ART: HCV Epidemiology, Transmission, Western and Chinese Medicine

[Kim]

http://www.numedx.com/readstory.phtml?story=v3n5alternative
HEPATITIS C VIRUS INFECTION Epidemiology, Transmission, Western and
Chinese
Medicine
By Misha Cohen, O.M.D., L.A.c.
Hepatitis C virus (HCV) infection is increasing in the United States
and
around the world today. More than three-quarters of those infected with
HCV
will develop chronic liver disease,1,2 and up to 20 percent will
develop
cirrhosis.3-5 It is estimated that there are 8,000 to 10,000
HCV-related
deaths each year, and the US Centers for Disease Control and the
National
Institutes of Health expect the rate to triple in the next 10 to 20
years.
Forty percent of all people with HIV infection are chronically infected
with
the hepatitis C virus (HCV). People with co-infection of HIV/HCV have
double
the risk of developing of severe liver damage, and there is some
evidence
that course of liver disease development is shorter. 6
Hepatitis C virus (HCV) infection is the most common chronic bloodborne
infection in the United States. The Centers for Disease Control and
Prevention (CDC) estimate that during the 1980s, an average of 230,000
new
infections occurred each year. The Third National Health and Nutrition
Examination Survey conducted from 1988 to 1994 indicated that an
estimated
3.9 million Americans (1.8%) have been infected with HCV. Most are
chronically infected and might not be aware of their infection because
they
do not have apparent symptoms. Infected persons may transmit the virus
to
others and are at risk for chronic liver disease or other HCV-related
chronic diseases during the 20 to 30 years following infection.
Hepatitis C virus infection is found in people of all ages. In the
general
population, the highest prevalence of chronic HCV infection is found
among
those aged 30-49 years and among males. However, the highest incidence
of
acute hepatitis C is among 20-39 year olds, with men having a slightly
higher rate of acute infections. Because most HCV-infected people range
between 30-49 years old, the number of deaths caused by HCV-related
chronic
liver disease could increase significantly during the next 10-20 years
as
the ageing HIV population develop a greater likelihood of
complications.
While African Americans and whites currently have a similar incidence
of
acute infection, African Americans have a substantially higher
prevalence of
chronic HCV infection than do whites. Latinos have the highest rate of
acute
infection. 8
HCV infection occurs with different prevalence among persons with
different
risk factors for infection. The highest prevalence of chronic infection
is
found among those with large or repeated direct exposures to blood
through
the skin including predominantly injecting drug users, persons with
hemophilia who were treated with clotting factor concentrates produced
before 1987, and people who received transfusions from HCV-positive
donors.
Moderate prevalence is found among those with frequent but smaller
direct
exposure through the skin such as long-term hemodialysis patients.
Lower
prevalence is found among those with mucosal or possible blood-to-blood
exposure through the skin such as in high-risk sexual practices or
among
those with small, sporadic through-the-skin exposures such as occur
with
needle sticks among healthcare workers. The lowest prevalence of HCV
infection is found among those like volunteer blood donors who have no
high-risk characteristics.
Most risk factors associated with HCV transmission in the United States
were
identified in case-control studies conducted by the Centers for Disease
Control and Prevention (CDC) from 1978 to 1986. These risk factors
included
blood transfusion, injection drug use, patient care or clinical
laboratory
employment, sex partner or household member who has had a history of
hepatitis, multiple sex partners, and low socioeconomic level. The
studies
reported no association with military service or exposures resulting
from
medical, surgical, or dental procedures or from tattooing, acupuncture,
ear
piercing, or foreign travel; it may be that the frequency of infection
through these means may be too low too detect. Currently, the highest
rate
of acute infection is among injecting drug users. Acute HCV infection
is
basically undetected in people who have had transfusions and in
hemophiliacs
since the early 1990s because the blood supply in the US has been
tested for
HCV since 1990, with more sensitive tests being developed in 1992.
General Symptoms of Hepatitis C Virus
Acute symptoms of Hepatitis C virus include flu-like symptoms, dark
urine,
light stools, jaundice, fever, fatigue, anorexia, nausea, and itching
skin.
Chronic HCV symptoms include fatigue, malaise, weakness, mild fevers,
liver
pain, decreased appetite, and itching skin. However, many persons
infected
with HCV do not have obvious symptoms, especially in the early stages
of
chronic infection with HCV.
WESTERN EVALUATION/TREATMENT
Western Lab Tests
The typical Western lab tests for Hepatitis C virus include collecting
liver
enzymes data. The levels of the liver enzymes AST and ALT are most
commonly
elevated in chronic HCV infection about 70% of the time (note that this
means that 30% of patients do not experience elevation in liver enzyme
levels despite chronic infection). Liver enzyme levels may fluctuate as
part
of the normal course of disease. High levels of ALT indicate that there
is
damage to the liver due to cell damage. However, unless a liver biopsy
