June 1998 - hepc.bull
Canada's Hepatitis C Newsletter
HeCSC VICTORIA VOLUNTEERS
NEEDED
Volunteers are needed for fundraising for the Victoria Chapter of
HeCSC. If you are interested, please contact Judith Fry at
592-0252.
Volunteers are needed to make ribbons. Please call Judith Fry at
592-0252.
If you would like to volunteer for the Fun Run, please call the
office (388-4311) and leave a message for Fatima Jones. We need
muffins, bought or home- made, and we need people to man the
tables.
Eur J Gastroenterol Hepatol 1998
Feb;10(2):125-131
Effects of interferon therapy on fibrosis serum
markers in HCV- positive chronic liver disease.
Mazzoran L, Tamaro G, Mangiarotti MA, Marchi P, Baracetti S,
Gerini U, Fanni-Cannelles M, Zorat F, Pozzato G
Istituto di Medicina Clinica, University School of Medicine,
Trieste, Italy.
OBJECTIVE: To evaluate serum levels of prolyl- hydroxylase and
helical domain of Type IV collagen, markers of hepatic
fibrogenesis, in patients with HCV- positive chronic liver
disease and the effects of interferon therapy on these markers.
DESIGN: Prolyl-hydroxylase and Type IV collagen were determined
before therapy and each month during the treatment and follow-up.
METHODS: Fifty-seven HCV-positive patients were studied. All the
subjects received alpha2a recombinant interferon, 6 MU
subcutaneously three times a week for 4 weeks, followed by 3 MU
thrice weekly for 5 months. After cessation of treatment, each
patient was followed for 12 months. Prolyl-hydroxylase and
helical domain of Type IV collagen were measured by using
immunoenzymatic methods. HCV-RNA and HCV genotype were determined
according to the method of Okamoto.
RESULTS: In the patients prolyl-hydroxylase (39.8+/- 8.9 ng/ml)
was not different from controls (39.1+/-5.9 ng/ml). On the
contrary, the patients showed a mean Type IV collagen
(133.6+/-93.3 ng/ml) significantly (P < 0.01) higher than
controls (100.2+/-10.5 ng/ml). A good relationship between the
degree of liver fibrosis and the Type IV collagen serum level was
found (r = 0.68; P < 0.005). In both responders and non-
responders the Type IV collagen levels decreased during
interferon therapy. During the follow-up, in responders the Type
IV collagen did not show modifications, while in
non-responders/relapsers it returned rapidly to the pretreatment
levels (139.1+/- 100.7 ng/ml).
CONCLUSION: In HCV-positive chronic liver disease,
prolylhydroxylase is not a good marker of hepatic fibrosis, while
Type IV collagen is a useful tool for evaluating fibrogenic
activity. Interferon seems to be able to reduce the liver
fibrosis even without the inhibition of viral replication and
independently from liver necrosis. [Editor: Emphasis mine]
PMID: 9581987, UI: 98241143
A Call for Participants in an
Herbal Study
by Darlene Morrow
Alta Natural Herbs and Supplements Ltd. along with the RA Co.
Ltd, Tbilisi, Republic of Georgia, plan to introduce and market
HEPATICO. HEPATICO is an herbal preparation (oral) made from the
extracts of wildcrafted herbs (nettle, plantain and immortelle in
a base of milk thistle) collected in the Mingrelian and
Zemo-svanetian mountains of the Republic of Georgia.
This herbal remedy has undergone extensive preclinical and
clinical investigations in the Republic of Georgia since 1992. At
present, there are 17 abstracts being translated from Russian
into English. This research looks at the treatment of acute and
chronic forms of hepatitis and cirrhosis. The translation of
these documents should be completed in the next month and copies
will be sent to me. When I receive them, I will update everyone
on what I find.
FROM THE COMPANY’S PRESS RELEASE:
“HEPATICO is a non-toxic, safe oral dietary supplement and
herbal remedy that restores the liver and normalizes its
functions. Clinical investigations with HEPATICO have shown that
patients (children and adults) ill with acute Hepatitis A, or C
were cured in 7 to 10 days, while patients (children and adults)
suffering from chronic forms recover in 14 to 28 days. Favorable
therapeutic results with HEPATICO were observed in patients with
cirrhosis. Recovery from cirrhosis took place in 1 to 7 months
depending on the complexity and stage of the disease.”
