Monday, December 19, 2005

my library code number is 21223026229057 - no reader's guide information - another new search found:

there is no reader's guide onnline avaibale - http://sflib1.sfpl.org/search/Xreader%27s+guide+to+periodical+literature&SORT=D/Xreader%27s+guide+to+periodical+literature&SORT=D/1,4,4,B/frameset&FF=Xreader%27s+guide+to+periodical+literature&SORT=D&4,4,?save=b1298563

From CDC website:
http://www.cdc.gov/ncidod/diseases/hepatitis/c/hepcprev.htm#1

From MD consult website:
http://home.mdconsult.com/das/patient/view/53305193-2/10062/15240.html/top?sid=433409897

From patient handout: "Hepatitis C
What is hepatitis?
Hepatitis is an inflammation of the liver. Inflammation causes soreness and swelling. Hepatitis can be caused by many things. Drinking too much alcohol, abusing drugs and taking some medicines can cause hepatitis. Many viruses can cause hepatitis, too.

There are 2 main kinds of hepatitis, acute hepatitis and chronic hepatitis. When a person has hepatitis, the liver may become inflamed very suddenly. This is called acute hepatitis. If you have acute hepatitis, you might have nausea, vomiting, fever and body aches. Or you may not have any symptoms. Most people get over the acute inflammation in a few days or a few weeks. Sometimes, however, the inflammation doesn't go away. When the inflammation doesn't go away, the person has chronic hepatitis.

How does hepatitis affect the liver?
The liver breaks down waste products in your blood. When the liver is inflamed, it doesn't do a good job of getting rid of waste products. One waste product in the blood, called bilirubin (say "billy-roo-bin"), begins to build up in the blood and tissues when the liver isn't working right. The bilirubin makes the skin of a person with hepatitis turn a yellow-orange color. This is called jaundice (say "john-dis"). Bilirubin and other waste products may also cause itching, nausea, fever and body aches.
What is hepatitis C?
Several viruses can infect the liver. Each hepatitis virus is named with a letter of the alphabet. There are 3 main types: hepatitis A, hepatitis B and hepatitis C. Hepatitis C is usually spread through contact with blood products, like accidentally being stuck with a dirty (used) needle, using IV drugs and sharing needles, or getting a blood transfusion before 1992. Most people don't feel sick when they are first infected with hepatitis C. Instead, the virus stays in their liver and causes chronic liver inflammation.

Most people who are infected with hepatitis C don't have any symptoms for years. However, hepatitis C is a chronic illness (it doesn't go away). If you have hepatitis C, you need to be watched carefully by a doctor because it can lead to cirrhosis (a liver disease) and liver cancer.

I've never used IV drugs or been stuck with a dirty needle. How did I get hepatitis C?
Many times, the cause of hepatitis C is never found. This virus may be transmitted through sex. It may also be passed from one person to another by living in the same house with someone who has hepatitis C. Sharing razors or toothbrushes may transmit the hepatitis C virus. It can be transmitted by tattoo needles. It can even be passed from a mother to her unborn baby. All of these ways of catching hepatitis C are uncommon, but they do occur.
Could I give hepatitis C to someone else?
Yes, as far as we know, once you have hepatitis C, you can always give it to someone else. If you have hepatitis C, you can't donate blood. You should avoid sharing personal items like razors and toothbrushes. Always use a condom when you have sex. If you have hepatitis C, your sex partners should be tested to see if they also have it.

Talk to your doctor first if you want to have children. The virus isn't spread easily by sexual contact or from a mother to her unborn baby. If you're trying to have a baby, don't have sex during the menstrual cycle, because the hepatitis C virus spreads more easily in menstrual blood.

