Liver Function Tests

Just something you should be aware of... when all those doctors are talking about your LFT's and Liver enzymes... this is what they are talking about. For us liver transplant patients, we hear it a lot!

Liver Function Tests a Simple FactSheet from the AIDS Treatment Data Network

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||||| What are Liver Function Tests?

LFTs (liver function tests) are a group of blood tests that can help to show how well a person's liver is working. LFTs include measurements of albumin, various liver enzymes (ALT, AST, GGT and ALP), bilirubin, prothrombin time, cholesterol and total protein. All of these tests can be performed at the same time.

||||| Measuring Liver Proteins:

Total protein testing (also called TP or serum total protein) measures the amount of proteins in the bloodstream. Many different things can cause abnormally high or low protein levels. A doctor may order total protein testing to help diagnose kidney or liver disease, blood cancer, malnutrition or abnormal body swelling. Normal protein levels in the bloodstream range from 6.5 to 8.2 grams per deciliter Two of the main proteins found in the bloodstream are albumin and globulin. Globulins are made by various liver cells and the immune system. They help to fight off infections. Low globulin levels can have many causes other than liver damage. Albumin is a protein made in the liver. If the liver is badly damaged, it can no longer produce albumin. Albumin maintains the amount of blood in the veins and arteries. When albumin levels become very low, fluid can leak out from the blood vessels into nearby tissues, causing swelling in the feet and ankles. Very low levels of albumin may be a sign of liver damage. The normal albumin range is from 3.9 grams/ deciliter to 5.0 grams/deciliter. Prothrombin (also called factor II) is a protein that helps to clot blood. Prothrombin is made in the liver. A prothrombin time test measures how much time it takes for a person's blood to clot. The normal time needed for blood to clot is between 10 and 15 seconds. A person with an abnormally long prothrombin time may be at risk for excessive bleeding. A longer prothrombin time can be caused by serious liver disease or: A lack of vitamin K, Blood-thinning medicines, Other medications that can interfere with the test. Certain bleeding disorders.

||||| Measuring Liver Enzymes:

ALT and AST are enzymes made in the liver. They are also known as transaminases. The liver uses these enzymes to metabolize amino acids and to make proteins. When liver cells are damaged or dying, ALT and AST leak into the bloodstream. Many different things can cause liver enzymes to rise above normal levels, including: Viral hepatitis Excessive alcohol intake/Alcoholic liver disease Liver inflammation from medications and certain herbs, Auto-immune hepatitis - a condition where a person's immune system mistakes the liver for an invader and attacks it, Fatty liver- fat build -up in liver cells, called steatohepatitis when the fatty liver is inflamed Inherited liver diseases Liver tumors Heart failure ALT (also called alanine aminotransferase or SGPT) is found in the liver only. High levels of ALT in the bloodstream mean that there may be liver inflammation and/or damage. This test cannot predict liver damage or disease progression. It is simply a direct measurement of the amount of ALT in the person's bloodstream at the time of the test. The normal range of ALT levels is between 5 IU/L to 60 IU/L (International Units per Liter). ALT levels in people with HCV often rise and fall over time, so additional testing such as HCV RNA, HCV genotyping and a liver biopsy may be needed to help determine the cause and extent of liver damage. AST (also called aspartate aminotransferase or SGOT) is found in other organs besides the liver. High AST levels in the bloodstream can be a sign of liver trouble. AST testing measures the level of AST in a person's bloodstream at a given time. The normal range for AST levels in the bloodstream are 5 IU/L to 43 IU/L. Like ALT levels, AST levels in people with HCV often vary over time and can't be used to forecast disease progression or specifically measure liver damage.

||||| Cholestatic Liver Enzymes:

GGT and ALP are also called cholestatic liver enzymes. Chloestasis is a term used for partial or full blockage of the bile ducts. Bile ducts bring bile from the liver into the gallbladder and the intestines. Bile is a green fluid produced in liver cells. Bile helps the body to break down fat, process cholesterol and get rid of toxins. If the bile duct is inflamed or damaged, GGT and ALP can get backed up and spill out from the liver into the bloodstream. ALP metabolizes phosphorus and brings energy to the body. GGT brings oxygen to tissues. Causes of elevated ALP and GGT levels include: Scarring of the bile ducts (called primary biliary cirrhosis), Fatty liver (steatosis), Alcoholic liver disease, Liver inflammation from medications and certain herbs, Liver tumors, Gallstones or gall bladder problems. ALP (also called alkaline phosphatase) is found in the bones, intestines, kidneys and placenta as well as the liver. Abnormally high ALP can have many causes other than liver damage, including: bone disease, congestive heart failure, and hyperthyroidism. A rise in ALP levels can indicate liver trouble if GGT levels are also elevated. The normal range of ALP is from 30 IU/L to 115 IU/L. GGT (gamma-glutamyltranspeptidase) is found in the liver. Obesity, PBC, heavy drinking, fatty liver, and certain medications or herbs that are toxic to the liver can cause GGT levels to rise the normal range of GGT is from 5 IU/L to 80 IU/L.

||||| Bilirubin:

Bilirubin is a yellow fluid produced in the liver when worn-out red blood cells are broken down. Bilirubin can leak out from the liver into the bloodstream if the liver is damaged. When bilirubin builds up, it can cause jaundice - a yellowing of the eyes and skin, dark urine and light colored feces. The causes of abnormal bilirubin levels include: Viral hepatitis, Blocked bile ducts, Other liver diseases, Liver scarring (cirrhosis) Total bilirubin testing measures the amount of bilirubin in the bloodstream. Normal total bilirubin levels range from .20mg/dl to 1.50 (milligrams per deciliter). Direct bilirubin testing measures bilirubin made in the liver. The normal level of direct bilirubin range from .00 to .03 mg/dl

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AIDS Treatment Data Network • The Access Project
Last modified: 12/29/2008

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Everybody poops... but what does yours say about you?

Prior to my transplant, I had nicknamed my poo "The ghoooooooost poo" because it was pale white, and almost looked like raw chicken, (a sometimes raw bloody piece of chicken) It would also float on most occasions almost oily looking. OMGAAAH I know, that is disgusting, and  waaaaaaaaaay to much information, but I feel like it is very important information. If you are not in tuned with each part of your body, you will not know when something is not right. Below is a great article I found on ...well, on poop. :)