I am strongly opposed to the use of the word “cure.”
The cure claim is based on the normalisation of the liver
enzymes, alkaline phosphatase, bilirubin, cholesterol and bile
acids. As we all know, this by no means suggests that the HCV is
no longer present. What it does suggest is that there is no
active liver damage going on at that particular time. Liver
enzymes normally fluctuate. How long was the follow up? Neither
PCR nor liver biopsies were performed to further validate their
claims.
However, they further claim: “Immunological indicators have
been studied. The immunological examinations were conducted one
day prior to the administration of HEPATICO and two weeks after
the treatment regimen ended. The following immunological
indicators were determined: the content of leukocytes,
lymphocytes, and the content of basis populations and
subpopulations of lymphocytes by the method of flour cytometry of
the T- cell (CD3), T-Helpers/Inducers (CD4), T-
suppressors/cytotoxic lymphocytes (CD8), B- lymphocytes (CD72),
natural killer cells (CD16), HLA-DR lymphocytes, the ratio Tx/Tc
(the immunoregulatory indicator—IRI), the level of serum
immunoglobulins (lg) of the 3 classes IgA, IgM and IgG and the
content of marker proteins. The researchers concluded that
HEPATICO has a positive effect on patients with various forms of
hepatitis as evidenced by its positive effect on the majority of
the measured immunological indicators.”
The company would like to continue to study the effects of
HEPATICO. They would like about 100 participants for a short one
month study. They expect rapid results. These results will be
measured by pre and post liver function tests. HEPATICO will be
supplied at no cost to participants.
The participants must have their physician’s permission.
Your physician would be responsible for monitoring your blood
tests and providing feedback to Alta Natural.
The company would like very much to work together with the
physicians. Alta Natural Herbs has 2 Russian physicians on staff:
Dr. David Khoupenia and Dr. Tamar Jvania. Both received their
medical training/education at Pirogov Medical University in
Moscow. At present they are not licensed to practice medicine in
Canada. As Medical Directors of Alta Natural, they would like to
encourage and invite other medical professionals to tour their
facility and discuss the existing research.
The company is based in Richmond, BC at 1148-20800 Westminster
Hwy. Please contact either Dr. David Khoupenia, or Mr. Greg
Shafransky or Mr. Vernon McKay at 604/303-1131 for more
information. Their email address is: Alta Natural
Am J Gastroenterol 1997 Jul;92(7):1081-1091
Diagnosis and treatment of gastrointestinal
bleeding secondary to portal hypertension.
American College of Gastroenterology Practice Parameters
Committee.
Guidelines for clinical practice are intended to suggest
preferable approaches to particular medical problems as
established by interpretation and collation of scientifically
valid research, derived from extensive review of published
literature. When data are not available that will withstand
objective scrutiny, a recommendation may be made based on a
consensus of experts. Guidelines are intended to apply to the
clinical situation for all physicians without regard to
specialty. Guidelines are intended to be flexible, not
necessarily indicating the only acceptable approach, and should
be distinguished from standards of care, which are inflexible and
rarely violated. Given the wide range of choices in any health
care problem, the physician should select the course best suited
to the individual patient and the clinical situation presented.
These guidelines are developed under the auspices of the American
College of Gastroenterology and its practice parameters
committee. These guidelines are also approved by the governing
boards of American College of Gastroenterology and Practice
Parameters Committee. Expert opinion is solicited from the outset
for the document. Guidelines are reviewed in depth by the
committee, with participation from experienced clinicians and
others in related fields. The final recommendations are based on
the data available at the time of the production of the document
and may be updated with pertinent scientific developments at a
later time.
The following guidelines are intended for adults and not for
pediatric patients.
OBJECTIVE: To develop practice guidelines for the management of
gastrointestinal bleeding in adult patients with cirrhosis and
portal hypertension.
