That hepatitis is only a first step, the next
face of the treatment head is heavy drama. While
the existing B and hepatitis C treatment is quite effective, but related
drug-induced side effects, or make some patients the treatment deterred,
hesitation, and even patients who are being treated or even terminate the
temporary discontinuation of therapy to regain lost health opportunities, it is regrettable.
Lee's
mother is a chronic hepatitis B patients, recently due to acute exacerbation of
chronic hepatitis B hospitalized during his sick bed in the mother, Lee also
hepatitis examination at the hospital, they discovered that he is also chronic
hepatitis B patients, and inflammation of the liver is in state, doctors advised him to
conduct oral drug treatment, but he is afraid there will be side effects, and
hesitant .......
Viral
hepatitis is divided into A-, B-, C-, D-and E-type five type, where A, E, two
kinds of hepatitis, acute hepatitis only limited, will not develop into chronic
hepatitis, cirrhosis or liver cancer and other diseases But
B-, C-, D-(only occur in patients with hepatitis B) in some patients, it may be
in the course of acute hepatitis after evolve into chronic hepatitis carriers,
and into hepatitis, cirrhosis, liver cancer Liver
trilogy.
Domestic
patients with chronic hepatitis B, C-type hepatitis based, B-type hepatitis
about Qi Cheng, about 300 million people, C-type hepatitis accounted refrain,
about 40 million to 60 million people, as the number of hepatitis D is very small. In
the more than three hundred ten thousand people are infected with hepatitis
premise, liver disease has been known as the country. According to
government statistics, there are more than ten thousand people a year die from
liver disease, the impact of more than ten thousand families, and therefore
against liver disease, a common issue for many families.
Hepatitis B replies
Hepatitis B virus is Taiwan's largest cases of hepatitis
virus
Hepatitis
B virus is harmful to people's health largest hepatitis virus, early
epidemiological survey found that if the mother is hepatitis B carriers, carrier
rate her children, compared to non-mothers of the children of hepatitis B
carrier rate ;
and hepatitis B e antigen-positive mothers if carriers, more than 95% of
neonatal hepatitis B will become carriers, mainly because in the production
process, was the mother of the fetus in the birth canal blood hepatitis B virus,
This
vertical pattern of infection until after July 1986, the government implemented
the national infant hepatitis B vaccination policy at public expense, only to
effectively curb, and now through this vertical hepatitis B infection in
newborns is significantly reduced.
In
addition to vertical transmission outside, B liver also possible through
tattoos, piercing, dangerous sexual behavior patterns infection, people infected
with hepatitis B virus, if the body does not produce antibodies, the virus will
present the liver to become chronic carriers. Although
the virus does not cause damage to the liver directly, but will stimulate the
body's immune system to recognize in addition to the matter (hepatitis B virus),
and then attack the liver cells, causing hepatitis; if repeated liver
inflammation, it may lead to cirrhosis of the liver, thus chronic
hepatitis B patients should follow your doctor regular visits tracking, if found
at the acute exacerbation of hepatitis, should be treated to avoid embark
hepatitis, cirrhosis, liver disease.
Hepatitis
B drug comparison and
Treatment of hepatitis B drugs, mainly oral and
injectable drugs into two categories. In
oral drugs, in the domestic market has dried Aneng (Lamivudine), dry fitness
(Adefovir), entecavir (Entecavir), Fu Xi will (Telbivudine) and Hui Li properly
(Tenofovir) of five kinds. The main
purpose of these drugs is hope inhibit hepatitis B virus replication in vivo, to
achieve therapeutic effectiveness, health care and benefits conditional formula
(Hui Li due in June 2011 for NHI). Injecting drugs, mainly interferon, both
antiviral and immunomodulatory two effects.
As to which of these treatments is better? Not necessarily, and not
necessarily every hepatitis B carriers are in need of treatment, the physician
must be determined according to different conditions. And the drug has its
side effects, if not liver inflammation, viral load is low, the patient can be
considered inactive carriers, tracing back to the clinic every six months once,
without drug treatment.
The following
brief description of the treatment of hepatitis B:
1 oral antiviral: Although side
effects, but not serious, and in many be improved after
discontinuation.
‧
qian'an energy (Lamivudine): the first listing in the domestic treatment of
hepatitis B oral antiviral drugs, the main purpose is to inhibit the in vivo
replication of hepatitis B virus and reduce liver inflammation opportunities.