The Bowel Truth: Stools Can Reveal A Lot About Your Health

From your stool you may be able to get clues about your diet, your gastrointestinal health, and even whether your stress, anger, or anxiety levels are too high.
HOW FOOD BECOMES STOOL
From the moment food enters your mouth, your body embarks on a campaign to turn it into a soupy mush called chyme. Chewing, saliva, peristalsis (the involuntary contractions of gastrointestinal muscles), bacteria, hydrochloric acid, digestive enzymes, bile, and other secretions all work to give each meal the consistency of split pea soup. While your digestive cells are absorbing sugars, starches, fats, vitamins, minerals, and other nutrients, waste products continue traveling down the line. In the colon, all the leftovers are combined, packed together, and partially dehydrated. What remains - our feces - consist of water, indigestible fiber, undigested food (such as corn and small seeds), sloughed-off dead cells, living and dead bacteria, intestinal secretions, and bile. (The worn-out red blood cells in bile give excrement its distinctive brown color.)
If all goes as it should, you'll end up with a healthy bowel movement. Although digestive idiosyncrasies, variations in intestinal bacteria, and other variables can produce different standards for a healthy stool, in general it should be brown to light brown; formed but not hard; cylindrical, not flattened; fairly bulky and full-bodied, not compacted; somewhat textured but not too messy; and very easy to pass. And it shouldn't smell - much. You're passing methane and bacterial, degraded foodstuffs, so there's always going to be an odor, but it shouldn't be a very strong, pungent odor.
Experts disagree on two other stool characteristics:
The number of pieces and their buoyancy.
WHOLE OR PIECES?
a) Each bowel movement preferably should be in one piece, about the shape and size of a banana and tapered at the end.
b) Stools don't have to be well-formed logs. They can disperse in the toilet water; they can break down.
FLOATING versus SINKING?
Opinion a) Stools should float because buoyancy is a sign that the body has absorbed the minerals in the food and that these nutrients are not contained in the waste.
Opinion b) Stools should sink because of their bulk and fiber content.
Loftiness is not impressed with either argument: most stools will sink. Whether it floats or sinks really doesn't seem to make any difference.
An occasional deviation from this total picture is usually considered okay; chronic deviations (or any featuring blood) are not, and should be checked with a doctor.
If Your Stool Looks BLACK, TARRY, AND STICKY It Could Mean:
Bleeding in your upper digestive tract. The black color comes from digested blood cells.
If Your Stool Looks VERY DARK BROWN It Could Mean:
You drank red wine last night or have too much salt or not enough vegetables in your diet.
If Your Stool Looks GLOWING RED OR MAGENTA It Could Mean:
You've eaten a lot of reddish foods such as beets.
If Your Stool Looks LIGHT GREEN It Could Mean:
You're consuming too much sugar, or too many fruits and vegetables with not enough grains or salt.
If Your Stool Looks PALE OR CLAY-COLORED It Could Mean:
Minimal amounts of bile are being excreted, perhaps because of problems with the gallbladder or liver.
If Your Stool Looks BLOODY OR MUCUS-COVERED It Could Mean:
Hemorrhoids, an overgrowth of certain bacteria in your gastrointestinal tract, colitis (inflammation of the colon), Crohn's disease (also known as inflammatory bowel disease), or colon cancer. Red blood usually means the ailment is located near the end of your digestive tract, whereas black blood signals partially digested blood coming from an ailment higher up the tract. Seek medical advice promptly.
If Your Stool Looks PENCIL-THIN AND RIBBONLIKE It Could Mean:
A polyp or growth in your colon that narrows the passage for stool. Or spastic colon. It can also be from a prolapse at either side of the transverse colon constricting the colon and lack of fiber.
If Your Stool Looks LARGE AND FLOATING, WITH GREASY FILM ON TOILET WATER It Could Mean:
Malabsorption -- your digestive system isn't getting full nutritional use of food.
If Your Stool Looks LOOSE AND WATERY, SOMETIMES DIARRHEA WITH UNDIGESTED FOODSTUFFS It Could Mean:
Possible causes are food poisoning, lactose intolerance, antibiotics, antacids, dietary intolerance, dietary changes, travel, anxiety, stress, inflammatory bowel disease, or irritable bowel syndrome.
If Your Stool Looks SMALL, HARD, ROUND PELLETS It Could Mean:
Constipation-even if you're defecating frequently. Possible causes are eating too much dry food, including protein, and not enough vegetables and raw foods; laxative abuse; worries; or irritable bowel syndrome.
If Your Stool (Has) ALTERNATING BOUTS OF DIARRHEA & CONSTIPATION It Could Mean:
Irritable bowel syndrome. This chronic condition can be aggravated by red meat, spices, sugar, alcohol, LACK of fiber, allergy-causing foods, irregular hours, and chaotic relationships.
If Your Stool (Is) REALLY BAD SMELLING It Could Mean:
An imbalance of intestinal bacteria or eating too much animal protein, which can putrefy in your digestive tract.
If your stool-watching isn't winning any awards, you might want to try a cleanse before joining the ISWA (International Stool-Watchers Association :-)
This content is from the Natural Health magazine along with added information from Georgiana Duncan and Enid M. Gilham.
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Children and Liver Disease

I came across some great articles today regarding kids health... and you know how passionate I am about the lil livers...
The following 2 articles discuss

• Finding out your child has liver disease

•  Q & A: Nutrition for infants and children with liver disease

We have to be our childs advocate, teaching them daily how to eat right and take care of their livers!

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Are You Difficiant in Magnesium

Well as many of you know, Ricki has had a problem with her magnesium since before she got rid of me... but now post her transplant, she has needed Magnesium infusions at least 2 times a week! However we were shocked to find out just how common low magnesium is, and the things that it causes... Just remember, it is always best to check with your doctor and get your mag level tested... but if you're not sure at least try to incorporate the following items into your diet.
Beans (especially Black and White)
Nuts (especially Almonds)
Buckwheat
Spinach
Artichoke
Tomato Paste
Pumpkin Seeds
Halibut
Now without further ado... some of the problems low magnesium causes.