METHOD: Randomized controlled trials published through October of
1993 were evaluated by members of the American College of
Gastroenterology Practice Parameters Committee. Each paper was
reviewed by three members of the committee and rated for quality
of design by predetermined criteria. Meta- analysis of the
studies for each treatment were evaluated for both outcome and
quality of design and formed the basis for recommendations for
treatment. Randomized controlled trials published between October
of 1993 and August of 1995 have been added to update and modify
the recommendations. The reader is referred to an excellent
article by D'Amico et al. (The treatment of portal hypertension:
A meta-analytic review. Hepatology 1995;22:332-354), which
presents most of the meta-analyses reviewed by this committee.
CONCLUSIONS: Once esophageal varices have been established by
endoscopy as the site of bleeding, either sclerotherapy or
endoscopic variceal ligation should be performed to control the
bleeding episodes. Concomitant use of vasoactive drugs lowers
portal pressure, potentially offers the endoscopist a clearer
field in which to work, and is the only noninvasive treatment for
nonesophagogastric variceal sites of bleeding related to portal
hypertension. For patients failing medical therapy, the
transjugular intrahepatic portasystemic shunt procedure is a
reasonable alternative to an emergency surgically created shunt.
Nonselective beta-adrenergic blockers are the only proven therapy
for prevention of first variceal hemorrhage. Both nonselective
beta-adrenergic blockers and endoscopic variceal ligation (which
has replaced sclerotherapy for this indication) are effective in
reducing the risk of recurrent variceal bleeding. For patients
failing these approaches, selective or total shunts or, in
selected patients, liver transplantation are appropriate rescue
procedures.
PMID: 9219775, MUID: 97363482
HOW HEP C IS TREATED IN EUROPE
by Joan King-Diemecke
According to an article appearing in the March 1998 issue of the
Journal of Viral Hepatitis, more than three hundred European
doctors filled out a questionnaire with respect to their medical
practices regarding hepatitis C virus (HCV) infection. The survey
found that there was general agreement concerning the necessity
of screening patients for HCV in cases of a history of blood
transfusion, haemodialysis, haemophilia or intravenous drug
addiction (90% of positive answers), but there were differing
opinions as to whether or not to test for possible cases of
vertical (mother to child) and nosocomial (occupational, such as
nurses) transmission of HCV.
To prevent sexual and vertical transmission, 22% of the doctors
were in favour of barrier methods (condoms, etc.), and 34% were
against; 49% encouraged breast-feeding for babies born to HCV-
positive mothers, and 14% were against. A great majority (70%) of
those surveyed were in favour of taking preventative measures in
the home.
Testing practices varied, 60% using RIBA (recombinant immunoblot
assay). PCR was ordered by 77% when ALTs were elevated and by 89%
when ALTs were normal. Biopsies were requested by 90% of the
doctors and ultrasounds were prescribed by 91% in cases of
elevated ALTs. However, in cases of normal ALTs, only 40% ordered
biopsies and 70% ordered ultrasound testing.
Only thirty per cent of those surveyed counseled their patients
to stop drinking alcohol and 60% advised moderation.
Two-thirds of the responders did not take into account biopsy or
PCR results before starting antiviral therapy (such as
Interferon) . Eighty per cent of the participants reported that
they gave their patients interferon (IFN) for 12 months. For most
of the items studied, there was a large variation of answers.
Those who ran the survey concluded that preventive and medical
practices towards HCV are not homogeneous throughout the EU and
suggested the need for a European consensus conference in this
regard.
Based on :
J Viral Hepat 1998 Mar;5(2):131-141
Medical practices regarding hepatitis C virus infection in
Europe.
Nalpas B, Delaroques-Astagneau E, Bihan CL, Drucker J, Desenclos
JC Reseau National de Sante Publique, St Maurice, France.
PMID: 9572038, UI: 98233565
U ASK
Natalie Rock RN, BS Hepatology Clinical Research Nurse,
Dept of Medicine UBC, Vancouver Hospital Div. Gastroenterology
Question: When is my hair going to stop
falling out?