Use as a daily oral
administration of treatment depending on the response of the patient, usually at
least one year. Possible side effects
include gastrointestinal discomfort, headaches, hair loss and so on.
Dry Aneng clinical use there is a
problem that may arise resistance.
‧ Dry fitness
(Adefovir): role also in the inhibition of hepatitis B virus replication,
security can be similar principle and dry, but the chance of resistance can be
lower than the dry safety. In addition, if there is resistance on
the dry safety of patients can be instructed by a doctor, plus dry fitness
therapy. Possible side effects are
headache, abdominal pain, fatigue and so on.
‧ Beilejia g (Entecavir):
An energy with dry, dry the same fitness, is already available in the country to
do the treatment of hepatitis B line drugs. Side effects may include headache, fatigue,
diarrhea, etc., but much can be improved after
discontinuation.
‧
Fu Xi will (Telbivudine): clinical experience, the joy will be blessing on the
inhibition of hepatitis B virus capability is quite good, especially for e
antigen-positive patients, some patients after treatment, e antigen can be
converted to negative, and its produced after treatment
resistant, it can be much lower than the dry safety; possible side effects such
as dizziness, rash and diarrhea.
‧ Hui Li properly
(Tenofovir): is a class of nucleotide drugs, the first since 2001 for the
treatment of AIDS. June 2011 has just
been NHI, for inhibiting the replication of hepatitis B virus, the main side
effects: nausea, gastrointestinal discomfort, skin rash, headache, fatigue and
so on.
(2) injecting drug
‧
interferon (interferon, IFN): Interferon is already present in the body of a
substance, when the virus invades the human body, the body's immune system to
produce interferon, stimulate the liver to produce specific proteins, and this
protein is inhibited B Hepatitis virus enters liver cells and
replicate in the liver cells, to reduce the damage of liver cells. However, most of the
serum of patients with chronic hepatitis interferon measured very low, displays
the body of interferon secretion, catch viral replication. This principle is the use of interferon
therapy to inhibit hepatitis B virus replication and reduce liver cell
damage.
Main
points of interferon α, β, γ three categories, now used clinically to treat
chronic viral hepatitis is mainly α interferon, and its rate of medication side
effects, significantly more than the oral antiviral high, common side effects
are similar to cold discomfort, hair
loss, reduce the number of white blood cells and platelets, anxiety, depression,
irritability, fatigue and insomnia, loss of appetite, nausea and
diarrhea.
Such as extreme depression,
abnormal changes in blood counts may be discontinued after assessment (extreme
depression or abnormal blood count changes awaiting
withdrawal)
Either
oral or injectable medications, B liver patients during treatment, are likely to
experience side effects, patients should be given at this time family care,
divert the attention of physical discomfort, but if found in patients with
extreme depression, or found in the monitoring of blood in the number of normal variation, there may
be a careful evaluation, considering the patient withdrawal. But avoid non-self-withdrawal, in order to avoid
oral antibiotic and other issues.
As
low viral load, GOT, GPT index normal hepatitis B carriers, as long as you can
trace back to the clinic, drug treatment is not recommended, partly because of a
long course of oral medication, there may be resistance or interactions with
other drugs issues; Furthermore,
the study also shows that the above-mentioned type of inflammation of the liver
is not in a state of hepatitis B carriers, the use of oral medications
underperforming; addition, the use of interferon may also cause physical
discomfort, therefore, B liver patients are needed to treat, Please listen to the doctor's professional
advice.
Hepatitis C article
Hepatitis C, a high proportion of patients with treatment
success
Acute
hepatitis C virus infection, about over half of those infected will become
chronic hepatitis C patients, after 20 or 30 years later, about two to three
percent will be converted into cirrhosis, and liver cirrhosis each year about 5
% will be complicated by liver
cancer.
Unlike
hepatitis B, C hepatitis patients after treatment, can be successfully treated
with a high proportion of so-called therapeutic success is defined, is the
result of more than six months, sustained undetectable virus in the blood, and
therefore for young hepatitis C patients, doctors via the assessment, the
majority would recommend their active treatment.
Current
clinical for the treatment of hepatitis C drugs, primarily injectable interferon
combined oral Ribavirin (ribavirin) therapy, which Asians, including the
Taiwanese effect is especially good, than Western whites, blacks effects are
good . Whether
the virus first, second and third type of hepatitis C patients after 24 to 48
weeks of injectable interferon combined oral Ribavirin (ribavirin) therapy, the
cure rate has more than Qi Cheng.