How should I take care of myself if I have hepatitis C?
You should eat a healthy diet and start exercising regularly. A dietitian can help you plan a diet that is healthy and practical. Talk to your doctor about medications that you are taking, including over-the-counter medications. Many medicines, including acetaminophen (brand name: Tylenol) are broken down by the liver and may increase the speed of liver damage. It is very important that you drink only a minimal amount of alcohol. An occasional alcoholic drink is probably OK, but check with your doctor first.
Is there a vaccine for hepatitis C?
No, not for hepatitis C. There are vaccines for hepatitis A and hepatitis B. If you have hepatitis C, your doctor may want you to take the vaccine for hepatitis B (and maybe the vaccine for hepatitis A), if you don't already have these viruses. If you have hepatitis C, you are more likely to catch hepatitis A or hepatitis B, and that would cause more damage to your liver.
Is there a treatment for hepatitis C?
Medicines available for hepatitis C include interferon alfa-2a (brand name: oferon-A), interferon alfa-2b (brand names: Intron-A), interferon alfacon-1 (brand name: Infergen), interferon alfa-2b plus ribavirin (brand name: Rebetron), and interferon alfa-n1 (brand name: Wellferon). These medicines are given as an injection (a "shot") every day, every other day, or 3 times a week for several months, and sometimes longer. About 1/4 of the people who take interferon for hepatitis C feel better. These medicines don't cure hepatitis C, but they do make people feel better and may prevent future liver problems.
What should I know about interferon?
Before you can start taking interferon, you will have a liver biopsy. A tiny bit of your liver will be taken out in a surgical operation. The doctor will check this sample of your liver to see how much damage there is. Younger patients with mild liver disease and fewer virus particles in the liver have a better response to interferon.

Interferon is expensive. It costs about $6,000 a year. You should check with your health insurance provider to see if your medical insurance will cover the cost.

What side effects will I have from taking interferon?
The most common side effect feels like having the flu. Some people taking interferon have fevers, body aches, headaches, fatigue, irritability, nausea, vomiting, loss of sleep, sleep disturbance or changes in their blood. If you take interferon, your doctor will want to examine you regularly to keep track of the side effects. If they get too bad, you may have to stop taking interferon.
Do I have to take interferon?
The choice is up to you and your doctor. Some people with hepatitis C don't have any symptoms. They only have a little inflammation of their liver. If you have hepatitis C but no symptoms, your doctor will want to keep a close watch on you. This is done by checking your blood at least once a year, and maybe 3 times a year. Your doctor will check the level of 2 enzymes that are made in your liver. Your doctor might decide to give you medicine for hepatitis C only if these enzymes reach a certain level.

The decision to use interferon therapy can be hard to make because of the expense and the side effects. Your doctor will pay attention to the type of the virus and the amount of the virus in your body. Your overall health and the results of your blood tests and the liver biopsy are also important to know about before your doctor gives you interferon treatment."

additional search on hepatitis C

1) found this on yahoo

http://search.yahoo.com/search?p=hepatitis+c&fr=FP-tab-web-t&toggle=1&cop=&ei=UTF-8

2) found out that the reader's guide to periodical literature in fact, is not a part of the collection at ucsf but is in CCSF and in the SFPL

3) MD Consult has a wonderful page:
general search was:
http://home.mdconsult.com/das/search/openres/53305193-2?searchId=433409939


patient handout search was:

http://home.mdconsult.com/das/patient/view/53305193-2/10041/9438.html/top?sid=433409897

with excerpt:
"Hepatitis
Introduction
Hepatitis is a disorder in which viruses or other mechanisms produce inflammation in liver cells, resulting in their injury or destruction. The liver is the largest organ in the body, occupying the entire upper right quadrant of the abdomen. It performs over 500 vital functions. Among them are the following:

It processes all of the nutrients the body requires, including proteins, glucose, vitamins, and fats.
The liver manufactures bile, the greenish fluid stored in the gallbladder that helps digest fats.
One of the liver's major contributions to life is to render harmless potentially toxic substances, including alcohol, ammonia, nicotine, drugs, and harmful by-products of digestion.
Old red blood cells are removed from the blood by the liver and spleen, and the iron contained in them is recycled to the bone marrow to make new red blood cells.



Damage to the liver can impair these and many other processes. Hepatitis varies in severity from a self-limited condition with total recovery to a life-threatening or life-long disease. It can occur from many different causes:

In the most common hepatitis cases, specific viruses incite the immune system to fight off infections (called viral hepatitis). Specific immune factors become over-produced that cause injury.
Hepatitis can also result from an autoimmune condition, in which abnormal immune factors attack the body's own liver cells.
Inflammation of the liver can also occur from medical problems, drugs, alcoholism, chemicals, and environmental toxins.
No matter what the cause of hepatitis, it can take either an acute (short term) or chronic form (persistent). In some cases, acute hepatitis develops into a chronic condition, but chronic hepatitis can also occur on its own. Although chronic hepatitis is generally the more serious condition, patients having either condition can experience varying degrees of severity.

