Progress in the knowledge of the natural history and treatment of hepatitis C has expanded tremendously since the discovery of the hepatitis C antibody in 1989. This viral disease is transmitted primarily in a parenteral manner, with previous recreational drug use and previous blood or blood product transfusion being the greatest risk factors. Diagnosis of hepatitis C is made by the detection of viral particles in the blood, and liver biopsy is essential to determine the extent of damage caused by this virus. Current therapies are based upon dual treatment with IFN and ribavirin. Recently, a new long- acting pegylated IFN has been approved for use as mono therapy in the United States, and any new agents are under development for the treatment of hepatitis C. The next decade hopefully will bring even greater advances in our knowledge of this common liver disease.
Monday, September 14, 2009
Hepatitis- Concluding Remarks
Hepatitis - Alternative Medicines
The rate of complementary medicine use by hepatitis C patients dissatisfied with conventional medications is estimated to be as high as 60%. Various types of agents and approaches are used in this setting, including milk thistle, vitamin therapies, Chinese herbal therapies, acupuncture, and lifestyle-modification techniques. Despite the widespread use of these modalities, few -- if any -- well-designed clinical trials evaluating the efficacy of these therapies in hepatitis C have been published.
Silymarin or milk thistle is the most common alternative medication used by patients with hepatitis. Silymarin, which exhibits certain antioxidant properties and may function as a free-radical scavenger, has been used to treat all forms of liver disease for more than 2000 years. It appears to be safe for use in this setting. The effects of this agent on HCV, however, have never been formally evaluated in controlled trials. Recently, results of a controlled trial showed no benefit of silymarin use in patients with primary biliary cirrhosis.
The widespread use of these products does present some serious health risks. Many patients who take alternative therapies either do not seek, or delay the use of, conventional therapies, which may have been effective. In addition, many alternative therapies are associated with significant liver toxicity. Common examples of hepatotoxic agents include chaparral leaf, valerian, skullcap, mistletoe, germander, Jin Bu Huan, and pyrrolizidine alkaloids. These products are available over the counter. Therefore, alternative medicines should be used with caution.
The increasing use of alternative medicines in hepatology has been fueled by patient dissatisfaction with conventional therapies. Physicians must keep an open mind and familiarize themselves with the purported efficacy and potential toxicities of alternative medications in order to provide effective counsel to their patients. Patients must inform their physicians of all their medications, alternative or conventional. Together, patients, pharmacists, and physicians must ensure that hepatotoxic agents are not ingested.
Silymarin or milk thistle is the most common alternative medication used by patients with hepatitis. Silymarin, which exhibits certain antioxidant properties and may function as a free-radical scavenger, has been used to treat all forms of liver disease for more than 2000 years. It appears to be safe for use in this setting. The effects of this agent on HCV, however, have never been formally evaluated in controlled trials. Recently, results of a controlled trial showed no benefit of silymarin use in patients with primary biliary cirrhosis.
The widespread use of these products does present some serious health risks. Many patients who take alternative therapies either do not seek, or delay the use of, conventional therapies, which may have been effective. In addition, many alternative therapies are associated with significant liver toxicity. Common examples of hepatotoxic agents include chaparral leaf, valerian, skullcap, mistletoe, germander, Jin Bu Huan, and pyrrolizidine alkaloids. These products are available over the counter. Therefore, alternative medicines should be used with caution.
The increasing use of alternative medicines in hepatology has been fueled by patient dissatisfaction with conventional therapies. Physicians must keep an open mind and familiarize themselves with the purported efficacy and potential toxicities of alternative medications in order to provide effective counsel to their patients. Patients must inform their physicians of all their medications, alternative or conventional. Together, patients, pharmacists, and physicians must ensure that hepatotoxic agents are not ingested.
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