Pegylated
interferon (Pegylated interferon alpha) mechanism of action, mainly by
stimulating the immune system fight the hepatitis C virus role to inhibit viral
replication effect. Ribavirin (Ribavirin) may
be through the regulation of the immune system, activation of the immune
function of T cells to inhibit viral purposes.
Hepatitis C treatment side-effects and more
While the existing treatment of
hepatitis C results are good, but also a lot of side effects caused by even the
patient discontinuation or termination of therapy. Studies
show that, in order to pegylated interferon combined oral Ribavirin (ribavirin),
minus the drug because of side effects resulting ratio Sicheng, another large
and complete withdrawal due to side effects were also 12%, we can see that
indeed Many patients, because of
unbearable pain caused by adverse drug reactions, forced to abandon
treatment.
Common
side effects of interferon many, including flu-like heavy fever, chills,
fatigue, muscle aches, headache, loss of appetite; while Ribavirin (ribavirin)
may destroy red blood cells make hemoglobin decreased, anemia; Both When used in combination, patients also tend to have a
dry cough phenomenon.
Therefore, C liver patients before and after
treatment are required by physician assessment and tracking. Some
patients are not suitable for treatment, for example, interferon or Ribavirin
(ribavirin) in patients allergic, thrombocytopenia, thyroid disease, severe
heart and lung disease, severe depression, pregnant women.
Strong will, family support to overcome the side
effects of interferon therapy
Although
the side effects of interferon therapy a lot, but if for "it" to understand
more, the majority of patients after treatment, you can still overcome drug
produces physical and mental discomfort, patience about six months to a year to
complete anti-hepatitis C treatment.
To overcome interferon cause side effects,
and doctors have a good cooperation and strong will is very important.
Clinically,
there was a middle-aged female patient in after six months, one year, two
courses, not only still fails with anemia, but she closely cooperate with the
doctor, to endure discomfort, and finally in 72 weeks after treatment, the body
had undetectable hepatitis C
virus.
In addition, family
companionship and support is also very important. Patients
during the treatment may occur irritability, depression and other emotional
reactions, family members should be more understanding and timely listen, once
they discover patients have suicidal thoughts, be sure to bring the patient back
to the clinic quickly by doctors assess the need to adjust the
medication.
Personalized hepatitis C
treatment trends
Hepatitis
C virus gene sequences can be divided into six types, the present study, the
virus type first type of hepatitis C patients, for example, after 48 weeks of
treatment, about 70% cured, ie more than six months in the body undetectable virus, while the second
type of hepatitis C cure rate in patients with 24 weeks of treatment, there are
80% of the effect is quite good.
Current
hepatitis C treatments have been made towards the development of personalized
treatment to each patient for different viruses of genotype, viral load, liver
health status, assessed by a doctor prescribing the most suitable patients with
treatment duration. If in the course of
treatment for patients with drug reactions, good standard course of 24 weeks is
expected to be shortened to 16 weeks, and vice versa if the poor response,
treatment may be extended to 48 weeks, or even longer.
Also,
according to many international research papers, C liver patients with IL28B
gene "CC" pattern matching, and human self-clearing hepatitis C virus and
response to interferon therapy related with "CC"-type pairing a higher
proportion of Asians, Compared with the body is not
"CC"-type pairing lower proportion of Westerners, for interferon therapy better.
(See table)
Expect
more new therapeutic
In
addition injectable interferon combined oral Ribavirin (ribavirin) therapy, the
U.S. Food and Drug Administration (FDA) in May, another approved Boceprevir and
Telaprevir Both DAA (direct-acting antiviral drug: direct antivirals)
Listed on the
existing ineffective therapy in patients with hepatitis C, to provide higher
cure rate in Taiwan is also expected in the next two drugs legally marketed
through this.
Telaprevir Boceprevir are
viral protease inhibitors and, to disrupt and block viral replication.
Telaprevir
combined with conventional therapy (interferon and Ribavirin) role in the
treatment of type genotype in patients with chronic hepatitis C, not only can
improve sustained virologic response rates, but also can shorten the course of
treatment. Studies
have demonstrated that even before the first type of treatment failure patients
infected with hepatitis C virus, the cure rate was also significantly increased.