Acute Hepatitis. Acute hepatitis can begin suddenly or gradually, but it has a limited course and rarely lasts beyond one or two months. Usually there is only spotty liver cell damage and evidence of immune system activity, but on rare occasions, acute hepatitis can cause severe, even life-threatening, liver damage.

Chronic Hepatitis. The chronic forms of hepatitis persist for prolonged periods. Experts usually categorize chronic hepatitis by indications of severity as one of the following:

Chronic persistent hepatitis. Chronic persistent hepatitis is usually mild and nonprogressive or slowly progressive, causing limited damage to the liver.
Chronic active hepatitis. Chronic active hepatitis involves extensive liver damage and cell injury beyond the portal tract.



Viral Hepatitis
Most cases of hepatitis are caused by viruses that infect liver cells and begin replicating. They are defined by the letters A through G:

Hepatitis A, B, and C are the most common viral forms of hepatitis. Investigators are still looking for additional viruses that may be implicated in hepatitis unexplained by the current known viruses.
Other hepatitis viruses include hepatitis E and hepatitis G. Like hepatitis A, hepatitis E is caused by contact with contaminated food or water. It is not serious except in pregnant women, when it can be life threatening. Hepatitis G is always chronic with probably the same modes of transmission as hepatitis C, but to date it does not appear to have serious effects.
Scientists don't know exactly how these viruses actually cause hepatitis (inflammation in the liver). As the virus reproduces in the liver, a number of proteins and enzymes, including many that attach to the surface of the viral protein, are also produced. Some of these may be directly responsible for liver damage. Researchers are investigating elevated levels of specific immune factors, including T-cell sub-types in the liver of hepatitis C and B patients. T-cells are important infection fighters in the immune system, which is some cases can release powerful inflammatory agents (e.g., tumor necrosis factor and interferon gamma) that can cause considerable damage leading to hepatitis B or C.

Autoimmune Chronic Hepatitis
Autoimmune chronic hepatitis accounts for about 20% of all chronic hepatitis cases. Like other autoimmune disorders, this condition develops because a genetically defective immune system attacks the body's own cells and organs (in this case the liver) after being triggered by an environmental agent, probably a virus. Suspects include the measles virus, a hepatitis virus, or the Epstein-Barr virus, which causes mononucleosis. It is also possible that a reaction to a drug or other toxin that affects the liver also triggers an autoimmune response in susceptible individuals. In about 30% of cases, autoimmune hepatitis is associated with other disorders that involve autoimmune attacks on other parts of the body.

Hepatitis Caused by Alcohol and Drugs
Alcohol. About 10% to 35% of heavy drinkers develop alcoholic hepatitis. In the body, alcohol breaks down into various chemicals, some of which are very toxic in the liver. After years of drinking, liver damage can be very severe, leading to cirrhosis in about 10% to 20% of cases. Although heavy drinking itself is the major risk factor for alcoholic hepatitis, genetic factors may play a role in increasing a person's risk for alcoholic hepatitis. Women who abuse alcohol are at higher risk for alcoholic hepatitis and cirrhosis than are men who drink heavily. High-fat diets may also increase the risk in heavy drinkers.

Drugs. Because the liver plays such a major role in metabolizing drugs, hundreds of medications can cause reactions that are similar to those of acute viral hepatitis. Symptoms can appear anywhere from two weeks to six months after starting drug treatment. In most cases, they disappear when the drug is withdrawn; but, in rare circumstances, they may progress to serious liver disease. Among the drugs most prominently cited for liver interactions are halothane, isoniazid, methyldopa, phenytoin, valproic acid, and the sulfonamide drugs. Notably, very high doses of acetaminophen (Tylenol) have been known to cause severe liver damage and even death, particularly when used with alcohol.

