Hepatitis B Virus (HBV) Overview
Hepatitis B Virus (HBV) OverviewThere are trials of new drugs being carried out by various pharmaceutical companies, hospitals and medical research teams and you may wish to consider joining one of these. Most of these studies are double blind. I.e. you will not know if you are taking the new drug or a placebo. Some studies also combine interferon with the new drug.
In considering to take an experimental drug you must make a decision regarding the possible gains (A cure) and the possible risks (unknown side effects) and should discuss things very thoroughly with your medical advisor.
Some of the drugs currently under study are shown below:-
Famciclovir
SmithKline Beecham is evaluating its antiherpes agent Famvir
(famciclovir) in the treatment of hepatitis and has recently
presented Phase II clinical data for the treatment of chronic
hepatitis B infection, according to Datamonitor. The report notes
that significant antiviral effect was observed in interferon
unresponsive and refractory patients. These results may have an
enormous impact in the treatment of chronic hepatitis patients, if
Famvir's potential use in long-term therapy is proven. However,
further clinical trials over a longer period will answer criticism
regarding Famvir as a long-term or maintenance therapy.
Granulocyte
Macrophage colony-stimulating factor
A small pilot study of this therapy demonstrated an antiviral effect, as documented by a fall in serum HBV DNA, and may have promise particularly in patients with leukopenia, who would otherwise benefit from interferon therapy
Lamivudine or 3TC
A preliminary trial of lamivudine for chronic hepatitis B
infection,
Dienstag, J. L., Perrillo, R. P., Schiff, E. R., Bartholomew, M.,
Vicary, C., and Rubin, New England Journal of Medicine, 1995. 333:1657-1661.
ABSTRACT: Lamivudine [(-)-2'-deoxy-3'-thiacytidine] is a nucleoside analogue that inhibits the reverse-transcriptase activities of the human immunodeficiency virus (HIV) and hepatitis B virus (HBV). In this double-blind trial, 32 patients with chronic hepatitis B, including 17 who had not responded to previous treatment with interferon, were treated with 25, 100 or 300 mg daily oral doses of lamivudine for 12 weeks. Levels of serum HBV DNA became undetectable in 70 % of the patients treated with 25 mg/day and 100 % of the patients treated with 100 or 300 mg/day. However, in only 6 patients (19 %), did HBV DNA remain undetectable and serum aminotransferase activities normalise 24 weeks after treatment was discontinued. Serum hepatitis Be antigen disappeared in four patients. Serum aminotransferase activities increased in 41 % of treated patients concurrent with the lose of detectable serum HBV RNA. Only minor adverse reactions occurred during treatment, most commonly fatigue and headache. The results of this preliminary study indicate that larger, controlled trials of lamivudine are warranted for the treatment of chronic hepatitis B.
T cell vaccine
Still in the pilot study phase is the use of a vaccine which takes
advantage of a T cell epitope for CTL in subjects with HLA-A2.1. It
is hoped that this vaccine will induce sufficient immune recognition
to initiate viral eradication by cell-mediated mechanisms and immune
clearance, without inducing massive hepatocellular necrosis. It is
possible that this vaccine may convert the carrier in the inactive
`immune tolerant' phase of their hepatitis B to an active phase which
seems to be a prelude to viral eradication.
Thymosin
A small pilot study of thymosin fraction 5 and thymosin in
patients with chronic `e' positive hepatitis B suggested the
treatment promoted loss of HBV DNA and seroconversion to anti `e'.
The results of a larger controlled trial are not yet available.
PC1323
KIRKLAND, Wash., Dec 15 (Reuters) - ProCyte Corp said it presented
findings showing the company's PC1323 compound inhibits the hepatitis
B virus by preventing release of the virus from infected cells.
PC1323 is an isomer, or restructured compound, of ProCyte's BCDS-copper compound, which the company is studying for its antiviral effects. "We are continuing to find that this family of proprietary compounds appears to inhibit specific viruses related to the outer core, or envelope, of the virus, said ProCyte principal scientist Andrew Branca, in a statement.
