#26 Hep C Community News

Hep C Community News Winter 04

Issue 26

Drug Action Week® is gearing up for 2004 and will be held from 2121-25 June with many events scheduled to be held in and around Adelaide.

Drug Action Week® is the premier event to raise awareness about alcohol and other drug issues in Australia and is hosted each year by the Alcohol and other Drugs Council of Australia (ADCA).

Further details page 3

The Future in Treatment Hep C in Prison’s

page 14

page 4

Herbs and Hepatitis C Feature page 8

Hepatitis C Community News

Contents

4 The Parade Norwood. SA 5067 Ph. (08) 8362 8443 SA Regional Callers 1800 021 133

Drug Action Week

3

Hep C in Prison’s Update

4

Prison Peer Support

5

Editorial, Drug Prohibition Diabetes after Transplant Herbs and Hepatitis C

Non-waged membership -— $5.50 Waged membership -——– $16.50 Organisational membership — $55

6—7 7 8—11

Treatment

12—13

The Future in Treatment

14—15

(GST inclusive)

You can request a zero-cost membership Donations do not attract GST

Personals

15

48 Week Course

16

Inspirations

17

The Liver, an Introduction

Postal Address

Additional Services

18—19 20

Hep C Community News PO Box 782 Kent Town SA 5071 PH. (08) 8362 8443 Fax. (08) 8362 8559 Email: admin@hepccouncilsa.asn.au Web site: www.hepccouncilsa.asn.au

Do you enjoy reading the Hep C Community Newsletter but always want to read more?

Check out the Hepatitis C Council of NSW "Hep C Review" online at http://www.hepatitisc.org.au/reviews/reviews.htm

We welcome contributions from Council members and the general public.

Views expressed in this newsletter are not necessarily those of the Hepatitis C Council of S.A. Inc. Information contained in this newsletter is not intended to take the place of medical advice given by your doctor or specialist.

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Drug Action Week® 2004 Drug Action Week® aims to raise awareness about alcohol and other drug issues and promote the achievements of those who work to reduce drug related harm.

Each day of Drug Action Week® has a specific theme to highlight the diversity and complexity of alcohol and other drug issues.

The 2004 Theme Days are: Monday Tuesday Wednesday Thursday Friday

21 June 22 June 23 June 24 June 25 June

Alcohol Treatment Prevention Indigenous Australians Prescription Medicines

For more information about Drug Action Week® or to find out what is happening in your area, visit the website www.drugactionweek.org.au or contact the ADCA office on telephone (02) 6281 0686 or email info@drugactionweek.org.au Drug Action Week® 2004 is proudly sponsored by the Alcohol Education and Rehabilitation Foundation.

Interactive Expo on Alcohol and other drugs Drug and Alcohol Services Council, Western Services in conjunction with a number of other local services in the western region will be holding an interactive expo on alcohol and other drugs in the Parks Basketball Stadium at the Parks Community Centre.

On the day community members will be able to access a variety of activities and information about alcohol and other drugs. There will be opportunities for community members to interact with workers from a variety of local services. The theme of the day is prevention.

A free BBQ will be available for community members.

This event is part of Drug Action Week® 2004 Wednesday the 23rd June 2004 10am-2pm Basketball Stadium Parks Community Centre Corner Trafford and Cowan Streets, Athol Park For further details please contact: Wendy Fraser on 8243 5715

Events that will be attended by Council staff.

Monday 21st June am “Health Promotion and Art.” Hepatitis C and Harm Minimisation Session followed by Art session at Magill Training Centre. Done collaboratively working with SAVIVE. Monday 21st June pm “Health Promotion and Art” by way of “Mosaic Art Piece” with a group of young people from JPET and Streetlink at Streetlink. Collaboratively working with Art Therapist Gina Allain, JPET and Streetlink.

Wednesday 23 June Fresh FM interview on the “Morning Show” with SAVIVE and the Hepatitis C Council of SA @ 11am Friday June 25th BBQ for Indigenous people in the West Parklands.

Hepatitis C Council in collaboration with Aboriginal Drug and Alcohol Council (ADAC).

Sunday 20 June Fresh FM Forum 9-11 pm with SAVIVE and the Hepatitis C Council of SA.

Promoting Prevention and Hepatitis C Information Sessions being conducted by our Rural Educator.

Date and Time

Location

Tuesday 22nd June 9.30am-12 noon

Day Room Tumby Bay Hospital Tumby Bay Board Room Cummins Hospital Cummins West Wing Lecture Room Port Lincoln Hospital Port Lincoln Sobering Up Unit Ceduna Kooniba Aboriginal Health Service Ceduna

Tuesday 22nd June 2pm-4.30pm Wednesday 23rd June 9.30am-12 noon Thursday 24th June 9.30am-12 noon

Thursday 24th June 2pm-4.30pm

Ceduna District Health Services Inc.

Friday 25th June 10am-12.30pm

Port Lincoln Aboriginal Health Service Port Lincoln

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Hepatitis C in Prisons History of imprisonment has long been independently associated with infection with the hepatitis C virus. Currently within the South Australian prison system there are around 1400 people held either in remand or serving a custodial sentence. There are also over 4000 admissions per annum.

Data from STD Services indicate that in 2002 10% of total notifications and 25% all new cases (incidence) were received from the prison system.

Not many studies have been carried out in prisons.

There is no standardised national data but various studies from around Australia indicate the prevalence of hepatitis C amongst prisoners to be about 40% in males and 65% in females.

The prison environment presents difficulties when attempting to access harm minimisation strategies including education and infection control initiatives, which are limited.

Some positive initiatives that are in place include the “Staying Safe in Prison – Hepatitis C Video� which is shown to all new prisoners. NGOs running collaborative education sessions with Vietnamese, Pitjantjatjara populations and Hep C Council sessions with prison peer supporters.

Other initiatives include differential sanctions for drug use, condom access, opioid and other drug substitution program and treatment (interferon) programs.

There are number initiatives that still need addressing including the lack of resources and the need for more comprehensive education and treatment programs. Infection Control initiatives such as bleach and needle syringe exchange. These could be seen as controversial issues within correctional settings. For any change to occur the wider community needs to become involved in the public debate and advocacy on these issues.

Prison Peer Support Programs Department for Correctional Services (DCS) supports the concept of Prison Peer Supporters (Educators). The Health Promotion Officer for DCS conducts this program at selected prisons.

The idea of prisoners supporting each other is not new and is an essential component of prison life.

What the Peer Support program does is skill up selected prisoners to provide accurate information, utilise communication skills and access appropriate referral services when required. The selected prisoners must have had some goal experience, a sentence longer than 12 months, be considered to have creditability with staff and prisoners and a have altruistic outlook.

The programs vary from 20-30 hours, some session are done by outside providers including the Hepatitis C Council. The content of the program varies from general health information, mental health stress management, blood borne viruses, harm minimisation, communication skills including listening, conflict resolution, assertiveness and negotiation skills through to values and ethics.