Many of us suffer for months and years from chronic conditions, that no one seems to detect the source of (not even the so-called experts). Only a few lucky ones realize that the true source of these conditions is due primarily to a magnesium deficiency. Many conditions are caused primarily by a deficiency and for many other conditions it is a major contributing factor.
Magnesium is a very important mineral for the body and is responsible for numerous functions. Some of which are the creation of new cells, the proper functioning of your heart and kidneys. It is sometimes known as the heart mineral,or the mineral of the heart.Other functions are the production of energy, proper digestion, the relaxation of muscles and the function of muscle. It also activates B vitamins, the adrenals ,the brain and the nervous system.
To understand the importance of this mineral, consider that 90-95% of the population is deficient, and many thought that regular magnesium supplements will fix this deficiency. But if it is not water soluble or available in ionic form it will literally pass through the digestive track with very little benefit to the body. For minerals to be absorbed into the body they must be available in ionic form.
Deficiency of magnesium, to any extent, will interfere with any of the functions that this mineral is responsible for. The solution is to take it in a form where it is completely dissolved in water. In this ionic form the it assimilates into the body fast, producing almost instant relief.
Symptoms of magnesium deficiency
* FATIGUE & LOW ENERGY
This mineral has a key role in the energy process within each cell, and our overall energy level. Energy production is inhibited, with inadequate amounts of magnesium, with the eventual outcome being fatigue and weakness. It is essential to regulating potassium levels and functioning of the adrenal glands which are both important to maintaining high energy levels.
* NERVOUSNESS & INSOMNIA
Deficiency in this mineral can cause insomnia, and wake us up with muscle spasms, cramps, tension and feeling uncomfortable. The proper functioning of the nervous system requires magnesium and without sufficient quantity the nerve cells cannot give or receive messages and tend to become excitable and highly reactive. Noises will seem excessively loud and the person will jump at sudden sound and be generally nervous and on edge. Light can appear to be too bright and the person can become highly sensitive and nervous.
* PMS & OSTEOPOROSIS
Instant relief can be obtained by taking a magnesium drink because PMS is mostly a magnesium deficiency and excess calcium. When it comes to OSTEOPOROSIS, this mineral is crucial in regulating bone density, as it is magnesium which allows calcium to assimilate. Calcium alone is potentially harmful.
* THE HEART CONNECTION
Without sufficient of this important mineral you would actually die as your heart will stop beating and the doctors will call it "a heart attack". Thus it is critical to have the proper levels of it in the body. Early signs of terminal extinction are unusual changes in heart rates (beats), angina pain, collapsing from exhaustion after heavy physical exercise or sports related activities. With low magnesium the heart muscle develops a spasm or cramp and stops beating because there is insufficient of it to relax the heart ready for the next contraction.
HEADACHES, DIABETES, HIGH BLOOD PRESSURE
Asthma, headaches, migraines, seizures, depression, fibromyalgia, anxiety, ADD, arthritis and kidney stones get worse when a sufficient amount of this mineral is not consumed.
Excess calcium DEPLETES magnesium from the body and as a result brings about symptoms of a deficiency. It is not important how much you take but how much is left in the body. Remember calcium and magnesium need to be in correct proportions, otherwise calcium goes from being a nutrient into a pollutant. When this mineral is deficient in the body excess calcium can cause heart disease, arthritis, senility, calcification of organs and tissues that eventually degenerate. Thus excess calcium can become a real problem, while excess magnesium is not any concern. This mineral does not build up in the body but the excess is eliminated while excess calcium builds up. This situation can be the cause of senility, arthritis, heart disease, calcification of organs and tissues, causing them to degenerate.
Besides calcium, there are other factors that deplete this mineral in the body. Learn what depletes it, and avoid them as much as possible. These factors dramatically deplete your body's storage and make it necessary for greater consumption of the mineral:
- coffee
- sugar
- mental stress
- alcohol
- cola type soda
- high sodium diet
- tobacco
- medical drugs of all types
- high perspiration
- low thyroid
- diabetes
- diuretics
- chronic pain
- a high carbohydrate diet
- a high calcium diet (yet too much calcium can be a problem)
Deficiency symptoms include Muscle Cramps, Anxiety, Spasms, Fatigue, Headaches, Irritability, Sleep-Disorders, Low Energy and Body-Tension.