People with hepatitis and or hepatitis need to be careful taking drugs these may be over the counter (I.e. available without prescription), Prescription drugs or recreational drugs. For people with liver problems drugs that are generally safe can cause problems including liver damage, reduced effect, enhanced effect, prolonged effect. If taking any drugs you are advised to discuss with your doctor/pharmasist. However I strongly advise that you confirm the safety of any drug using a drug reference book. (One recommendation "The Nurses Drug Guide 1995", ISBN 0-8385-6998-6) especially if seeing different doctors (e.g. General Practitioner, Hepatoligist, Dermatologist etc.) as many of these are very knowledgeable in their own field but may not be up to date on current effects/safety on those with liver disease or taking interferon.
9.1 Over The Counter (OTC) Drugs
The following are available OTC, in the UK they may not be available OTC in all countries.
i) Acetaminophen (Paracetamol).
This is a common pain killer for mild to moderate pain and is also
effective in reducing high body temperature. Acetaminophen can cause
liver damage if taken in overdose and/or for long periods. It is
therefore recommended that in adults no more than 4 doses per day are
taken and not for longer than 10 days without medical supervision.
Liver damage occurs from acetaminophen when the liver is depleted of glutathione which normally detoxifies the drug by binding to potentially dangerous intermediate metabolites. When this pathway is saturated the resulting free intermediates cause liver damage.
The antidote for acetaminophen is acetylcysteine (Trade names: Airbron, Mucomyst, Mucosol, N-Acetylcystene ) given by IV or orally. acetylcysteine repletes glutathione and hence prevents damage. In the case of overdose this must be given within 10 to 12 hours of poisoning but is ineffective if a delay of 16 to 20hrs has occurred. Also the amino acid Methionine is an antidote if taken at the same time or soon after ingesting acetaminophen.
From the above it would seem OK to take acetaminophen for pain relief on occasions but not constantly.
In the UK there is a brand of acetaminophen called Pameton that contains the antidote methionine and so makes overdose impossible and it only costs a little more. The amino acid methionine is also available in capsules from health food shops. It may be wise for those with liver damage if ingesting acetaminophen to use the antidote containing brand (Pameton), or if methionine was taken concurrently with the acetaminophen as it would ensure that the metabolic pathway for acetaminophen metabolism was working as well as possible and so reduce any possible liver damage to a minimum.(?)
From what I've read of the OTC pain killers acetaminophen is the least risky pain killer to take for people with hepatitis and taking acetaminophen with methionine may reduce any chance of damage to a minimum.
ii) Aspirin
This was one of the first pain killers and is used for mild to
moderate pain, it is also effective in reducing high body
temperature, is antiinflammatory and inhibits blood coagulation.
Aspirin may also cause abnormalities in liver function tests. The odd
aspirin is probably OK but if taking interferon or if in the later
stages of liver disease more care is needed. I would advise if
suffering from hepatitis it is best to discuss taking aspirin with
your doctor.
iii) Ibuprofen (Neurophen)
This is one of the newer OTC pain killers for mild to moderate
pain, is also effective in reducing high body temperature,
antiinflammatory and inhibits blood coagulation. Ibuprofen is
reported to be better for joint and muscle pain than other OTC pain
killers. Ibuprofen can cause a transitory rise in ALT and cases of
toxic hepatitis have been reported from it's use. . Of all the OTC
pain medications this is probably has the highest risk of causing
problems. If suffering from hepatitis it is best to discuss use of
ibuprofen with your doctor.
iv) Codeine & Di-hydrocodeine
These opiate drugs are only available OTC in combination with
other drugs such as acetaminophen (paracetamol). Taken as such and
for occasional pain they are OK although my drugs book states that it
should be used with caution in those with hepatic impairment. However
more caution should be used if taken with interferon. Taking opiates
and interferon concomitantly (at the same time) should be avoided.
v) Morphine
This is generally only available with kaolin as an anti-diarrhoeal
and used as such is safe. However if suffering from diarrhoea and
have hepatitis please see a doctor immediately especially if taking
interferon as this could be a sign of a more serious infection.