Nonalcoholic Fatty Liver Disease (NAFLD)
Nonalcoholic fatty liver disease (NAFLD) affects between 10% and 24% of the population covers a number of conditions, notably nonalcoholic steatohepatitis (NASH). NAFLD has features similar to alcohol-induced hepatitis, particularly a fatty liver, but it occurs in individuals who do not consume significant amounts of alcohol. Severe obesity and diabetes are the major risk factors and may pose a risk for more severe conditions. NAFLD may also occur in conjunction with small intestine surgery or other factors.

NAFLD is usually benign and very slowly progressive. In certain patients, however, it can lead to cirrhosis, liver failure, or liver cancer.

Weight reduction and management of any accompanying medical condition are the primary approaches to nonalcoholic fatty liver disease. To date, however, there is no effective treatment for NAFLD. Drugs, such as fibrates, used to lower triglycerides or those that increase insulin levels, such as metformin, may help protect against liver damage. Other drugs showing some promise include ursodiol and betaine. Vitamin E may help reduce liver injury.

Diagnosis
In people suspected of having or carrying viral hepatitis, physicians will measure certain substances in the blood.

Bilirubin. Bilirubin is one of the most important factors indicative of hepatitis. It is a red-yellow pigment that is normally metabolized in the liver and then excreted in the urine. In patients with hepatitis, the liver cannot process bilirubin, and blood levels of this substance rise. (High levels of bilirubin cause the yellowish skin tone, known as jaundice.)
Liver Enzymes (Aminotransferases). Enzymes known as aminotransferases, including aspartate (AST) and alanine (ALT), are released when the liver is damaged. Measurements of these enzymes, particularly ALT, are the least expensive and most noninvasive tests for determining severity of the underlying liver disease and monitoring treatment effectiveness. Enzyme levels vary, however, and are not always an accurate indicator of disease activity. (For example, they are not useful in detecting progression to cirrhosis.)



General Tests to Determine Causes of Viral Hepatitis
Radioimmunoassays. To identify the particular virus causing hepatitis, blood tests called radioimmunoassays are performed. Typically, radioimmunoassays identify particular antibodies, which are molecules in the immune system that attack specific antigens. (Antigens are any molecules that the body considers threatening or dangerous and which can be targeted by antibodies.) Some of these tests can pinpoint hepatitis antigens directly. These tests, however, have limitations:

There may not be sufficient numbers of antibodies to be detectable by blood tests for up to weeks or months after hepatitis develops. Blood tests that are taken too early, then, may miss these signs of infection.
Antibodies also persist after patients recover, so a positive antibody test can indicate a previous infection but does not necessarily determine if the infection is active.
The assays for individual hepatitis viruses may differ.

Polymerase Chain Reaction. In some cases of hepatitis C, a polymerase chain reaction (PCR), may be performed. PCR is able to make multiple copies of the virus' genetic material to the point where it is detectable.

Liver Biopsies
A liver biopsy may be performed for acute viral hepatitis caught in a late stage or for severe cases of chronic hepatitis. No laboratory tests for enzyme or viral levels can truly determine the actual damage to the liver. A biopsy helps determine treatment possibilities, the extent of damage, and the long-term outlook.

The biopsy requires abdominal surgery, most often laparoscopy. This procedure requires general anesthesia and involves the following steps:

The physician makes one or more small incisions (about 0.5 - 1.0 inch) in the abdomen.
Carbon dioxide or nitrous oxide is delivered through the incision to inflate the abdomen so that the involved area is visible.
The surgeon inserts a thin tube, called a laparoscope, which contains a tiny camera. Surgical instruments are also inserted through the incision to remove the liver tissue for biopsy.
It takes about an hour.



A less invasive procedure, called a minilaparoscopy, uses a smaller scope and may prove to reduce the time of the procedure.

Screening for Liver Cancer
Patients with cirrhosis are usually screened for liver cancer using tests for a substance called alpha-fetoproetin (AFP) and ultrasound. It is not known, however, if such screening has much impact on survival, since it is not very sensitive and has a high rate of false positives (suggesting the presence of cancer when it is not actually present). Screening is not necessary in patients without cirrhosis.

Hepatitis B and D
Hepatitis B and D were formerly called serum hepatitis. Hepatitis B is mainly transmitted through blood transfusions, contaminated needles, and sexual contact. Blood screening has reduced the risk from transfusions. It can also be passed from cuts, scrapes, and other breaks in the skin. Hepatitis D virus can replicate only by attaching to hepatitis B and therefore cannot exist without the B virus being present.