Peer Supporters are often used by other prisoners for a variety of reasons, anything from health advice on current information or in a counselling capacity. This can take place on a casual basis or be used in a more official capacity by prison staff if they have concerns about a certain prisoner.

Many peer supporters report gaining a sense of self-satisfaction from completing training and the development of skills that not only help others but themselves during incarceration and upon their release.

Anton Colman Health Promotion Officer Department for Correctional Services

Anton Colman Health Promotion Officer Department for Correctional Services

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Hepatitis C Council involved in educating Prison Peer Supporters With unacceptably large numbers of people in prison with hepatitis C, (approximately 40% in males and 65% in women’s prisons compared to 1% prevalence within the broader community), it is essential that a range of strategies are implemented to prevent new transmissions and to prevent people with hepatitis C being reinfected. It is also critical that people in prison are offered the best possible information and support to make informed choices about medical, alternative and complementary therapy options, along with information that will inform decisions relating to harm reduction and health promotion. Ultimately law reform is critical to ensure that fewer people with drug related issues are incarcerated.

Over the past eight months, the Hepatitis C Council Rural Education Officer has been involved in providing education on hepatitis C and related issues as part of the Prison Peers Support Program. Eighteen men, eight from Port Lincoln Prison and ten from Port Augusta Prison have participated to date. These sessions have been enthusiastically received with participants particularly interested in clarifying information on transmission, exploring other risk factors that might exist in prison, discussing the dilemma of safe injecting in a prison context where harm reduction strategies are not available, ideas for optimising health and current information on treatment. Other risk factors of concern to a number of Peer Supporters have been - sharing blood stained boxing gloves and the use of hair clippers for large numbers of prisoners.

If you are currently in prison and would like further information on any aspect of hepatitis C, try the following: ♦ Ask workers in your health clinic ♦ Check out what’s in your library-if there’s not a lot ask staff responsible for ordering resources to call the Hepatitis C Council of SA, ph: 8362 8443 ♦ Contact the Prisoner Hepatitis Line (You can ask workers on this line to call the Hepatitis C Council if you have a specific request) ♦ Write to the Information Officer at the Hepatitis C Council of SA with your request, PO Box 782 Kent Town 5071 ♦ Become a Hepatitis C Council member and receive the newsletter Don’t forget if you want to write an article, personal story, whatever, for Hep C Community News please send this information to The EditorHep C Community News (See address above)

Feedback from participants has indicated that these sessions have increased participants’ knowledge of hepatitis C, specifically relating to transmission and prevention and that most participants felt that the information would be readily translated to peers. A number of participants have been interested in receiving information on an ongoing basis and have been keen for information to be sent to prison libraries or for Hepatitis C Council membership to be pursued.

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Drug Prohibition and hepatitis C in Australia In May 1953, over half a century ago, the Commonwealth government over rode objections from the states and the medical profession and banned the importation and production of heroin.

The Director-General of Health in New South Wales, the British Medical Association (later to become the Australian Medical Association), the Royal Australasian College of Physicians and the Royal College of Obstetricians and Gynaecologists were among those to declare that ‘the use of heroin should not be prohibited’. Nevertheless, the Commonwealth advised the State Premiers in May 1953 that the importation of heroin was to be absolutely prohibited. Until the states and territories subsequently ran out of stock, heroin continued to be lawfully prescribed by doctors and dispensed by pharmacists under careful controls, much as it had for many previous decades and much as other drugs derived from the opium poppy are still used medicinally today.

The ban was introduced largely due to external pressure from the Permanent Central Opium Board, the forerunner of the International Narcotics Control Board. The involvement of the United States in this intervention has long been suspected but never confirmed.

Before heroin was prohibited, very few people used illicit heroin in Australia. Significant illicit heroin use in this country began a decade and a half after heroin was prohibited in the late 1960s when US servicemen, briefly visiting on leave from the Vietnam War, introduced the drug and the practice of injecting to young Australians.

Once introduced, heroin injecting, and then later other illicit drug use, increased rapidly. Drug arrests in New South Wales grew five fold from 173 in 1972 to 909 in 1977 while overdose deaths increased three fold from 14 in 1974 to 49 in 1976.

Every few years, a new crisis occurred with the community shocked to discover that the illicit drug problem was growing alarmingly. Almost every year for the last quarter century, one or other Australian jurisdiction has launched a parliamentary enquiry or Royal Commission into the drug problem. The result of these reviews in the early years was always the same: expand the police drug squads and increase the severity of the penalties.

Draconian responses to drugs soon became a spectacular political magic pudding capable of electing even the otherwise unelectable.

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But illicit drug problems continued to deteriorate steadily. The numbers of drug users, the range of drug types, the quantities of drugs consumed, the number of casualties and crimes all increased inexorably. As the price of street drugs fell, their purity and availability continued to increase. Faced with these consistent findings, most politicians and many community members called repeatedly for more of the same. If all the King’s horses and all the King’s men had not succeeded, perhaps a few more horses and men might do the trick.

However, the growing cost, limited effectiveness and serious unintended negative consequences of prohibition slowly began to concern an everincreasing number of commentators. Drug overdose deaths in Australia soared from only six in 1964 to 958 in 1999. The search began for alternatives to banning substances whose demand seems largely irrepressible and whose supply seems largely uncontrollable.

Australia’s experience with illicit drugs during the twentieth century was common to most industrialised and later many developing countries.

Global drug prohibition had started slowly at the beginning of the twentieth century but included virtually all nations by the end of the century. The international community gathered at the United Nations in New York in 1998 to take stock of global drug prohibition and contemplate a new slogan (“a drug free world, we can do it”). This was denial on an impressively global scale and took place at the very time that AIDS, the worst international public health threat since the Black Death, was quickly gathering pace. In most continents, sharing of needles and syringes was either the major or the second most important risk factor for HIV infection. In many countries, a deeply entrenched commitment to solving the drug problem by law enforcement had tragically prevented or delayed the introduction of effective means of controlling HIV infection, such as needle syringe programmes.

In April 2003, the half term review of the 1998 UN commitment to eliminating or significantly reducing heroin, cocaine and cannabis use by 2008 was held at the United Nations in Vienna. The United Nations Office on Drugs and Crime declared improbably that “encouraging progress had been made to still distant goals,” even though global drug production and consumption showed no overall reduction from 1998 and even though

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problems had deteriorated substantially in many parts of the world.

The extent to which domestic law enforcement has contributed to the recent heroin shortage in Australia is still debated. While the dramatic reduction in overdose deaths is welcomed, there have also been some concerning negatives. The sustainability of any benefits is also in doubt.

Heroin availability has increased from its post 2000 nadir but has not yet returned to pre-shortage levels.

Nor is support for Draconian supply control the political magic pudding it once was. For example, the Greens Party almost doubled their vote at the 2003 NSW elections even though their liberal drug policy was widely criticised during the campaign.

In the USA since 1996, majorities have supported drug policy reform in 19 of 23 state based ballot initiatives. In Switzerland in 1997, 71% of voters in a national referendum supported retaining the option of heroin prescription for treatment refractory, severely dependent heroin users.

Change in social policy often takes a long time.