http://www.nucellcanada.ca/store/ionicmagnesium.html - http://www.nucellcanada.ca/store/healthyheart.html

Article Source: http://EzineArticles.com/?expert=Betty_Hart

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15 Tips for Managing Interferon-Ribavirin Side Effects

Many people abandon this challenging HCV treatment mid-course. Here are 15 ways to help manage the side effects of Hepatitis C combination therapy, to help patients' likelihood of completing the extremely challenging treatment. Share this article among patients contemplating and/or already undergoing chemotherapy for Hepatitis C, so they can help increase their likelihood of conquering the virus.

by Nicole Cutler, L.Ac.

Although it affects an estimated four to five million Americans, there is still no easy formula to eliminate the Hepatitis C virus (HCV). At best, infected individuals have a 50 percent chance of triumphing over the virus by enduring standard combination therapy, a notoriously challenging treatment with pegylated interferon and ribavirin medications. Most experts believe that the success rate of these drugs would be much higher without the burden of their potentially serious side effects. In cooperation with a physician, those with HCV who can manage standard combination therapy’s side effects are more likely to complete the drug regimen at full strength – and thus have a better chance of ridding the virus from their body.

Especially apparent in the first several weeks of treatment, the side effects of these drugs range from mild to severe. Managing these effects can be simple, involving lifestyle modifications, logical home remedies and taking some routine medications. Beyond these basics, working with a knowledgeable physician is important for customizing a plan to help someone manage their side effects.

The side effects from interferon and ribavirin therapy often lead to lowered dosages or even discontinuation of these drugs. Physicians agree that the more a dosage is reduced, the less of a chance the therapy has at successfully killing HCV. However, dose reduction or discontinuation of interferon or ribavirin may be indicated immediately if severe side effects develop.

Fifteen suggestions to discuss with your physician for managing the most common side effects of combination therapy are outlined below:

1. Getting a full night’s sleep helps the body recover from physical and emotional stressors. Being fully rested lessens the side effects of fatigue, headache, fever, myalgia (muscle pain), irritability and insomnia.

2. Keeping hydrated is helpful to counteract the drying properties of combination therapy. Keeping hydrated is advised to improve fatigue, headache, fever, myalgia and dry mouth.

3. Eating well-balanced meals helps the body bounce back from fatigue, headache, fever and myalgia.

4. Engaging in regular exercise keeps your circulation going and thus helps prevent fatigue, headache, fever and myalgia.

5. Taking a hot bath or using hot packs is recognized for helping relieve myalgia.

6. Taking acetaminophen (Tylenol) or NSAIDS can reduce fatigue, headaches, fever, myalgias or liver pain. However, dosage and safety considerations must be confirmed by your doctor since these drugs may place an additional burden on the liver.

7. Include ginger in your day by drinking it in tea, ale or snacking on ginger baked goods to relieve nausea.

8. Taking ribavirin with food and eating small, frequent meals helps ease ribavirin-related nausea.

9. Prochlorperazine (compazine) may stop nausea but should only be done under a physician’s guidance.

10. Avoiding stimulants like caffeine at night can reduce insomnia and irritability.

11. Practicing relaxation techniques, such as taking a deep breath and counting to ten, can significantly help reduce irritability.

12. Taking selective serotonin reuptake inhibitors (SSRIs) have been proven effective in treating the depression associated with interferon therapy for certain individuals. The additional side effects of SSRIs and treatment guidelines must be carefully evaluated by your physician.

13. Sharing feelings with friends, family or a support group can help many people cope with the irritability and depression often accompanying HCV therapy.