However caution is advised if taken with interferon. Taking morphine
and interferon concomitantly should be avoided.
vi) Anti-Histamines
There are too many of these to list here (at present) and I would
advise discussing taking these with your doctor. However it has been
reported, but I have seen no actual research, that anti histamines
can reduce the side effects of interferon.
vii) Cough Mixtures
Again there are too many to list here so you are advised to check
the ingredients and discuss with your doctor. However if taking
interferon you should avoid theophyline derivatives, unfortunately
many cough mixtures contain these so a discussion with the available
pharmacist is advised.
viii) Indigestion Tablets
In general these are safe generally containing calcium carbonate,
magnesium oxide etc. However the newer brands such as Tagamet that
contain cimetidine are contraindicated for cautious use in those with
hepatic imparement. Discuss the use of these new preparations with
your doctor.
The drugs discussed here are generally used for recreational purposes. However some of these drugs are illegal in many if not most countries. The illegality has in general inhibited research on them and there is very little information available. The following section represents my best efforts, however due to the lack of information from reliable sources (especially the illegal drugs) do not regard this section as necessarily accurate. I strongly advise you to avoid these drugs. However since hepatitis can be caught through drug use (IV, cocaine snorting tubes) and some may be prescribed I include them here. Be it on your own head!
Before continuing, the subject of purity must be discussed. When a drug is obtained from a pharmacist you obtain a pure and known dose of the drug, however because the source of a recreational drug is generally not pure there may be other contaminants and adulterants present. For legal things such as coffee, tea, brandy, beer etc there are many other toxic chemicals present but these tend to be fairly consistent in a brand but may still be stressful to the liver. In illegal drugs such as amphetamine (speed, wizz), cocaine (Charlie), heroin (smack), MDMA ("E", "X") there many be many unknown and toxic adulterants from sugar via toilet cleaner through to ground glass. You are advised to avoid illegal drugs for this reason alone. However if you decide to take these drugs make sure you have a reliable supplier and know what your taking.
i) Alcohol
In cases of acute hepatitis alcohol must not be consumed.
In cases of chronic hepatitis, consumption of alcohol is a bit like pouring alcohol on a smouldering fire and should be avoided. Some doctors say it's OK to have a very occasional drink but most others recommend complete abstinence. The consumption of a large amount of alcohol in a single session damages your liver. In the same way, the consumption of a small amount of alcohol regularly is bad for those with hepatitis whereas alcohol in small amounts in the general population has been shown to be beneficial to health. It is therefore recommend that you avoid all alcohol but if you do decide to continue to drink: don't get drunk; limit your consumption to rare occasions and above all be sensible.
Alcohol also temporarily causes abnormal results in liver function tests, i.e. raised ALT, AST. It is therefore important to not consume ANY alcohol for several days before giving blood. If you have consumed alcohol in the days before giving blood for tests you should inform your doctor of how much alcohol was consumed and where. Failure to do this may cause your doctor to make clinical decisions based on inaccurate results from liver function tests.
If you have any alcohol dependency you are advised to seek help and support as hepatitis and alcohol can be an explosive combination.
ii) Amphetamine (Speed, Wizz) &
Methamphetamine (Crystal, Crank)
If prescribed under medical supervision theses drugs is probably
safe for people with hepatic dysfunction. However if taken for
recreational reason the lack of sleep they may induce and the extra
stress on the body is not a good idea. Unless there is a medical
reason it is advised that amphetamines should be avoided.
iii) Caffeine
(Coffee, Tea, Cola's, Some
OTC pain killers...)