But after fifty years of heroin prohibition in Australia the winds of change are now well and truly blowing. If demand is constant, the more successful prohibition is in reducing supply, the higher drug prices rise. The higher prices and therefore profits rise, the more attractive drug trafficking becomes to the desperate or ruthless.

This economic flaw remains the Achilles heel of prohibition. Australia will not see another fifty years of heroin prohibition. What will follow heroin prohibition is still not clear. In 1992, the most recent figures available, 84% of commonwealth and state government expenditure on illicit drugs was allocated to supply control.

Government spin doctors refer to this as ‘the balanced approach’. While drug policy continues to rely so heavily on law enforcement, illicit drugs such as heroin and increasingly amphetamine, will continue to be administered almost entirely by injection. While these drugs continue to be injected by a large and growing army of drug users, the number of hepatitis C infections and other injecting-related health problems will continue to soar.

Dr. Alex Wodak, St. Vincent’s Hospital, Darlinghurst, NSW 2010

New Onset Diabetes Mellitus After Liver Transplantation: The Critical Role of Hepatitis C Infection Epidemiological studies suggest diabetes mellitus (DM) may be an extrahepatic manifestation of chronic hepatitis C virus (HCV) infection.

Since diabetes and HCV are common in liver transplant recipients, we sought to examine the unique contribution of HCV infection to risk of de novo (newly acquired) diabetes post-transplantation.

Using a cohort of 555 liver transplant recipients (median age 49 years, 54% males, 82% Caucasian) without pre-existing diabetes from 3 U.S. centres, enrolled between 1990 and 1994 and followed for a median duration of 5 years, researchers determined the incidence of de novo diabetes and the independent predictors of the development of diabetes. De novo diabetes was defined by the use of anti-diabetic medications.

De novo diabetes developed in 209/555 (37.7%) patients of whom 157 (28.3%) had transient-DM (T-DM) and 52 (9.4%) had persistent-DM (P-DM).

Among HCV-infected transplant recipients, de novo T-DM and P-DM developed in 26% and 14%, respectively. HCV was predictive of P-DM (P = .02) but not T-DM. Older age (P = .03) and tacrolimus use (P = .02) were also independent predictors of P-DM. In conclusion, de novo diabetes is common in transplant recipients, but is typically transient in nature. However, among those developing de novo persistent diabetes, HCV is one of the most important risk factors.

This adds further support to the epidemiological data linking HCV and diabetes.

03/17/04 Reference M Khalili and others. New onset diabetes mellitus after liver transplantation: The critical role of hepatitis C infection. Liver Transplantation 10(3): 349-355. February 26, 2004.

Abridged with thanks via hivandhepatitis.com

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Herbs & Hepatitis C A series of fact sheets written by experts in the field of liver disease Lucinda K. Porter, RN

A Word from the Author Interest in herbs and supplements seems to be on the rise. When I first wrote this article, it was difficult to find reliable sources of information about herbs. As more information became available, it became clear it was time to update “Herbs and Hepatitis C.“ This article is not meant to be the final stop on the information highway. I hope the reader will use this as a tool towards gaining more insight and knowledge about the world of herbs. Of course, this information is not meant to be used for medical care.

Always talk to your primary healthcare provider before using herbs.

The use of herbs for medicinal purposes has a long and interesting history. The origins of some modern medications are actually plants, such as aspirin from white willow bark, digitalis from foxglove, morphine from poppies and warfarin (Coumadin) from sweet clover. Many cultures use indigenous plants for healing purposes. The use of herbs however, is controversial in contemporary western medicine due to the lack of evidencebased research to support safety and efficacy.

Couple this with the potential harm some of these substances can inflict and it is easy to see why physicians are reluctant to endorse herb use. Some patients are interested in alternative methods to use with or instead of the treatment their physicians have prescribed. This is particularly true for patients living with chronic hepatitis C virus (HCV). Although huge progress has been made in the HCV treatment arena, current antiviral therapy has many side effects and is not always effective.

Add these elements to the symptoms some people experience from HCV and it is no wonder that herbs seem attractive.

Although herbs and other supplements may seem appealing, a number of herbs can cause harm.

Some herbs are known to have potentially carcinogenic properties and to cause neurological damage. There are herbs that can be particularly harmful to the liver and can cause damage and death. It is because of the potential for

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hepatotoxicity (poisoning of the liver) that HCV patients are advised to avoid herbs or to use them cautiously.

The Food and Drug Administration (FDA) is the federal agency responsible for drug and food safety. Drugs undergo years of rigorous testing on animals and humans before the FDA allows them to be marketed. Herbs and supplements, on the other hand, are considered to be dietary supplements. This means that they are regulated by different standards, called the Dietary Supplement Health and Education Act of 1994 (DSHEA). Under this act, it is the manufacturer that ensures the safety of the dietary supplement.

In general, the supplement manufacturers do not need FDA approval and do not need to register their product. They are required, however, to label the supplement in a truthful manner.

The point at which the FDA may become involved with herbs is after marketing. The FDA may monitor product labelling, information, and safety.

Adverse event reporting is voluntary.

Whether the FDA should regulate supplements is a hotly debated issue. The FDA has been criticized both for regulating and under-regulating dietary supplements. For a variety of reasons, the FDA's involvement with herb use has been minimal. To date, the notable exception to this is the sale of dietary supplements containing ephedrine alkaloids. Ephedra, also called Ma Huang, is one of the plants that are a source of ephedrine alkaloids. Its use has been associated with an increase in blood pressure, a condition which will increase the risk of heart attack, stroke, and death.

There is very little independent research involving the use of herbs. The gold standard randomised, controlled, double blind placebo controlled studies are few in the area of botanical remedies, let alone the use of herbs and HCV. In 1991, the U.S. Congress established the Office of Alternative Medicine (OAM) within the National Institutes of Health (NIH). In 1998 the National Centre for Complementary and Alternative Medicine (NCCAM) became a new centre of the NIH. Responding to the need for more research about the safety and efficacy of herbs and supplements, NCCAM and the NIH Office of Dietary Supplements established the first Dietary Supplements Research Centres with an emphasis on botanicals. The specific subject of herbs and viral hepatitis was included in the Complementary

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Feature Article and Alternative Medicine in Chronic Liver Disease conference in 1999 and a few clinical trials are being conducted in this area. Unfortunately funding is limited and evidence-based data about herbs and HCV is largely unavailable.

The insufficiency of independent research does not mean that there is no value in herbs. Herbs have made a significant contribution to medicine.

Herbal practice has been around for centuries and has produced some sound observations.

Indigenous practitioners relied on botanicals for medicine. In these modern times it is common for people to self-treat mild sunburns with aloe vera, mild stomach aches with ginger, or mild colds with peppermint or chamomile tea. Generally these are assumed to be safe alternatives.

However, the use of herbs for treatment of more serious conditions such as HCV is more complicated and raises a number of questions. For example when choosing an herb, which part of plant is used, when is it harvested, and how is it processed? Botanicals are not made in a lab setting. This means that the consistency of the product is at risk. Is the herbal product safe, which brands are the best, and what is the recommended dose?