Hair loss, although not common, does occur with interferon
treatment. Often it is mild and not apparent to others, but
occasionally it may be more marked. Growth of hair requires
nutrients, particularly protein, but loss of hair can occur for
many reasons including some immune abnormalities. It takes a
while for hair to grow out from the follicle once the reason
depressing hair growth has been removed. Thus, it usually takes 3
to 4 weeks after the stopping of interferon before new hair
starts to grow out. From then on the hair growth generally
returns to normal. There is, however, individual variation in the
rate of hair growth. It will take some months before full- length
hair has returned.
Question: What does it mean when you are
told that you have the virus (determined through a PCR) but that
it is dormant? What course of action should be taken, are there
regular tests one should have, and is there anything one can do
to lower the risk of the virus becoming active?
It is uncommon for viruses to cause chronic disease. Most
viruses, such as measles, chickenpox etc., are eradicated from
the body in a short time. Herpes, HIV, and hepatitis C are,
however, chronic viruses that stay in the body and inside cells
permanently. The activity of the disease caused by the virus
varies, however; at times the disease is active, at times not.
Herpes virus, for example, causes the so- called "cold
sores." Cold sores are not always present—indeed they
may only occur infrequently—but the virus is always present
and if one did a biopsy at the site where the cold sore occurs
the virus may be seen inside the cells but there is no
inflammation or activity. The reason for this is not understood.
Since the disease (inflammation, ulceration) may be the body's
response rather than the activity of the virus, it may be that
the disease activity is related to the "host" (or
patient) rather than the virus. There may be a number of factors
that influence the body's response, including immune activity,
the presence of other infections, stress, and so forth. Hepatitis
C is like herpes in that at times there appears to be no
inflammation in the liver although the virus may be identified in
the blood or in the liver. In essence, the virus is
“'dormant” although it would be better to say that
there is no "disease activity." This period of
inactivity is extremely variable: in some people it may last many
years, in others only brief periods of time, and in some people
not at all.
Studies of patients whose disease is inactive have suggested that
it is best not to treat, since treating may alter the state of
inactivity and actually create active disease. Thus it is the
present recommendation that patients be checked every 6 to 12
months and if there is evidence of disease activity (elevated
enzymes) treatment should be considered at that time. It has been
shown that alcohol in some way makes the hepatitis C virus more
active and so alcohol use is discouraged. General good health and
good nutrition is important. Patients should be vaccinated
against hepatitis A since this disease combines with hepatitis C
to induce a more fulminant disease.
Independent and combined action
of hepatitis C virus infection and alcohol consumption on the
risk of symptomatic liver cirrhosis.
By Howard J. Worman, M. D. Corrao, G., and Arico, S. .
Hepatology 1998. 27:914-919.
Alcohol abuse and hepatitis C virus (HCV) infection are the two
major risk factors for the development of cirrhosis in the
Western Hemisphere. This report examined these two risk factors
in two case-control studies from Italy. The cases were 285
patients with cirrhosis admitted for the first time to a hospital
for worsening liver disease. The controls were 417 patients
admitted during the same time period for acute diseases not
related to alcohol. The odds ratio of developing symptomatic
cirrhosis was 9.2 in subjects who drank no alcohol and had HCV
infection compared to subjects who had zero lifetime daily
alcohol consumption and no evidence of HCV infection. For heavy
lifetime alcohol users (greater than 175 g/day), the odds ratio
for developing symptomatic cirrhosis was 15 in those without HCV
infection and 147 in those with HCV infection.
An additive relative risk for developing symptomatic cirrhosis
was also seen with lower levels of daily alcohol consumption in
individuals with chronic HCV infection. These results show that
alcohol abuse and chronic HCV infection are independent risk
factors for developing cirrhosis. These two risk factors together
greatly compound the odds of developing cirrhosis, especially at
high levels of alcohol use.
Stuffed Cabbage
2 cups cooked wild rice
1 cup diced onion
4 cloves of garlic, thinly sliced
raisins
apple cider (for sautéing)
one small head cabbage
tangy tomato sauce (recipe below)
In apple cider, sauté onion and garlic until onion is soft. Add
rice, raisins and some more cider. Heat gently for a few minutes
to let flavours meld.
Take cabbage and core and plunge into hot water for a few (5?)
minutes to loosen leaves. Peel off a dozen or so leaves.