is
done, it is basically impossible to know what level of damage has been
done
to the liver. If a client is having hepatitis symptoms, the
practitioner
should order hepatitis panels for hepatitis B and hepatitis C. If there
are
acute symptoms, an additional test for hepatitis A should be given. And
if
the antibody tests are positive for HBV or HCV, viral load tests should
be
done.
Western Drug Therapies
Western drug therapies may be appropriate for an individual. I advise
consultation with a Western medical doctor in order to discuss the most
current and appropriate treatment available for the particular
individual.
Current Western bio-medical treatment is most likely combination
interferon/ribavirin therapy. Clients need to talk with their Western
doctor
about eligibility for these programs.
Recent studies of interferon/ribavirin combination therapy have shown
higher
sustained response rates than found with interferon alone; however,
these
rates remain well below 50 percent (and most probably in the 15% to 20%
range).10-13 In people with HIV co-infection, there may be less
indication
for treatment because many ARV therapies may also cause liver damage or
because the HCV may create difficulties in metabolizing medications for
HIV.
There are a number of side-effects of drug therapy, including flu-like
syndromes, headaches, fatigue, fevers, anorexia, nausea, vomiting, hair
loss, and depression, as well as the possibility of lowering white
blood
counts and platelets through bone-marrow suppression. Ribavirin may
cause
sudden, severe anemia as well as birth defects. If clients along with
their
Eastern and Western practitioners decide to use a combination of
Eastern and
Western therapies, the specific treatment approaches should be dicussed
with
both practitioners. Some herbal therapies may be inappropriate in
conjunction with interferon therapy. Chinese medicine, however, is
highly
effective for managing the side effects of drug therapies. It may also
be
used as an alternative in some cases. A list of herbs and drugs that
are
considered liver toxic will be available in the appendices of The
Hepatitis
C Help Book by Misha Cohen, OMD, LAc, and Robert Gish, MD.
Hepatitis Vaccinations
Acute infection with other forms of viral hepatitis is highly dangerous
for
people with HCV; consequently, vaccination for hepatitis A and B is
suggested. These vaccinations are also generally recommended for those
at
risk of becoming infected and for children (see the guidelines of the
Hepatitis Foundation, whose phone number appears at the end of this
section).
People who do not have adequate antibodies to Hepatitis B virus (HBV)
should
have an HBV vaccination. Three injections over a 6 to 12 month period
are
required to provide complete protection. Some people do not develop
enough
antibodies to become immune to HBV.
People with hepatitis C who have not had hepatitis A i should have a
Hepatitis A vaccination. Immune globulin can be given to provide
temporary
immunity for up to 3 months. If one has not had hepatitis A and has not
been
vaccinated after exposure to hepatitis A, immune globulin should be
given as
soon as possible after exposure, and no later than 2 weeks.
For more details and for guidelines on vaccination and Western
treatment,
please contact the Hepatitis Foundation International at
1-800-891-0707.
CHINESE TRADITIONAL MEDICINE FOR HCV
Many people with Hepatitis C virus and HIV/AIDS are turning to Chinese
traditional medicine, which has a rich history in the treatment of
chronic
hepatitis. Hepatitis B-and increasingly, Hepatitis C-are prevalent
throughout China, accounting for the increased risk of hepatocellular
carcinoma in the mainland Chinese population. The Chinese medical
system has
been dedicated to solving the problem for many years, and has worked to
eliminate sources of hepatitis as well as to develop treatments for
hepatitis using both Chinese traditional medicine and Western medicine.
At the International Symposium on Viral Hepatitis and AIDS held in
Beijing,
China in April 1991, more than 100 papers on viral hepatitis were
presented,
several of which documented the positive results of studies of Chinese
herbal medicine. Studies of herbal antivirals and Xue-cooling and
Xue-circulating herbs for repairing liver damage supported the hundreds
of
years of practical experience with Chinese herbs for the symptoms of
hepatitis.14-16 A literature review by Dr. Kevin Ergil in 1995 revealed
the
use of at least 55 herbal formulas that may be used to treat hepatitis
clinically. There have also been some recent herbal studies in China
and
Australia that showed positive results in hepatitis C using formulas
similar
to those used widely in clinics in the United States.17-21
In the United States, Chinese traditional medicine is a popular
complementary or alternative therapy among patients with chronic liver
disease. A 1996 anecdotal report from one of the largest clinical
hepatology
practices in San Francisco suggests that at least 20% to 30% percent of
patients in this practice report use of Chinese herbal interventions
for
hepatitis.22 The level of use is probably underestimated because
patients
often choose not to divulge the use of complementary and alternative
medicine therapies to their Western primary care physician.
Chinese medicine uses nutrition, acupuncture, heat therapies such as
moxibustion, exercise, massage, meditation, and herbal medicine for the
treatment of people with hepatitis C virus. Protocols have been
developed