To answer these questions, start with the label.

Herbs can vary in strength and purity, so it may be wise to take a standardised and certified form.

Certification and standardisation is voluntary. The goal of the United States Pharmacopeia (USP) is to set industry standards for drugs and dietary supplements in the U.S. The label of a supplement that displays the USP seal is worth considering. A product that is certified by NSF International (formerly the National Sanitation Foundation) is another indicator that the manufacturer complies with particular standards. A seal of approval from ConsumerLab.com (CL) also carries some distinction. Another standard is that of the world's leading authority on herbs, the German Commission E. This agency is the German equivalent of the Food and Drug Administration (FDA). The American Herbal Pharmacopoeia is also developing standardisation guidelines for the American marketplace. Companies that belong to the American Herbal Products Association and submit to this organization's code of ethics are another good choice.

Suggested Guidelines for Herbal Use • Assess your overall health. If you smoke, drink alcohol, and have other unhealthy habits, do not

expect herbs to offset the potential damage these habits can cause. Adopting healthy habits will provide far more benefit than any herb can possibly give.

• Discuss herb and supplement use with your healthcare provider. Identify all the herbs and supplements you take, even if you think your doctor might disapprove. Drugs and supplements can interact with each other as well as with other health conditions.

• Apply the same commonsense approach and standards to herbs as you would to any drug. If you are reluctant to take any prescription or overthe counter drug, be equally as reluctant to take an herb.

• Be informed and be sure your information is current.

• Before you take an herb or supplement, find out if it is compatible with other drugs or supplements you are taking. Verify that the supplement is not contraindicated for any other condition you may have.

• Take extra precautions if you have a history of allergies. Botanical products can cause allergic reactions.

• Follow the label's dosage recommendations.

(More Is Not Better) • Know your source. Herbs may be contaminated.

Before ingesting anything, ask yourself what you know about what you are about to take.

• Choose herbs and supplements that are standardised.

• Buy products that submit to voluntary selfregulation.

• Natural does not equal healthy or safe. Snake venom is natural but not healthy.

• Do not be swayed by bargain prices. Herbs are not all equal.

• Check the expiration date on the container.

• Do not rely on the health food store staff for health care information. Although they may be helpful, remember that salespeople are usually not licensed to practice medicine. Do not treat your condition on the advice of a salesperson.

• Be sceptical. Claims made by the product manufacturer or seller may vastly differ from independent evidence-based research.

• Do not be swayed by personal testimonies.

Although individuals may benefit from botanical use, the notion that "one size fits all" does not apply in medicine.

• Do not be influenced by the latest supplement to make headlines. Dietary supplements can be compared to cars.

(Continued on page 10)

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Feature Article When new models are introduced, sometimes it takes time before problems develop. A product that really has value will be around for awhile.

• Herbs and supplements should not be given to children or taken by pregnant or nursing women without a physician's approval. Older adults and those with various health conditions should also exercise extra caution before taking nonprescribed supplements. Herbs should never be used with decompensated cirrhosis.

• Some herbs prolong bleeding times or interfere with anaesthetics. Stop all herb use at least a week prior to any surgery or procedure that uses anaesthesia. Tell your attending physician and anaesthesiologist about any herbs you are using, particularly if the procedure occurs before you have sufficient time to observe this "wash-out" period.

• Report any suspected adverse reactions to an herb or supplement to the FDA's monitoring program, Medwatch. www.fda.gov/medwatch.

Some Herbs Associated with Liver Toxicity This list is primarily liver specific and by no means exhaustive. The substances on this list are referred to in their oral form only.

• Blue-green Algae • Borage (Borago officianalis) • Bupleurum • Chaparral (Larrea tridentata) • Comfrey (Symphytum officinale and S. uplandicum) • Dong Quai (Angelica polymorpha) • Germander (Teucrium chamaedrys) • Jin Bu Huan (Lycopodium serratum) • Kava • Mistletoe (Phoradendron leucarpum and viscum album) • Pennyroyal (Mentha pulegium) • Sassafras (Sassafras albidum) • Shark Cartilage • Skullcap (Scutellaria lateriflora) Valerian

Ephedra Although not specifically associated with liver toxicity, products containing ephedrine alkaloids (ephedra) should be avoided. Reports of heart attacks, strokes, seizures, psychosis and death have been linked to the use of ephedrine alkaloids. The FDA has banned the sale of dietary supplements containing ephedrine alkaloids, including ephedra and Ma Huang.

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Milk Thistle Milk thistle, Silybum marianum, is the most commonly used herb for liver problems. A frequently asked question regarding chronic hepatitis C viral (HCV) infection concerns the use of this herb. If you are considering taking a milk thistle product, talk to your doctor and find out if it is compatible with other drugs or supplements you are taking. Verify that the supplement is not contraindicated for any other condition you may have (see “A Warning about Milk Thistle and Drug Interactions” below). Do not use milk thistle if you have decompensated cirrhosis.

Medical consultants for the Consumers Union recommended the following in the April 2001 issue of Consumer Reports On Health: • Patients should not use milk thistle to replace a conventional treatment for viral hepatitis; • Patients should not take milk thistle while on a conventional treatment for viral hepatitis; • Milk thistle is probably safe and no one should be discouraged from taking it if there are no other options; • Choose a brand that contains silibin and phosphotidyl choline, which may be better absorbed.

There is insufficient research to establish a suggested daily dose of milk thistle. Typical dosages are in the range of 140-420 mg in divided doses, 2-3 times a day of 70-80% silymarin. See the section " Suggested Guidelines for Herbal Use" (above) for more information on choosing milk thistle along with other herbal products.

A Warning About Milk Thistle and Drug Interactions Raman Venkataramanan and colleagues 1 at the University of Pittsburg reported observations about silymarin, a compound found in milk thistle.

In short, this report raised concerns that silymarin may impair the metabolism of certain drugs when taken together. Further, the potential exists for increased toxicity of co-administered drugs in the presence of silymarin.

The medications levels of the following may increase if taken by people who are also using milk thistle. The source for this list is the Community AIDS Treatment Information Exchange (CATIE) and is not meant to be complete.