14. Being gentle with your hair can help minimize hair loss. This includes not pulling on or braiding the hair, avoiding vigorous combing or brushing and only using natural (not harsh) hair products.

15. Avoiding hot or spicy foods minimizes mouth irritation. For those dealing with the side effects of a dry mouth or mouth sores, avoiding these types of foods is a must.

Some of these tips for managing side effects are easily accomplished at home while others require collaboration with your physician. However it is accomplished, reducing side effect severity helps people endure a full course of combination therapy, a feat that increases their odds of eliminating the Hepatitis C virus.

YOU CAN DO IT!! It is tough work, but we have to try!

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Steps to reverse fatty liver disease

Did you know that one third of all Americans suffer from a little known condition named "steatosis" or fatty liver?
This common disease causes nausea, obesity, hypertension, diabetes, bad breath, rashes, among other small maladies that are so frequent nowadays.


Four key steps to reverse fatty liver disease:
1. Limit yourself to no more than one fast-food meal a week. For some people, that’s going to be a major downshift. But for the sake of your health, a visit to a fast-food restaurant should be considered a treat – not a regular event.

2. When you do eat fast food, eat as healthfully as possible. Try the burger without mayo and cheese, and avoid fries and sugary soft drinks. Better yet, go for a grilled chicken sandwich, a salad with a lower-fat dressing and bottled water or a diet soft drink.

3. Get active. If you don’t already exercise at least three times a week, start now. Regular exercise helps keep your weight down and helps your body better metabolize and process the food you eat.

4. Ask your doctor to do a blood test to check your level of liver enzymes, a key measure of the health of your liver. Many doctors now order test this routinely when doing blood work on adults, but kids who eat a lot of fast food especially need to have their liver enzymes checked.

A recent study from Europe showed that eating too much fast food – a diet high in fat and sugar – can cause serious liver damage called fatty liver disease.
Yet for those who overdo it with too many trips to their favorite burger joint, there’s good news. You can likely reverse the damage done to your liver and other vital organs by a “super-size me” diet if you simply give up the unhealthy lifestyle, according to a leading liver specialist at Saint Louis University who conducted a similar study with mice.
“There’s strong evidence now that a fast-food type of diet – high in fat and sugar, the kind of diet many Americans subsist on – can cause significant damage to your liver and have extremely serious consequences for your health,” says Brent Tetri, M.D., professor of internal medicine at the Saint Louis University Liver Center and one of the country’s leading experts on non-alcoholic fatty liver disease.
“The good news is that most people can undo this damage if they change their diet and they keep physically active,” Tetri says. “If they don’t, however, they are asking for trouble.”
Particularly alarming, says Tetri, is that physicians are starting to see children and teenagers with cirrhosis, a serious liver disease once seen mostly in adults with a history of alcohol abuse or hepatitis C. Tetri suspects this is because many kids today eat far too much fast food or junk food and get far too little exercise – the kind of behaviors that can lead to liver damage.
“The fact we’re starting to see kids with liver disease should really be a wake-up call for anyone eating a diet high in fat and sugar and who’s not physically active,” Tetri says.
Tetri last year studied the effects on mice of a diet that mimicked a typical fast-food meal. The diet was 40 percent fat and replete with high-fructose corn syrup, a sweetener common in soda and some fruit juices. The mice were also kept sedentary, mimicking the lifestyle of millions of Americans.
The result: Within four weeks, the mice displayed an increase in liver enzymes – a key indicator of liver damage – and the beginnings of glucose intolerance, a marker for type II diabetes.
Similarly, in February researchers in Sweden published the results of a study in which 18 healthy and slim adults ate fast food and restricted their physical activity for a month. The result: an average weight gain of 12 pounds and, within as little as a week, a sharp rise in liver enzymes.
Tetri is quick to emphasize that fast food per se doesn’t causes liver damage. Rather, he says, the harm comes from eating too many calories and too much fat and sugar – which happens with a steady diet of burgers, fries, sodas and most other items on the typical fast-food menu.
“The big issue here is caloric content,” says Tetri. “You can put away 2,000 calories in a single fast-food meal pretty easily. For most people, that’s more calories than they need in an entire day.”
For adults and children who’ve repeatedly indulged in fast food, Tetri advises the following four steps to help reverse the damage they’ve done to their liver. The steps will also probably lead to healthy weight loss back to a more normal weight.