that have successfully helped HIV- and HCV-infected people to decrease
symptoms, normalize or lower liver enzyme levels, and slow down the
progression of liver disease. A pilot study conducted among people
co-infected with HIV and hepatitis at the Quan Yin Healing Arts Center
in
1995 indicates that acupuncture alone may have an effect in lowering
and
normalizing liver enzyme levels. 2-3
In future articles, I will discuss nutrition, herbal medicine,
acupuncture,
and other areas in which people with HIV/HCV co-infection can perform
self-care treatment. Misha R. Cohen, Doctor of Oriental Medicine and
Licensed Acupuncturist, is an internationally recognized practitioner,
lecturer and leader in the field of traditional Chinese medicine and is
the
author of The Chinese Way to Healing: Many Paths to Wholeness (Perigee,
1996), The HIV Wellness Sourcebook (Holt, 1998) and The Hepatitis C
Help
Book (St. Martin's Press, 2000). POZ Magazine named her one of the Top
50
AIDS Researchers in the Country in 1997.
References
1. Shakil AO, Conry-Cantilena C, Alter HJ, Hayashi P, Kleiner DE,
Tedeschi
V, et al. Volunteer blood donors with anitbody to hepatitis C virus:
Clinical, biochemical, virologic, and histologic features. The
Hepatitis C
Study Group. Annals of Internal Medicine. 1995, Vol. 123, No. 5, Pages
330-337.
2. Seeff LB, Buskell-Bales, Wright EC, Durako SJ, Alter HJ, Hollinger
FB, et
al. Long-term mortality after transfusion-associated non-A, non-B
hepatitis.
The National Heart, Lung, and Blood Institute Study Group. New England
Journal of Medicine. 1992, Vol. 327, No. 27, Pages 1906-1911.
3. Fattovich G, Giustina G, Degos F, Tremolada F, Diodati G, Almasio P,
et
al. Morbidity and mortality in compensated cirrhosis type C: A
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Alter
HJ. Long-term clinical and histopathological follow-up of chronic
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virus. Hepatology. Vol. 12, No. 4.1, Pages 671-675.
6. Cohen and Gish, The Hepatitis C Help Book. St, Martin's Press, 2000,
Page
68.
7. MMWR 47(RR19); 1-22 10/16/1998.
8. MMWR 47(RR19); 23-39 10/16/1998.
9. Reichard 0, Norkrans G, Fryden A, Braconier JH, Sonnerberg A,
Weiland 0.
Randomised, double-blind, placebo-controlled trial of interferon
alpha-2b
with and without ribavirin for chronic hepatitis C. The Swedish Study
Group.
Lancet. 1998, Vol. 351, No. 9096, Pages 83-87.
10. Sostegni R, Ghisetti V, Pittaluga F, Marchiaro G, Rocca G,
Borghesio E,
et al. Sequential verus concomitant administration of ribavirin and
interferon alfa-n3 in patients with chronic hepatitis C not responding
to
interferon alone: Results of a randomized, controlled trial.
Hepatology.
1998, Vol. 28, No. 2, Pages 341-346.
11. Schalm SW, Hansen BE, Chemello L, Bellobuono A, Brouwer JT, Weiland
0,
et al. Ribavirin enhances the efficacy but not the adverse effects of
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from European centers. Journal of Hepatology. 1997, Vol. 26, No. 5,
Pages
961-966.
12. Schvarcz R, Yun ZB, Seonnerborg A, Weiland 0. Combined treatment
with
interferon alpha-2b and ribavirin for chronic hepatitis C in patients
with a
previous non-response or non-sustained response to interferon alone.
Journal
of Medical Virology. 1995, Vol. 46, No. 1, Pages 43-47.
13. Chen Z, et al. Clinical analysis of chronic hepatitis B treated
with TCM
compositions Fugan No. 33 by two lots. [Abstract, Page 2].
International
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Beijing Association of Integration of Traditional and Western Medicine
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cases of hepatitis with severe cholestatis by blood-cooling and
circulation-invigorating Chinese herbs. [Abstract. Page 5].
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Symposium on Viral Hepatitis and AIDS, April 1991, Beijing China.
Sponsors:
Beijing Association of Integration of Traditional and Western Medicine
and
The China Medical Association
15. Zhao R, Shen H. Antifibrogenesis with traditional Chinese herbs.
[Abstract, Page 20]. International Symposium on Viral Hepatitis and
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16. Batey RG, Bensoussen A, Hossain MA, Bollipo S On-line report,
Gasteroenterology Unit and Cathay Herbal Labs, Sydney Australia. 1998.
17. Deng D. 30 cases of hepatitis C treated with Song Zhi mixture.
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18. Yao Z, Liu Mi, Wang C. A preliminary report on the effect of 911
granules on chronic viral hepatitis of the B and C types. Journal of
Integrated Traditional and Western Medicine. 1995, Vol. 3
19. Li H, et al. Qingtui Fang applied in treating 128 cases of chronic
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20. Wu C, et al. 33 patients with hepatitis C treated by TCM syndrome
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21. Gish R. California Pacific Medical Center, Liver Transplant
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personal communication, 1996.
22. 12th International AIDS Conference Geneva, abstract book, June
1998.

[Mick]

hepaut...@hotmail.com (Kim) wrote in message news:<ec181702.02100...@posting.google.com>...

> http://www.numedx.com/readstory.phtml?story=v3n5alternative
> HEPATITIS C VIRUS INFECTION Epidemiology, Transmission, Western and
> Chinese
> Medicine
> By Misha Cohen, O.M.D., L.A.c.

Thanks for posting this one, Kim. It seems like a fairly balanced sort
of introductory summary.

Mick (working his way through the articles from the last week :)).