• protease inhibitors • non-nucleoside analogues • methadone

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Feature Article • heart drugs - Tambocor (flecainide), Rythmol (propafenone) • antibiotics - erythromycin, rifampin • anti-seizure drugs - carbamazepine (Tegretol) • antidepressants - St. John's wort, Zyban/ Wellbutrin (bupropion), Paxil (paroxetine), Prozac (fluoxetine), Luvox (fluvoxetine) Serzone (nefazodone), Zoloft (sertraline), Effexor (venlafaxine) • antihistamines - Hismanal (astemizole), Seldane (terfenadine) • antifungals - itraconazole (Sporanox), Ketoconazole (Nizoral) • gastrointestinal motility agents - Prepulsid (Cisapride) • ergot drugs - Ergonovine, Ergomar (ergotamine) • anti-psychotics - Clozaril (clozapine), Orap (pimozide) • sedatives/sleeping pills - Ambien (zolpidem), Halcion (triazolam), Versed (midazolam) • lipid-lowering drugs (statins) - Lescol (fluvastatin), Mevacor (lovastatin), Pravachol (pravastatin) and Zocor (simvastatin), Baycol (cerivastatin) • transplant drugs - cyclosporine (Neoral, Sandimmune), ProGraf (tacrolimus) Milk thistle also has the potential to lower levels of the following drugs: • anti-parasite drugs - Mepron (atovaquone) • sedatives/sleeping pills - Ativan (lorazepam) • hormones - estrogen

Warning: Bupleurum is a popular herb used in a variety of Traditional Chinese and Japanese Medicine Mixtures for liver conditions. At least 16 deaths have been reported in Japan for HCV patients being treated simultaneously with alpha interferon and Xiao Chai Hu Tang (Minor Bupleurum).

Final Words Herbs have been part of the healing arts for centuries. Clearly more information and research needs to be conducted in this area in order to better understand and incorporate the use of botanical products into current health practices. In the meantime, make informed decisions regarding your health. Your future depends on it.

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Venkataramanan R, Ramachandran V, Komoroski BJ, et al. Milk thistle, a herbal supplement, decreases the activity of CYP3A4 and uridine diphosphoglucuronosyl transferase in human hepatocyte cultures. Drug Metabolism and Disposition 2000;28(11):1270-1273.

This information is provided by the Hepatitis C Support Project • a nonprofit organization for HCV education, support and advocacy• © 2004 Hepatitis C Support Project.

Contact information: Hepatitis C Support Project PO Box 427037 San Francisco, CA 94142-7037

Abridged with Thanks via hcvadvocate.org

HCV Treatment and Herbs There is virtually no research on the safety of herbs and supplements co-administered with peginterferon/ribavirin therapy. Because of this, it is common for patients to abstain from milk thistle and herb use while undergoing antiviral therapy.

Even commonly used botanicals need to be used with caution. Some herbs and supplements can hinder the ability of the blood to clot. For instance, ginger is widely used to relieve nausea. However, patients with gallstones should talk to their health care provider prior to using ginger. Additionally, ginger has an anticlotting action and should not be taken if you have reduced blood clotting ability.

Interferon therapy and/or cirrhosis can also interfere with blood clotting, so there may be an increased risk if some herbs are used simultaneously under these conditions. Other commonly used herbs, such as chamomile and St. John's Wort carry a warning of potential drug interactions. The rule of thumb is to be informed and talk to your healthcare provider prior to using any botanical product.

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Hepatitis C Treatment In the March 2004 issue of Gastroenterology, Dr Jean-Michel Pawlotsky and colleagues reported on the antiviral action of ribavirin in patients with chronic hepatitis C. Combining ribavirin with interferon has been shown to improve virological response and prevent relapse. Dr Pawlotsky’s team studied 38 subjects with chronic genotype 1b hepatitis C receiving various schedules of standard interferon and/or ribavirin, plus seven untreated control subjects. Blood samples were assessed frequently (every 4-12 hours for the first four days) for HCV viral kinetics and ribavirin pharmacokinetics (how the drug is metabolised and distributed in the body). They found that four of the seven (57%) who received ribavirin monotherapy experienced a “significant, moderate, early, and transient” viral load decrease at days 2 and 3, an effect associated with higher ribavirin blood concentrations and slower drug clearance. The effect disappeared after four days, and no patients who received ribavirin monotherapy completely cleared HCV. In combination therapy, ribavirin improved the effectiveness of interferon, partially reducing viral load rebound between injections in patients receiving interferon three times weekly (this rebound was not seen in those receiving daily interferon, so ribavirin did not play such an important role). Patients receiving combination therapy went on to experience a further “second phase” decline in HCV viral load, which was not seen in those receiving ribavirin alone. The researchers concluded that “ribavirin exerts a significant, moderate, and transient antiviral effect in a significant proportion of patients with chronic hepatitis C… and is partly responsible for the improved efficacy of the combination of standard interferon and ribavirin compared with interferon monotherapy.”

In the March 2, 2004 issue of the Annals of Internal Medicine, Stephanos Hadziyannis and colleagues with the Pegasys International Study Group reported results of a trial of different doses and durations of combination therapy with pegylated interferon-alpha-2a (Pegasys) plus ribavirin. In this randomised study conducted at 99 international centres, 1311 chronic hepatitis C patients (90% white, 65% men, about 25% with compensated cirrhosis, all with elevated ALT) were treated with once-weekly Pegasys, plus ribavirin either low-dose (800 mg daily) or

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standard-dose (1000 or 1200 mg daily, depending on weight), for either 24 or 48 weeks. The authors found that among patients with HCV genotype 1, 48 weeks was superior to 24 weeks and standarddose ribavirin worked better than the lower dose.

Among the genotype 1 subjects, sustained virological response (SVR) was seen in 52% treated for 48 weeks with standard-dose ribavirin.

41% treated for 48 weeks with low-dose ribavirin, 42% treated for 24 weeks with standard-dose ribavirin, and 29% treated for 24 weeks with lowdose ribavirin. In all groups, patients with lower initial HCV viral loads responded better than those with higher viral loads. Among patients with genotypes 2 or 3, however, SVR rates were not significantly different based on ribavirin dose, treatment duration, or initial viral load (about 80% in all groups). Adverse side effects were more common in the longer-duration and higherdose ribavirin arms, and early discontinuation due to insufficient response occurred more often in the lower-dose arms. “Treatment with Pegasys and ribavirin may be individualized by genotype,” the authors concluded. “Patients with HCV genotype 1 require treatment for 48 weeks and a standard dose of ribavirin; those with HCV genotypes 2 or 3 seem to be adequately treated with a low dose of ribavirin for 24 weeks.”

Some recent research indicates that certain “hard to treat” patients may benefit from a longer course of therapy. For example, HCV/HIV coinfected individuals appear to clear HCV more slowly, and may require longer treatment—perhaps 72 weeks for those with genotype 1 and 48 weeks for those with genotypes 2 or 3. In the April 2004 issue of the Journal of Hepatology, Johannes Brouwer and colleagues from Belgium and the Netherlands reported on a study looking at whether prolonging therapy could reduce relapse rates in patients with chronic hepatitis C. Three hundred patients were randomly assigned to receive 6-month treatment with standard interferon plus ribavirin, 18-month treatment with interferon plus ribavirin, or 18month interferon monotherapy. At the end of treatment, HCV viral load was undetectable in 55% and 49% of those on 6-month and 18-month combination therapy, respectively, compared with

Hepatitis C Community News

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26% of those receiving monotherapy. Sustained response rates in the three groups were 34%, 43%, and 16%, respectively. Thus, the relapse rate was 38% for both the 6-month combination therapy and 18-month monotherapy arms, compared with just 13% for the 18-month combination therapy arm. While this study showed that six months of treatment is not adequate for many patients, it did not answer whether 18 months is superior to the typical 12-month course of therapy for genotype 1 HCV. References: Pawlotsky, J. et al. Antiviral action of ribavirin in chronic hepatitis C. Gastroenterology 126: 703-14.