Risk Factors for Hepatitis B. About 1.2 million Americans are chronically infected with HBV and between 20% and 30% acquired the infection when they were children. Men are at higher risk than women. Fortunately, in the US the number of new infections has declined dramatically--by 67% between 1990 and 2002. In 2002, 8064 cases were reported compared to over 20,000 in 1990. And the greatest decrease has occurred in children. Among young adults and people living in the Northeast, however, the incidence has increased since 1999. This may indicate that sexual activity is an important route for viral transmission and that the protective effect of the vaccine has not yet reached older, high-risk groups. Also, as with hepatitis A, the increase in travelers to underdeveloped nations may be responsible for the steady rate.

HBV is far more common overseas, and about 600,000 people die each year from conditions, such as liver cancer or cirrhosis, that are related to chronic hepatitis B. Nearly 70% of these infections were acquired during infancy or early childhood.

The following are some people at risk:

Drug users who share needles.
Children of infected mothers. Pregnant women with hepatitis B can transmit the virus to their babies. Even if they are not infected at birth, unvaccinated children of infected mothers run a 60% risk of developing it before age five. Children are more likely than adults to become chronic carriers, although between 6% and 12% of children spontaneously recover each year.
People with multiple sex partners or other high-risk sexual behavior.
Hospital workers and others exposed to blood products. Contaminated medical instruments, including fingerstick devices used for more than one individual, have been known to transmit the virus.
Staff members of institutions for mentally impaired people.
Prisoners.
Emigrants from areas where the disease rate is high. (International travelers who spend long periods in such areas may also be at risk.)
People at highest risk for becoming chronic carriers of the virus are the following:

Children infected before they are five, including newborns, most of whom become carriers.
Infected people with damaged immune systems, such as AIDS patients.
Risk Factors for Hepatitis D. Hepatitis D occurs only in people with hepatitis B. It is not common in the US and the incidence of this hepatitis is declining rapidly overseas. Experts anticipate that it will be extremely rare in the near future. Those who recover from hepatitis B are immune to further infection from both hepatitis B and D viruses.

Lifestyle Precautions for Preventing Hepatitis B and C Virus Transmission
The following are some precautions for preventing the transmission of HBV or HCV:

All objects contaminated by blood from patients with hepatitis B or C must be handled with special care. (Restrictions on food preparation are not necessary for these hepatitis viruses.)
Patients with viral hepatitis should abstain from sexual activity or take strict precautions if they cannot. Infected patients should use condoms and contraceptives that prevent passage of the virus, possibly even in relationships that last for years. Women partners or infected women should abstain from sexual activity during menstruation. Either partner with infections that cause bleeding in the genital or urinary areas should avoid sexual activity until the infection is no longer active.
Couples with an infected partner or people sharing household with an infected person should avoid sharing personal items, such as razors or toothbrushes.
Note: There is no evidence that the viruses can be passed through casual contact, or other contact without exposure to blood, including kissing, hugging, sneezing, or coughing or by sharing eating utensils or drinking glasses. People infected with chronic hepatitis B or C should not be excluded from work, school, play, and child-care or any social or work settings on the basis of their infection.


Symptoms of Hepatitis B
Symptoms appear long after the initial infection, usually four to 24 weeks. Many patients may not even experience them or they may be mild and flu-like. About 10% to 20% of patients have a fever and rash. Nausea is not common. Sometimes there is general aching in the joints. The pain can resemble arthritis, affecting specific joints and accompanied by redness and swelling.

Outlook for Patients with Hepatitis B
The virus does not kill cells directly, but seems to activate cells in the immune system, which cause inflammation and damage in the liver.

Acute Form. Acute hepatitis B is generally mild, but it can be lethal in about 1% of patients. Patients who are coinfected with hepatitis D or C are at risk for serious complications. In patients whose immune systems are severely compromised, such as in AIDS, there is risk of a rapidly progressive form of HBV called fibrosing cholestatic hepatitis. Even patients with mild symptoms can remain chronically infected with the virus.

Chronic Form. About 70% of patients infected with hepatitis B will eventually eliminate the virus without any treatment. The rest will progress to chronic hepatitis. Hepatitis B can also become chronic without an acute stage. The risk for developing a chronic form of hepatitis D is the same as for hepatitis B alone.