Put a layer of sauce in the bottom of the pan. Roll the cabbage
leaves around the rice mixture by putting a tablespoon or so of
the mixture in the middle of the cabbage leaf, fold up the sides
and roll. Put the rolled cabbage on the sauce; layer as needed by
putting sauce on top of the cabbage, adding more rolls, and end
with sauce. Cover and bake 30 minutes in a 350 degree oven.
Tangy Tomato Sauce
1 28-oz can crushed tomatoes
1 cup diced onion
4 or more cloves minced garlic
1 tbs. apple cider
1 tbs. lemon juice
Sauté onion and garlic. Add crushed tomatoes. Simmer 5 minutes.
Add apple cider and lemon juice. Simmer 5 more minutes. It's
done!
KUDOS
by Darlene Morrow
I would like to thank Dr. Anderson and all the office staff for
their continued help and collaboration on some of the articles
that appear in the hepcBC.bull.
Natalie Rock is extremely busy and dedicated to helping those
with HCV, among others. She patiently answers endless questions
and encourages phone calls for any items that require
clarification. Many a time she has sent me her column for the
newsletter at 11 p.m. Other times she will submit them on a
Saturday.
We all owe them a tremendous debt of gratitude for their untiring
efforts to promote education about HCV.
Thank you!
AN OPEN LETTER TO THE
HONOURABLE ALLAN ROCK AND ALL MEMBERS OF THE FEDERAL GOVERNMENT
RE: THE TAINTED BLOOD TRAGEDY!
Dear Mr. Rock,
As a victim of tainted blood I have watched the shenanigans in
Ottawa with a mixture of disbelief, disgust, contempt and as much
anger as I can muster given the precarious state of my health.
In my opinion, you, the Prime Minister and members of the Liberal
government, have become past masters at the art of obfuscation.
You are right when you state that there is risk in any medical
procedure. I accepted that risk when I had my heart valve
replaced in 1983 and re-replaced in 1996. What I cannot, and will
not, accept is the fact that my life is in jeopardy due to
money-saving decisions made by faceless bureaucrats who are now
deemed not to be responsible or accountable.
To suggest that compensating all the victims of tainted blood
will bankrupt the health system and lead to a flood of claims is
obfuscation and arrant nonsense. Does it bankrupt the system when
we give billions of dollars to countries like Indonesia? Does it
bankrupt the system when we aid our fellow Canadians affected by
floods, ice storms, and so forth? I think not. About the only
thing bankrupt in this whole sorry mess is, in my opinion, the
morality of the federal and many provincial governments.
All decent people must feel for those who suffer from
"medical misfortune," but to refer to the tainted blood
tragedy as a "medical misfortune" is another example of
obfuscation. The list of dates when our government could have
acted goes back to the 1960's but I refer only to the decision
made on July 13, 1981, by so-called "regulators" and
officials of the Red Cross, not to buy a readily available
surrogate test. In my opinion this decision alone condemned
hundreds, perhaps even thousands, of Canadians, including me, to
death. And I thought the death penalty had been abolished in
Canada.
"Window of Opportunity"? My how you Liberals love that
phrase. To use it in the context of the tainted blood tragedy is
another example of obfuscation. I put it to you, Sir, that there
is no "window," but a bloody great chasm as wide as the
Grand Canyon, and you and your lackeys are teetering on the
brink, and, in my opinion, unless you listen to the wishes of the
vast majority of the Candian people who are your employers, you
will all be pushed over the edge in the next election.
"Precedent"? This is a word you Liberals appear to hate
as much as you love "Window of Opportunity." Again I
put it to you, Sir, that by using the dates 1986 to 1990 you have
created two dangerous precedents that could have an enormous
impact on Canada. You have made the United States not only
arbiter of the Canadian health system but also of Canadian law.
We are sick and tired of hearing about the United States. A
country where the number of citizens who cannot afford health
insurance exceeds the population of Canada is no example by which
to judge our health care system. You did not wait for the United
States to act when you brought in gun control against the wishes
of vast numbers of law-abiding citizens.