March 2004.

Hadziyannis, S. et al (PEGASYS International Study Group). Peginterferon-alpha2a (Pegasys) and ribavirin combination therapy in chronic hepatitis C: a randomised study of treatment duration and ribavirin dose. Annals of Internal Medicine 140 (5): 346-355. March 2, 2004.

Brouwer, J. et al. Reduction of relapse rates by 18month treatment in chronic hepatitis C: A Benelux randomised trial in 300 patients. Journal of Hepatology 40 (4): 689-695. April 2004.

Abridged with thanks via hcvadvocate.org

P Value From time to time you may notice something that looks similar to this (P=0.0023) and you may be wondering what this means.

Interferon Improves Survival A. Kasahara and colleagues from Japan reported in the March 2004 issue of the Journal of Viral Hepatitis that interferon improves survival in hepatitis C patients who respond well to therapy.

In a long-term study of nearly 2954 patients with chronic hepatitis C patients (2698 treated with interferon and 256 untreated), death due to liverrelated disease occurred in 68% of the treated patients and 81% of the untreated patients. In addition, the risk of death from all causes was lower for treated compared with untreated patients.

Broken down by treatment response status, patients who achieved a sustained virological response had a significantly lower liver-related disease mortality rate than untreated patients, but this was not true for patients who achieved only a transient virological response. However, both sustained and transient biochemical responders (but not biochemical nonresponders) had a significantly lower liver-related death rate than untreated patients. The researchers concluded that “interferon treatment improved survival in chronic hepatitis C patients showing a biochemical as well as a virological response by preventing liverrelated deaths.”

Reference: Kasahara, A. et al. Interferon treatment improves survival in chronic hepatitis C patients showing biochemical as well as virological responses by preventing liver-related death. J. Viral Hepatitis 11 (2): 148-156. March 2004.

Abridged with thanks via hcvadvocate.org

Well here’s the short answer.

P= Probability of the result having occurred by chance, therefore being incorrect.

So (P=0.0023) means that there is a 0.0023% chance of the result being incorrect.

New under the Pharmaceutical Benefits Scheme (PBS) The PEGATRON REDIPEN® will be available as standard treatment with the dispensing of Pegatron under the PBS.

Hepatitis C Community News

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The future in Hepatitis C treatment Pegylated interferon in combination with ribavirin is the current “gold standard” in treatment and will probably be so for the next few (an estimated 4-5) years. However it is certainly not the end of the road in terms of treatment for hepatitis C as new research and advances are occurring all the time.

This is particularly important for people who relapsed or did not respond to treatment (either combination therapy or pegylated interferon and ribavirin). Also, knowing that there will almost certainly be improvements in treatment in the future may be something those considering treatment will take into account when making the decision whether or not to go on pegylated interferon and ribavirin – but this should not be the only factor in making the treatment decision.

Several biotech and drug companies are currently working to develop new hepatitis C treatments.

It is important to highlight that these therapies are in very early stages of development. Researchers are trying to develop new drugs that attack the virus directly and that have fewer side effects than the current drug regimen, which boosts the immune system to fight the virus. “Protease inhibitors” are one of the main new types of treatment agents that are currently being trialed (some of these are listed below). These protease inhibitors aim to prevent replication of the hepatitis C virus. There are also trials investigating the effectiveness of herbal and natural treatments to hepatitis C. A summary of these potential therapies is listed below: ♦ ScheringPlough is developing an HCV protease inhibitor, SCH 6, that has shown promise in early studies. ♦ Merimepodib from Vertex is another HCV protease inhibitor.

The drug is also active against HCV that has become resistant to BILN 2061, according to

♦

♦

♦ ♦

♦ ♦

♦

♦

♦

Vertex. 86% of patients taking the highest dose of the drug experienced undetectable viral loads.

Zadaxin, already approved in several countries, is in phase III studies in the US, and shows promise when used in combination with pegylated interferon. Studies in combination with Pegasys are in progress.

Amantadine in double combination with ribavirin and in a triple combination with interferon alfa and ribavirin may benefit non-responders to initial HCV therapy.

Perfidenome has been shown to reduce necroinflammation and steatosis in patients with liver cirrhosis.

Viramidine is in phase III development by ICN Pharmaceuticals. It may provide less toxicity than ribavirin (in terms of anaemia), but is unlikely to have improved efficacy over ribavirin.

CellCept has shown promise as a treatment for non responders when used in combination with interferon and ribavirin Ribozymes are an emerging technology that in preliminary studies appears capable of disrupting the viral lifecycle of hepatitis B virus (HBV) and hepatitis C virus.

Isis Pharmaceuticals. Isis 14803 drug, which is also taken in combination with ribavirin, is currently in Phase II trials. Earlier studies using the combination treatment showed that five of 17 patients experienced "at least" a 90% reduction in virus levels.

The Hep573* trial is a herbal study which is now underway at Royal Prince Alfred Hospital (Sydney) and John Hunter Hospital (Newcastle).

This study is particularly looking at the effectiveness of Silymarin (the active ingredient of St Mary’s Thistle) and other herbs and vitamins in hepatitis C treatment.

The Japanese herbal Sho-saiko-to* is currently being studied by researchers in New York to see if it can help people with chronic hepatitis C. Sho-saiko-to is a herbal medicine that has been used for many years in Asia to treat liver disease. It is currently in phase II trials. It is being studied to assess its effectiveness in treating liver inflammation and injury caused by chronic hepatitis C in people who cannot take interferon.

(Continued on page 15)

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Hepatitis C Community News

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*It is important to point out that complementary and alternative therapies such as herbs and vitamins will not clear the hepatitis C virus.

However they may reduce liver inflammation which could potentially slow progression. These therapies may also be useful in alleviating symptoms of hepatitis C and side effects of pegylated interferon and ribavirin therapy.

If you are particularly interested in reading more about emerging therapies, the website: www.hivandhepatitis.com has up-to-date information about research. !!!!!!!!

While the new treatments are in development there are ways you can help to manage your hepatitis C and improve your health such as healthy eating, exercise, stress management and ensuring you have good information and support. If you would like some more resources or information contact the Hepatitis C Council’s Hep C Info and Support Line on 8362 8443 or 1800 021 133 (for SA regional callers) Sources: http://www.hivandhepatitis.com/hep_c/news/010504_a.html

The Specialist

http://www.hivandhepatitis.com/hep_c/news/060903c.html The Hep C Review Edition 43, December 2003 page 10 With thanks to Dr. Greg Dore, Viral Hepatitis Program, National Centre in HIV Epidemiology and Clinical Research who provided feedback on this article.

He has two eye’s, but doesn’t see He has two ears, but he can’t hear me I lost my job, couldn’t work in the end I also lost quite a few of my friends My personality has changed, my parents are ashamed Even my zest for life has waned I’ve lost my husband, nearly lost my child But I won’t give up, I still have some pride With a smile on my face I can hide the pain The anger, the sadness, myself to blame This specialist of mine, what on earth does he see?