The great majority of people with hepatitis B have a good long-term outlook, especially children infected with the virus. Still, about 5% to 10% eventually develop cirrhosis, and worldwide, approximately two million people die each year from hepatitis B, globally making it the ninth leading cause of death. Co-infection with hepatitis D or C increases the risk for cirrhosis. HBV also poses a risk for liver cancer. In Asia about 15% of people who have chronic hepatitis B develop liver cancer, but this high rate is not seen in other parts of the world. Diet may play a role in a higher or lower risk for liver cancer.

Specific Tests for Identifying Hepatitis B
A diagnosis of hepatitis B relies on measuring the liver enzymes aspartate (AST) and alanine (ALT), are released when the liver is damaged, assays to identify the viral DNA, and a liver biopsy.

Physicians then must determine if the condition is chronic but inactive or whether it is more aggressive. This is suggested by identifying a specific antigen called HBsAg, which is a protein that is found in the blood in early stages of hepatitis B and suggests the presence viral replication. Most people develop antibodies to this antigen during convalescence. Their condition is referred to as HBeAG negative or anti-HBe and suggests that infection is on the wane. About 5% to 10% of people do not clear the infection but become carriers of the antigen (called HBsAG-positive). Evidence of its persistence for more than six months suggests that the condition is chronic.

Tests have been developed that can identify specific genetic types of hepatitis B virus (designated A to G). It is not clear how significant they are in treating patients with HBV.

It is important to remember, however, that viral levels are not an accurate measure of actual liver damage. Only a biopsy can determine this.

To diagnose hepatitis D using an antibody test, hepatitis B must already have been identified.

Preventing Hepatitis B and its Transmission
General precautions for preventing hepatitis B when traveling are the same at those for hepatitis A. In infected people, preventing transmission are similar to those for hepatitis C.

Vaccinations for Prevention of Hepatitis B. Several inactivated virus vaccines, including Recombivax HB, GenHevac B, Hepagene, and Engerix-B, can prevent hepatitis B (HBV) and are safe even for infants and children. A triple-antigen hepatitis B vaccine (Hepacare) is proving to be effective for people who do not respond to the standard vaccines. Vaccination programs are also proving to reduce the risk for liver cancer. A combination vaccine (Twinrix) that contains Engerix-B and Havrix, a hepatitis A vaccine, is now approved for people with risk factors for both hepatitis A and B.




Until recently, the vaccine contained a mercury-based preservative called thimerosal. In response to concerns, professional organizations recommended suspending vaccinations in infants with noninfected mothers. In September 1999, a thimerosal-free vaccine became available and medical centers are now urged to continue vaccinations. Unfortunately, even after the thimerosal-free vaccine became available, a number of hospitals still haven't restored vaccination of all infants. This is a safe vaccine and it is reducing the need for hospitalization in children. Parents should be sure their children are immunized.

Candidates for HBV Vaccinations. Experts now recommend that all infants and children not previously vaccinated be immunized by the time they reach seventh grade.

Typical schedules for hepatitis B vaccinations in childhood are as follows:

All infants should receive the hepatitis B vaccine soon after birth and before hospital discharge. (The first dose may also be given by age 2 months if the mother has no evidence of infection.) The second dose should be given at one to four months (at least four to six weeks after first dose); and the third between six and 18 months (at least 16 weeks after first dose and eight weeks after second dose). (A fourth dose may also be given as part of a combination vaccine.) This is a safe vaccine, even in newborns, and parents should be sure their infants are immunized.
Infants of mothers infected with HBV should be treated with immune globulin plus the hepatitis vaccine within 12 hours of birth. The second dose should be given at one to two months and the third at six months. Infants should be tested for antibody status at nine to 15 months to see if they are chronic virus carriers or need to be re-vaccinated.
When it is not known if a mother is infected or not, the infant should receive the vaccine within 12 hours of birth. The mother's blood should then be tested right away. If she is infected, the infant should receive immune globulin as soon as possible (no later than a week).
Children who are between 11 and 12 and who have not been immunized should receive two or three doses of the vaccine (depending on the brand) given over a few months.
Hepatitis B vaccine protection lasts at least eight to 10 years. Booster shots after that may be recommended depending on continuing risk, such as sexual exposure. In fact, a 2002 study suggested that there is risk for infection in teenagers who were vaccinated in infancy, although protection against chronic hepatitis B may be maintained.