Caffeine is not contraindicated for those with liver disease so
taking caffeine in OTC preparations (depending on any other drugs
present) poses the same risk to those with hepatitis as the general
population. The drug is however metabolised in the liver, this may
place more stress on the liver than if it was not consumed (?).
However if caffeine is taken to excess or late at night this may cause stress on the immune system due to insufficient sleep, exhaustion and this should be avoided.
In coffee there are many other compounds present and their metabolism may stress the liver so excessive consumption should be avoided. A switch to tea or even cola may be preferable if you cannot resist your morning cup of coffee.
iv) Cocaine (Charlie, Crack)
Cocaine is hydrolysed in serum so probably does not pose a risk if
taken for medical reasons or available in a pure form. However the
stimulant effect, late nights, desire to take more etc pose a risk to
the immune system and therefore taking of cocaine for non medical
reasons should be avoided.
v) Heroin (Smack, Shit)
Pure heroin taken under medical supervision for pain relief is OK
if used with caution for those with hepatitis. Heroin taken for
recreational purposes with the (very high) risk of impurities can be
very bad especially when injected. Heroin and other opiate
derivatives is also contraindicated for anyone taking interferon.
vi) L.S.D (Acid, Trips)
In itself, this drug, effective in very low doses is probably non
toxic to the liver. After taking LSD the majority is metabolised and
excreted within 2 hours after consumption. However in people with
impaired liver function it has been reported that this may take
longer so the effect of the drug may be more powerful. Taking LSD is
probably not advised as interferon has a tendency to make you
depressed and this may be exacerbated or enhanced by the LSD and
cause a bad trip(?).
vii) Marijuana
(Dope, Shit, Mary Jane)
It has been known for marijuana to be "spiked" with PCP (Angel
dust) so once again, be it on your own head.
The metabolism of this drug has been reported to place a strain on the liver however it is also noted that marijuana can also sometimes help in increasing appetite, suppressing nausea and relieving other symptoms of hepatitis or side effects of interferon. However attention is drawn to the following article which may indicate that marijuana may inhibit the action of interferon.
Genital warts do not respond to systemic recombinant interferon alfa-2a treatment during cannabis consumption Dermatologica, 1991, 183(3):203-7.
ABSTRACT: The case of a 22-year-old man suffering from genital warts is described. The lesions responded completely to recombinant interferon alfa-2a only after discontinuation of cannabis consumption. Cannabis was detected using the enzyme immunoassay/1-trans-tetrahydrocannabinoid method in urine. Southern blotting of frozen genital wart biopsy material revealed papillomavirus type 11 DNA, the amount of which increased significantly during interferon treatment. The final clearing of lesions after discontinuation of cannabis consumption implicates that the drug-induced impairment of cellular immunity was reversible. It is concluded that drug abuse and especially cannabis consumption may play some role in the world-wide increase in genital papillomavirus disease and in the high number of recalcitrant courses of genital warts.
viii) MDMA ("E" or "X")
This has the same contradictions as amphetamines. It has been
reported that taking between 60-120mg of MDMA once every 2 to 4 weeks
can have an antidepressant effect similar to being on prozac however
consumption of larger doses or more than once per week may cause a
permanent depletion of seritonin in the brain and make depression
worse. In addition most MDMA or "E" on sale is generally MDA, MDEA,
LSD, Methamphetamine, amphetamine or combinations of the above. It is
recommended that MDMA is avoided.
ix)Nicotine
Nicotine has no general medical use and is a poison. However it is
sometimes found in treatments to assist in the treatment of nicotine
addiction. E.g. nicotine patches, gum etc.
Nicotine is generally found in tobacco products and the nicotine and the many other chemicals in tobacco are stressful to the liver and have many associated health risks (cancer, heart attack etc). It is strongly advised that you try to stop smoking / chewing tobacco. If you feel that nicotine gum or patches may be useful to you in achieving this please discuss with your doctor especially if on interferon.
NEXT PAGE
FULL TABLE OF CONTENTSPREVIOUS PAGE
GLOSSARY
Next chapters are :