“Even for those people with the worst kind of diets, it’s not too late to start exercising and eating right,” Tetri says (Newswise).

Food Link to Fatty Liver

According to the Boston Children's Hospital study, fatty liver disease may be treatable through dietary changes. While these results are still unconfirmed in humans the following results link diet and fatty liver:

High-glycemic Foods

High-glycemic foods raise blood sugar fast, and are linked to contributing to fatty liver. High-glycemic foods include:

• White bread
• White rice
• Most prepared breakfast cereals
• Concentrated sugar 

Low-glycemic Foods

Low-glycemic foods which low blood sugar slowly include:

• Vegetables
• Fruits
• Beans and unprocessed grains are examples

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Pegylated Interferon plus Ribavirin Has High Sustained Response Rates in Children with Hepatitis C

Hepatitis C Research and News:

SUMMARY: Children with hepatitis C virus (HCV) infection who were treated with pegylated interferon plus ribavirin showed a high rate of sustained virological response, greater than that seen in most adult studies, according to a report in the June 2010 Journal of Hepatology. Nearly 60% of children with hard-to-treat HCV genotypes including 1 and 4 -- and more than 90% of those with easier-to-treat genotypes 2 or 3 -- achieved a cure.

By Liz Highleyman

Studies of combination interferon-based therapy for chronic hepatitis C usually focus on adults, who typically demonstrate sustained virological response (SVR) rates of just under 50% for HCV genotype 1 and 70%-80% for genotypes 2 or 3 using a standard regimen of pegylated interferon plus ribavirin for 48 or 24 weeks, respectively. Treatment of children with hepatitis C has not been as extensively studied.

In the present study, Etienne Sokal from Catholic University Louvain in Belgium and an international team of colleagues evaluated the safety and efficacy of pegylated interferon alfa-2a (Pegasys) plus ribavirin in previously untreated HCV antibody positive children with detectable HCV RNA viral load.

This prospective analysis included 18 children with HCV genotypes 2 or 3, who were treated for 24 weeks, and 47 children with harder-to-treat genotypes 1, 4, 5, or 6, who were treated for 48 weeks.

Results

• 83% of the genotype 2/3 children and 57% of the genotype 1/4/5/6 children achieved early virological response at week 12.
• End-of-treatment response rates were 94% (at week 24) and 57% (at week 48), respectively.
• Relapse rates were low, with 89% of easier-to-treat participants and 57% of hard-to-treat children achieving sustained response at 24 weeks after completion of therapy.
• 10 participants overall (15%) stopped treatment prematurely -- 2 due to serious adverse events and 8 due to lack of virological response at week 24.
• 15 children overall (23%) had their pegylated interferon or ribavirin doses adjusted -- 11 (17%) due to neutropenia and 3 (5%) due to anemia.
• The most common treatment-related adverse events included:

--Fever and flu-like symptoms (54%);
--Abdominal pain (38%);
--Irritability, depression, or mood changes (34%);
--Dermatitis (29%);
--Vomiting (23%);
--Loss of appetite (22%).

• Interferon-based treatment had no observed effect on the children's growth in height.

These results, the researchers concluded, show that children have an improved rate of sustained virological response compared with reference studies of adult chronic C patients treated with similar regimens.

Investigator affiliations: Université Catholique de Louvain, Cliniques universitaires St Luc, Bruxelles, Belgium; Paediatric Gastroenterology, Hospital de clinicas de Porto Alegre, Porto Alegre, Brazil; Unidade de Hepatologica Pediatrica, Hospital das clinicas da faculdade de medicina da universidade de Sao Paulo, Sao Paulo, Brazil; Department of Pediatrics, Stradinš University, Riga, Latvia; Department of Paediatrics, CLINTEC, Karolinska University Hospital, Huddinge, Stockholm, Sweden; Liver Unit, Birmingham Children's Hospital, Birmingham, UK.

8/31/10