Now you are faced with an issue where the vast majority of
Canadians believe the victims of tainted blood should be
compensated and those responsible be brought to account. And what
is your response? To go against the wishes of the people and
continue defending the indefensible. If one of our ships is in a
collision the captain has to answer to a court martial and is
held responsible for his actions. Yet in the civil arm of
government, individuals or groups of individuals can cause untold
harm to their fellow citizens by their actions or lack of action,
yet walk away scot free. Why is there this double standard? Why
are those who fail to carry out their duties in a responsible
manner never held accountable?
In my opinion those who are responsible for the blood tragedy
should be made to answer for their actions or lack thereof as has
happened in other countries.
Ron Thiel
ROCK HARD IN OTTAWA - ODE TO A
ROCK HEAD
Like the Rock of Gibraltar
He stands firm and square
Allan Rock will not alter
So try if you dare
He's made his stand
And stuck to his guns
By treating Hep-C’ers
Like miserable bums
And if you don't like it
Well, that's just sour grapes
But remember ----- Gibraltar
Is crawling with apes.
Ron.T.
CLASS ACTION SUITS:
BRITISH COLUMBIA
Camp Church and Associates
Sharon Matthews / Kim Graham
4th Floor, Randall Building
Vancouver, B.C. V6B 1Z5
1-(800) 689-2322
Grant Kovacs Norell
Bruce Lemer
Grosvenor Building
930-1040 West Georgia Street
Vancouver, BC, V6E 4H1
Phone: (604) 609-6699 Fax: (604) 609-6688
Before August 1, 1986
Klein Lyons
David A Klein
805 West Broadway, Suite 500
Vancouver, B.C. V5Z 1K1
(604)874-7171 or 1-(800) 468-4466
(604)874-7180 (FAX)
also:
Dempster, Dermody, Riley and Buntain
William Dermody
4 Hughson Street South, 2nd Floor
Hamilton, Ontario L8N 3Z1
(905) 572- 6688
The toll free number to get you in touch with the
Hepatitis C Counsel is 1-(800)-229-LEAD (5323).
ONTARIO AND OTHER PROVINCES
Pre 1986/post 1990
Mr. David Harvey
Goodman & Carr
200 King Street West
Suite 2300
Toronto, Ontario, M5H 3W5
Phone: (416) 595-2300
Fax: (416) 595-0527
TRACEBACK PROCEDURES:
This information is for anyone who has received blood
transfusions in Canada, if they wish to find out if their donors
were Hep C positive.
TRACEBACK INQUIRIES
Contact:
Dr. Lisa Jeppesen, Dr. P Doyle, or Glenda
The Canadian Red Cross Society
4750 Oak Street
Vancouver, BC, V6H 2N9
1-(888) 332-5663 (local 207)
Class Action/ Compensation
If you would like more information about class
action/compensation, you can contact:
Tricia Plunkett. Tel.
(250) 479-5369
Meetings will be set up so that we can share our experiences
dealing with lawyers, the results of our own investigations, and
so that we can decide what is in our own best interest as far as
legal steps to take.
RUN FOR LIFE!
Hepatitis C Society 5K Fun Run
June 28, 1998 at 9:00am
Location: Cordova Bay - Lochside Park- Lochside Trail, Dooley
Road, Hunt Road back to to Lochside Park via Lochside Trail.
Course: Flat trail, country roads.
Catagories: Men's and Women's winners.
Awards: Trophies for overall Male and Female winners.
Prizes: Draw prizes after the race.
T-Shirts: First 200 get t-shirts before race. Later registration
get shirts after race.
Entry Fee: $15.00 up to June 14th. $20.00 late registration up to
June 28th deadline.
Registration: Drop off at Victoria Running Room, 1008 Douglas
Street.
Race Kit Pick-Up: 10:00am to 5:00pm on June 27th.
For More Information: Call Victoria Running Room at 383-4224
OR
Hepatitis C Society at 388-4311.
**Proceeds go to the Hepatitis C Society of Canada**
Joan King-Diemecke
joan_king@bc.sympatico.ca
[Editors: Darlene Morrow,
David Mazoff & Joan Diemecke].
Copyright © 1998, 1997 by [HeCSC- Victoria Chapter
and HepC BC].
Revised: May 26, 1998.