He sees my liver, that’s all, not me.

Dotti.

Hepatitis C Community News

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48 week course too short?

Is a 48-week Course of Treatment with Peginterferon Plus Ribavirin Too Short to Maximise a Sustained Viral Response Among Patients with Hepatitis C Virus Genotype 1?

Hepatitis C virus (HCV) is a major cause of mortality and morbidity and has infected 2.7 million individuals in the United States alone.

Although there have been major advances in therapy for infection with HCV, patients infected with genotype 1 strains have a much poorer prognosis for clearing the virus than do patients infected with genotype non-1 strains, even if they receive treatment with high-dose pegylated interferon (IFN) plus ribavirin.

Therapy with pegylated IFN plus ribavirin is associated with a response rate of ~ 50% among patients infected with HCV genotype 1; also, the regimen is expensive and is associated with a number of predictable toxicities. Flu-like syndrome, depression, and alterations in haemoglobin levels and white blood cell (WBC) counts are common adverse events that occur with prolonged therapy with this regimen.

Consequently, it is not trivial to suggest the use of longer durations of therapy with this regimen, because of both the cost of therapy and the attendant toxicities. The response rate among patients infected with HCV of genotype non-1 is ~ 80%. It is important to attempt to improve the response rates among patients infected with genotype 1, so as to obtain approximately the same response rate as that observed among patients not infected with genotype 1, given the severe long-term sequelae attendant to continued rounds of replication of HCV. In the current study, researchers present an analysis of a large trial of pegylated IFN plus ribavirin. The results of this trial have been presented elsewhere [Manns and others.

Peginterferon alfa-2b plus ribavirin compared with interferon alfa-2b plus ribavirin for initial treatment of chronic hepatitis C: a randomised trial. Lancet 2001; 358: 958-965].

The objective of the study was to develop models and to examine the effect of duration of therapeutic response on outcome. The central idea of these analyses is that the major benefit of antiviral therapy can be seen through its effect on the virus load.

The investigators wanted to determine whether the current state-of-the-art 48-week duration of pegylated IFN plus ribavirin therapy is optimal for patients infected with HCV of genotype 1.

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It was thought that there may be an association between the duration of therapeutic response during drug therapy (i.e., having an undetectable HCV load in serum for a specific number of weeks continuously) and the probability of attaining a long-term response after discontinuation of therapy.

A model predicting SVR was generated; it included the following covariates: duration of continuous non-detectability of an HCV load in serum, estimated creatinine clearance, and whether the isolate was of genotype 1.

The validation model demonstrated positive and negative predictive values as well as sensitivity and specificity exceeding 90%. The model predicted that patients infected with HCV genotype 1 require continuous non-detectability of virus load in serum for 36 and 32 weeks, to attain 90% and 80% probabilities, respectively, of a SVR. The average time to clear serum of genotype-1 virus was 30.4 weeks, which indicates that the 48 week duration of therapy provided a suboptimal probability of a SVR.

Conclusions For some patients, suboptimal therapy with pegylated IFN plus ribavirin may need to be of longer duration than the currently recommended 48 weeks. If the hypothesis can be proved to be true, it has the possibility of adding 14% more patients to the long-term response group.

This hypothesis requires prospective validation.

Ordway Research Institute, Albany, New York.

03/17/04 Reference G L Drusano and S L Preston. A 48-Week Duration of Therapy with Pegylated Interferon 2b plus Ribavirin May Be Too Short to Maximize Long-Term Response among Patients Infected with Genotype-1 Hepatitis C Virus. The Journal of Infectious Diseases 189(6): 964-970. March 15, 2004.

Abridged with thanks via hivandhepatitis.com

Hepatitis C Community News

Issue 26

Inspirations Two travelling angels stopped to spend the night in the home of a wealthy family.

The family was rude and refused to let the angels stay in the mansion’s guest room.

Instead the angels were given a small space in the cold basement.

As they made their bed on the hard floor, the older angel saw a hole in the wall and repaired it.

When the younger angel asked why, the older angel replied, “Things aren’t always what they seem.”

The next night the pair came to rest at the house of a very poor, but very hospitable farmer and his wife.

After sharing what little food they had the couple let the angels sleep in their bed where they could have a good night’s rest.

When the sun came up the next morning the angels found the farmer and his wife in tears.

Their only cow, whose milk had been their sole income, lay dead in the field.

The younger angel was infuriated and asked the older angel how could you have let this happen?

The first man had everything, yet you helped him, she accused.

The second family had little but was willing to share everything, and you let the cow die.

“Things aren’t always what they seem,” the older angel replied.

“When we stayed in the basement of the mansion, I noticed there was gold stored in that hole in the wall. Since the owner was so obsessed with greed and unwilling to share his good fortune, I sealed the wall so he wouldn’t find it.”

“Then last night as we slept in the farmers bed, the angel of death came for his wife. I gave him the cow instead.”

“Things aren’t always what they seem.”

Sometimes that is exactly what happens when things don’t turn out the way they should. If you have faith, you just need to trust that every outcome is always to your advantage. You just might not know it until some time later...

Hepatitis C Community News

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An Introduction to The Liver The liver is the largest internal organ. It is reddishbrown, weighs approximately three pounds (in the adult male) and is about the size of a football. It is located behind the ribcage on the upper right side of the abdomen. The liver has the unique ability to regenerate its own tissue, as much as three-quarters of the liver can be lost, and the organ can grow back within several weeks. This allows people who need transplants to receive part of the liver of a living donor.

The liver is divided into four lobes; these are in turn composed of multiple lobules, which contain the hepatocyte's, or working liver cells. The liver has an extensive blood supply. It receives oxygenrich blood from the hepatic artery. The portal vein delivers blood containing nutrients, toxins, and other substances absorbed from the intestines to the liver. The liver filters this blood, then sends it on to the heart via the hepatic vein.

FUNCTIONS OF THE LIVER The liver is responsible for some 500 bodily functions. It plays a role in digestion, sugar and fat metabolism, and the body’s immune defence. It processes almost everything a person eats, breathes, or absorbs though the skin. About 90% of the body’s nutrients pass through the liver from the intestines. The liver converts food into energy, stores nutrients, and produces blood proteins. The liver also acts as a filter to remove pathogens and toxins from the blood. In the developing foetus, blood cells are produced in the liver.

Digestion The liver plays an important role in the digestion and processing of food. Liver cells produce bile, a greenish-yellow fluid that aids the digestion of fats and the absorption of fat-soluble nutrients. Bile is delivered to the small intestine through the bile duct; when there is no food to digest, extra bile is stored in a small organ called the gallbladder located beneath the liver. By-products from the break-down of drugs and toxic substances processed by the liver are carried in the bile and excreted from the body. A person with a damaged liver may experience impaired bile production and flow. When this happens, the body may not be able to properly absorb nutrients. Liver cells also convert heme (a component of haemoglobin that is released when red blood cells are broken down) into bilirubin. When the liver is damaged, bilirubin may build up in the blood, causing jaundice (yellowing of the skin and whites of the eyes).

