In general, this class of drugs speeds up the aging process and patients develop diabetes, osteoporosis, coronary artery disease, cataracts, etc. Usually, if steroids are necessary for a prolonged period, other drugs such as Imuran (azathioprine) or cytoxan (cyclophosphamide) will be used. These drugs are used in different cancer protocols and have their own individual risks.

Epidural Risks
Question: I am taking Brufen Retard for lower back pain, due to a worn disk. I have been advised to have an epidural for longer term relief, as I am considering starting a family. What are the risks of the epidural ?

Answer: Low back pain is a common problem and unfortunately, has few good treatment options. Initially, anti-inflammatories and physical therapy are used to relieve the pain. If these regimens are insufficient, surgery or injection is the next line of treatment. Usually, surgery is a last resort and only used with clear pressure of the disc on the nerve or nerve root. In the absence of an x-ray showing this I would recommend a trial of an injection. In my experience, this is only a temporary relief and will buy 6-9 months of relief at best. Long term side effects appear minimal if there are only a couple of injections. There is always a risk of infection, leakage of spinal fluid from the injection site and trauma to other nerve roots causing more severe pain.

Hepatitis C
Question: I have a friend that tested positive for hepatitus C. His doctor reccomented treatements of infuran. Is there any alternative treatment.

Answer: Hepatitis C is an infection of the liver by a virus that has been labeled "C". This means that it is the third virus for which a diagnostic test is available, the others being A and B. Since C was "discovered" there have been numerous other viruses identified up to G. This can be a particulary deadly virus progressing to cirrhosis of the liver and death. Treatment options are fairly limited. Like Hepatitis B7 most of the cases of Hepatitis C are spread by blood transmission, sexual contact;however, most cases of Hepatitis C the source of the infection is unknown. Although this virus commonly procedes to cirrhosis,(50-60 % of pabents) it is generally a slow process 10-20 years. Interferon alpha has been approved for the treatment of Hepatitis C-however, whether to treat or not treat is controversial due to the long course of this disease. Immuran is not usually used to treat this disease unless it is part of an investigational protocol.

Hepatitis B
Question: Recently, I was told that I have Hepatitis B. How infectious am I if the HBs AG is positive, HBe AG is positive, Hep B DNA PCR is over 540 PG/ML, and the HEP. Delta Virus Antigen is negative? Are there any possibility of reversing the process of Hepatitis? Is there a way to change the antigen to positive? Should I be alert if my SGPT (ALT) is 111 U/L?.

Answer: As long as the antigen is positive, you are potentially infectious. However, I'm confused since you refer to changing the antigen to positive( I think it already is). The lack of Delta Virus gives a better long term prognosis since co-infection with both B and D leads to much more serious liver disease and progression. The amount of elevation of any particular enzyme is not too important. However, if you start on treatment these can be markers to measure response.

Hepatitis C
Question: Please let me know if are new drugs against hcv. thanks!

Answer: Are you referring to Hepatitis C? Currently, there is no treatment. Interferon is used as the best treatment option and is effective in 30% or so to slow the progression of the disease.

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