Many of you have asked in your letters what your liver enzymes have to be before they are serious? Below is a chart with normal and abnormal ranges of some of the tests they run when you are HCV positive. Some doctors would have you believe that if your liver enzymes are only slightly elevated that your liver is OK. This is not true in many cases. ALT levels alone do not give a comprehensive picture of liver damage. A biopsy is the best diagnostic and available tool available in determining what stage of the disease you are in. Liver enzymes show how much inflammation is going on in the liver at the time of the blood test, but it doesn't determine how much damage the virus has done to your liver. Its good to have low liver enzymes, but liver enzymes can fluctuate for many reasons. There are many other things to watch for. Blood levels of bilirubin may go up and down when infected with HCV but if they continue to stay elevated over a period of time it may mean that you have cirrhosis. If your albumin and prothrombin time become abnormal this is another possible indication of cirrhosis. Always ask for copies of your lab results and keep them for future reference.
Laboratory Tests Note: Every lab has its own normal range
LIVER ENZYMES
AST- Normal - under 40 IU/l Moderate - 40-200 Severe - Over 200
ALT - Normal - under 40 IU/l Moderate - 40-200 Severe - Over 200
GGT - Normal - under 60 IU/l Moderate - 60-200 Severe - Over 200
Alkaline Phosphatase - Normal - under 112 IU/l Moderate - 112-300 Severe Over 300
LIVER FUNCTION TESTS
Bilirubin - Normal - under 1.2 mg/dl Moderate - 1.2- 2.5 Severe- over 2.5
Albumin - Normal - 3.5-4.5 g/dl Moderate - 3.0 - 3.5 Severe - Under 3.0
Prothrombin Time - Normal - Under 14 seconds - Moderate - 14 - 17 Severe - Over 17
BLOOD COUNT
WBC - Normal - Over 6,000 - Moderate- 3,000 - 6,000 Severe - Under 3,000
HCT - Normal - Over 40 Moderate - 35-40 Severe - Under 35
Platelets - Normal - Over 150,000 Moderate - 100,000 - 150,000 Severe - Under 100,000
ALT - Alanine Aminotransferase AST - Aspartate Aminotransferase GTT - Gamma - Glutamyl Transferase WBC - White blood count (total number of white cells given in volume of blood usually measured in centimeters) HCT - Hematocrit (measure of red blood cell volume) IU - International Units l - Liter dl- Deciliter mg- Milligrams HEPATITIS A, B, and C
Hepatitis A Virus (HAV) People are exposed to HAV from a fecal oral route or person-to person contact. People who are at the greatest risk are daycare workers (changing diapers), injection drug use, recent travel, or from a food or waterborne outbreak. Forty-two percent of cases of HAV have no known source of infection. HAV infection is always of short duration; it is not a long-term disease. Sixty percent of people with HAV recover in two months and 100 percent recover in six months.
Incidence: Occurs is 9.1 persons per 100,000 in U.S. Symptoms: Fatigue, weakness, anorexia, nausea, vomiting, and abdominal pain. Jaundice occurs in 90 percent of people with HAV and lasts less than two weeks. Once jaundice occurs, symptoms tend to decrease. Medications - none Vaccine - A vaccine is available for HAV
Hepatitis B Virus (HBV)
Transmission of HBV occurs through needle exposure, transfusions, sexual contact and exposure while giving birth. HBV infection can be either short-term (acute) or long term (chronic). Chronic infection develops in 90 percent of infants infected at birth and 25 to 50 percent of children infected between 1 and 5 years of age. Ninety-five percent of people with acute HBV will spontaneously clear the virus, however, in 2 to 5 percent of adults, the virus will become chronic. Persons who develop chronic HBV may develop liver failure, cirrhosis, and 22 percent of people with chronic disease will develop liver cancer. There are no medications for acute HBV and the virus will ordinarily spontaneously clear. Interferon and lamivudine are approved medications in the U.S. for chronic infection. The way interferon works is not clearly understood but it appears to interfere with the body's ability to replicate the virus. About 30 to 40 percent of people on interferon respond to treatment and clear the virus. Lamivudine, an antiviral that also inhibits viral replication, may be given with interferon to help clear hepatitis B virus. Transplantation may not be a very good option for people who have HBV due to the high rate of reinfection with HBV after transplant. Incidence: There are 350 million carriers of HBV worldwide. About 1 to 1.25 million persons in the U.S. are infected. Symptoms: People with HBV commonly have no symptoms. Medications: None for acute infection; interferon and lamivudine available for chronic infection in the U.S. Vaccine: A vaccine is available and highly effective. It is recommended that healthcare workers, adolescents and all newborns receive the vaccine.
Hepatitis C (HCV)
Exposure to HCV occurs predominantly through intravenous drug use. Transfusion and any other blood-to-blood contact are other modes of transmission. Of the people who are exposed to HCV, 15 percent will clear the virus. Meanwhile, 85 percent will have chronic (long-term) infection; 20-50 percent will eventually be diagnosed with cirrhosis, 20 percent will eventually be diagnosed with cirrhosis, 20 percent will have liver failure and 20 percent will have liver cancer. HCV is most commonly diagnosed during routine testing at the doctor's office or during a blood test prior to donating blood. This is because disease progression is silent, taking 20-30 years to develop into cirrhosis, although it is much quicker in the elderly and in persons with alcoholic liver disease. Combination therapy with interferon and ribavirin is often suggested for treatment of HCV. Interferon is injected three times a week for 12 months and ribavirin is taken daily by mouth for 12 months. The goal of treatment is to reduce replication of the virus and eventually clear the virus from the body. Close to 40 percent of people who undergo treatment clear HCV. The response rate is lower in those co-infected with HIV. Research on alternative HCV treatment is quite active Incidence: Among intravenous drug users, 48-90 percent have HCV. In t he U.S., 4 million people are infected. Symptoms: People with HCV report the following symptoms, fatigue, depression, nausea, abdominal discomfort, and difficulty concentrating. Jaundice occurs more in people who have acute disease, and is rare in chronic disease. Medications: Interferon and Ribavirin are approved for use in the U.S. for chronic HCV. Vaccine: There is no vaccine available
Be In Charge - A Guide to living with Chronic Hepatitis B and C, Edited by Willis C. Maddrey, M.D. & Eugene R. Schiff, M.D.
Hepatitis C and Naturopathic Medicine Moses David Ethan Goldberg
Hepatitis C Support Project Information Packet
Hepatitis C Curriculum Information Packet
National Institutes of Health Consensus Development Statement - Management of Hepatitis C March 24-26, 1997
The information in this packet is for information only and does not constitute medical advice. All persons with hepatitis C should consult a medical practitioner for diagnosis and treatment of hepatitis C. For additional information contact the Hepatitis C Awareness Project at (541) 607
5725.
What is Hepatitis-C?:What is Hepatitis-C?
Therapies:Therapies
Alternitive Treatments: Alternitive Treatments:
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