In
addition, through human trials found that, for the previous course of treatment
failure with standard first-type hepatitis C virus infection in the same 48-week
course of re-treatment success rate of only 14%; However, if the extra added
Telaprevir, the highest success rate can be to 53%.
Drug Boceprevir has a similar
effect.
Although such
new drugs are still rash, anemia, and dysgeusia complications, there are
patients so early to give up treatment, but such new drugs or for the treatment
of hepatitis C bring a new dawn.
The
development of the rapidly growing medical, whether B, C hepatitis have made
great progress in the treatment, gene therapy is also experimental stage,
therefore patients with hepatitis, as long as a good fit with the doctor to
track with the original case, at the appropriate time for treatment,
Most patients can avoid embark
hepatitis, cirrhosis and liver cancer trilogy.
Table: Impact hepatitis C treatment outcome
variables
Treatment outcome
variables
Virus genotype 1
about 70%, the second type can be up to 80%
Viral load is low, better treatment
results
The shorter duration of
infection by the age, the better the outcome of the
treatment
Cirrhosis or liver
cirrhosis without health lesser extent, the cure rate of up to Qi Cheng;
However, if reached cirrhosis, the cure rate drop troughs twelve months the
following
Whether the IL28B gene in
vivo with "CC" genotype paired with "CC" genotype matched patients better
response to interferon treatment---------------------------------------------◎ About Hepatitis Treatment six questions
Q: hepatitis superficial, can be fatal without treatment
do?
A:
liver, nerve pain, but not developed, exists only in the surface layer of the
liver capsule membrane, so in the event of disease, and more to the performance
will not pain, but no pain, no itching, does not mean no health threat, if
severe
inflammation of the liver has even been complicated by liver fibrosis,
cirrhosis, liver cancer, ignored, not treated, of course, there may be
killed.
Q: small hospital
B, C hepatitis drug, with the big hospital medicine same as
you?
A:
At present, the Department of Health approved treatments B, C hepatitis drugs,
regardless of any medical institutes, they use drugs are the same. NHI
is more relaxed this year, local grass-roots clinics digestive specialist for
hepatitis B patients treated with prescription, getting patients to the nearest
viral load testing, treatment, eliminating the psychological and economic
pressures, significantly increasing medical convenience.
Q: B, C hepatitis treatment is good, and will
recur?
A: Both are possible. Hepatitis
B treatment is now well defined as control the disease and the virus can not be
completely clear the liver, so the future can still be longer liver
inflammation; For hepatitis C after treatment, for six months are undetectable
virus in vivo, that is considered good treatment, at a later date chance of recurrence about 1% to 2%.
In
addition to possible recurrence of hepatitis C, but also may clear the virus in
the body after again for tattoos, sharing needles, sharing toothbrushes, nail
clippers and other common infectious blood or body fluid pathways, so daily
life, still avoiding these risk factors.
Q: B, C hepatitis treatment is good, you will get
liver cancer?
A: There are possible.
If
the condition of the liver in the previous inflammation, has long been fibrosis,
cirrhosis circumstances, the risk of liver cancer arise in the future, thereby
completing the course of B, C liver patients, still have regular visits to
accept fetoprotein and abdominal ultrasound and other tests.
Q: Is someone in your family hepatitis B
or C liver disease being treated, other family members have to treat
it?
A: It depends on the family without
infection may be. In
general, if someone in the diagnosis of infection in B, C hepatitis, family
members should be blood tested to see whether infected; if infection is
confirmed, it should be depending on the degree of liver inflammation, follow
doctor's advice, to assess the need for treatment. If you do
not suffer infections and hepatitis B antibodies in vivo without, can be applied
to fight hepatitis B vaccine protection, as no hepatitis C vaccine today, can
only be avoided in life through the blood, body fluids and other risk factors
for infection.
Q: I have
hepatitis B, C liver, which should first treatment?
A: If you are also infected
with hepatitis B, C liver before treatment must be evaluated based on what the
patient's virus, and then decide the main goal of treatment. Clinical
findings BC hepatitis virus coinfected patients, viral hepatitis C virus is
usually dominated, so much to hepatitis C infection drug treatment, and this
treatment for hepatitis B treatment is also helpful in some patients after
treatment than can be measured body hepatitis C virus, hepatitis B even love is
under control, to achieve the effect of killing two birds with one
stone.