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Liz Highleyman Alan Franciscus, Editor-in-Chief HCSP Publications

Metabolism The liver carries out many metabolic functions, providing the body with the energy it needs. It regulates the production, storage, and release of sugar, fats, and cholesterol. When food is eaten, the liver converts glucose (blood sugar) into glycogen, which is stored for later use. When energy is needed, the liver converts glycogen back into glucose in a process called gluconeogenesis.

The liver regulates the storage of fats by converting amino acids from digested food into fatty acids such as triglycerides; when the body does not have enough sugar, the liver converts fatty acids into ketones, which can be used for fuel. The liver also controls the production, metabolism, and excretion of cholesterol, which is an important component of cell membranes and certain hormones.

Storage The liver stores several nutrients, including vitamins A, D, B9 (folate), and B12. It also stores iron and plays a role in converting iron into heme, a component of haemoglobin (the oxygen-carrying molecule in red blood cells).

Protein Synthesis The liver synthesises (builds) several important proteins, including enzymes, hormones, clotting factors, and immune factors. Liver enzymes called amino-transferases or transaminases (ALT and AST) break down amino acids from digested food and rebuild them into new proteins needed by the body. When liver cells are damaged, these enzymes can leak out and build up to high levels in the blood; these enzymes can be measured using a simple blood test. Several of the proteins synthesised by the liver are needed for proper blood functioning. These include various binding proteins (which bind and transport substances such as vitamins, minerals, hormones, and fats) and albumin (a protein that helps maintain proper blood volume). Clotting factors produced by the liver include fibrinogen, prothrombin (Factor II), and Factor VII. These enable the blood to clot following an injury; low levels can lead to prolonged bleeding and easy bruising. Other proteins synthesised by the liver include alkaline phosphatase, gamma-glutamyl transferase (GGT), and insulin growth factor.

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Continued Detoxification

KEEPING THE LIVER HEALTHY

The liver plays a crucial role in detoxifying substances that are harmful to the body, including alcohol, drugs, solvents, pesticides, and heavy metals. When a person is exposed to high levels of these chemicals, the liver can become overwhelmed.

Toxins are delivered to the liver by the portal vein.

The liver processes these chemicals and excretes them in the bile. The liver also processes and excretes toxic by-products of normal metabolism (such as ammonia) and excess hormones (in particular, sex hormones such as oestrogen). Many drugs, including common over-the-counter drugs such as acetaminophen (Tylenol), most anti-HIV drugs, and certain herbal remedies, are processed by the liver and can cause liver damage. People should be especially cautious about combining multiple drugs or herbs. If the liver is damaged it may not be able to break down and excrete drugs efficiently, which could potentially lead to dangerously high blood levels and intensified side effects.

There are many steps people with chronic hepatitis can take to maintain liver health.

LIVER DAMAGE Chronic hepatitis C or B, heavy alcohol use, and other factors can lead to serious liver damage.

Given how many vital functions the liver performs, it is not surprising that liver injury can have an affect on almost all body systems, including the digestive, endocrine, cardiovascular, and immune systems. As the liver sustains damage, normal liver tissue becomes fibrous (fibrosis), fatty (steatosis), and scarred (cirrhosis).

If the liver becomes too heavily damaged, it is no longer able to carry out its normal functions.

In compensated cirrhosis, the liver is scarred but can still function relatively normally.

In decompensated cirrhosis, the liver has sustained so much damage that it is unable to function properly. Scar tissue may block the normal flow of blood through the liver, causing blood to back up. This can lead to portal hypertension (high blood pressure), the development of varices (stretched and weakened blood vessels) in the oesophagus and stomach, and internal bleeding. People with severe liver damage may also develop ascites (fluid accumulation in the abdomen), oedema (swelling, especially in the legs and ankles), and kidney damage. If the liver is unable to filter out toxins and metabolic by-products such as ammonia, these chemicals may build up in the blood, leading to impaired mental functioning, personality changes, and (in severe cases) coma. People with long-term liver damage may also develop liver cancer.

Healthy Liver Tips: •Eat a healthy, well-balanced diet that follows the general guidelines for good nutrition based on the Food Guide Pyramid; such a diet is low in fat and sodium, high in complex carbohydrates, and has adequate protein.

•Avoid or reduce the consumption of alcohol.

•Avoid or limit the use of recreational drugs.

•Take no more than the recommended doses of medications.

•Use caution when mixing over the counter medications, prescription drugs, herbs, street drugs, and/or alcohol.

•Avoid exposure to toxic liquids and fumes including solvents, paint thinners, and pesticides.

If it is necessary to use such chemicals, work in a well-ventilated area, cover the skin, and wear gloves and a protective facial mask.

•Avoid raw or undercooked shellfish, which may contain bacteria or viruses.

•Get vaccinated against hepatitis A and hepatitis B if appropriate.

Hepatitis C Community News

This information is provided by the Hepatitis C Support Project • a non-profit organization for HCV education, support and advocacy • © 2003 Contact information: Hepatitis C Support Project PO Box 427037 San Francisco, CA 94142-7037

Abridged with thanks via www.hcvadvocate.org

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Hepatitis C Council of SA Adelaide Dental Hospital

SAVIVE provides peer-based support, information and user education.

SAVIVE is a Clean Needle Program outlet 64 Fullarton Road, Norwood.

Phone: 8334 1699 Email: savive@savive.org.au

SAVIVE (SA Voice for IV Education)

For more info on any of the services listed phone the Hepatitis C Council or the services directly.

Streetlink is a service for people aged 12-25 years who are homeless or at risk of being homeless. Through Streetlink you can access information about hep C prevention as well as free medical and counselling services for you or your children.

1st floor, 27 Gresham St, Adelaide Phone: 8231 4844 Email: streetlink@ucwadel.org.au

Streetlink

The Adelaide Dental Hospital is a specially funded clinic for people with hep C who also have a Health Care Card to receive priority dental care.

Some research on dental health is carried out at the clinic, however it is up to you if you choose to participate.

Phone the Hepatitis C Council on 8362 8443 for a referral.

PEACE provides support, education, information and referral services for culturally and linguistically diverse communities affected by, or at risk of infection of hepatitis C and/or HIV. Phone: 8245 8100

P.E.A.C.E. (Personal Education and Community Empowerment) A Multicultural Program

Phone the Hep C Council for confidential information and support about hep C, as well as free written information. The Hep C Council also runs information and support sessions.

Phone to find out about upcoming sessions.

4 The Parade, Norwood.

Phone: 8362 8443 or 1800 02 11 33 (SA Regional Callers) Email: admin@hepccouncilsa.asn.au Web: www.hepccouncilsa.asn.au

MOSAIC— MOSAIC—a program of Relationships Australia (SA) Free and confidential counselling for people with hepatitis C. Daytime and evening appointments are available.

Telephone counselling is available for people living in rural/regional SA. “Living Well with Hepatitis C” courses are also ran throughout the year.

Phone: 8245 8100 and ask for MOSAIC

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