The following adults are at very high risk and should be vaccinated:

Healthcare and public safety workers who may be exposed to blood products. Such individuals have a risk for hepatitis B virus that ranges from 15% to 30%.
People in the same household as HBV infected individuals. (Unvaccinated people who have had intimate exposure to people with HBV may be protected with immune globulin, which is sometimes administered with the vaccine.)
Travelers to developing countries.
Patients who require transfusions and have not been infected with HBV. (Those with blood clotting disorders should have the vaccination administered under the skin, not injected in the muscle.)
Sexually active homosexual or heterosexual individuals with multiple partners or who engage in high-risk sexual behavior.
People with any sexually transmitted diseases.
Other people at risk who would benefit from vaccinations are the following:

Patients and workers in mental institutions and morticians.
Patients on hemodialysis. (People on hemodialysis may need larger doses or boosters; they also may need to be re-vaccinated if blood tests indicate they are losing immunity.)
People who use injected drugs.
Pregnant women at risk for the virus should be vaccinated; there is no evidence that the vaccine is dangerous to the fetus.
People receiving treatments or who have conditions that suppress the immune system may need the vaccination, although its benefits for this group are unclear except for those at high risk, such as people with HIV or spleen abnormalities.
The regimen in adults is typically three doses given over six months. One study reported that older adults would benefit from a fourth dose without incurring serious side effects. People with alcoholism may need high doses.

A small percentage of people do not develop immunity even after a vaccine has been given repeatedly. A more potent vaccine is proving to be effective in these people; it loses its effect after five years in about a third of those who receive it.

Soreness at the injection site is the most common side effect. There have been some reports of nerve inflammation after vaccinations for hepatitis B, and there has been some concern about three small studies associating the vaccine with an insignificant increase in multiple sclerosis. Studies in 2001, however, have found no evidence to support these concerns. Nonetheless, some groups oppose the vaccination in children who are not in high-risk groups. It should be strongly stressed that worldwide 65 million people with chronic hepatitis are expected to die from liver disease. And, vaccinations are saving lives. For example, in Taiwan, where infection rates are high and infants are at risk for hepatitis B from infected mothers, vaccination programs have significantly reduced the risk for liver cancer.

Treatments for Chronic Hepatitis B
Interferon alpha and nucleoside analogues are the important treatments at this time for hepatitis B. At this time, interferon alpha-2b is the standard agent but experts expect the nucleoside analogue lamivudine to replace it as the primary agent. Lamivudine is not only effective, it is less expensive than the interferon. Most likely, the best approach in the future will be combinations of these and other agents to achieve the greatest possible viral reduction and to minimize the chances of drug resistance.

Interferon Alpha for Hepatitis B. Interferon alpha-2b (Intron) is the standard drug for hepatitis B. It has eliminated the virus and sustained significant remission in 25% to 40% of patients with chronic hepatitis B. The drug is usually taken by injection every day for 16 weeks. (It does not appear to be effective for hepatitis D.) Unfortunately, even in hepatitis B, the virus recurs in almost all cases, although this recurring mutation may be weaker than the original strain.

Administering the drug for longer periods may produce sustained remission in more patients while still being safe. Interferon is also effective in eligible children, although long-term effects are unclear. A 2001 study suggested that it may temporarily disrupt growth, but it should be noted that hepatitis itself, even without interferon treatment, can compromise growth.

Lamivudine and Other Nucleoside Analogues. Nucleoside analogues are drugs that can block viral replication, and they are important in hepatitis B. The primary agent used in hepatitis is lamivudine (Zeffix). It can be taken orally, has few severe side effects, and is less expensive than interferon. Experts expect it to become the first-line treatment for hepatitis B. Famciclovir is an alternative. Newer nucleoside analogues, adefovir (Hepsera) and entecavir, may prove to be even more effective than the older agents.

Lamivudine has reduced viral count in over half of hepatitis B patients who have taken it as sole therapy for about a year. It also appears to significantly reduce the risk for liver damage and cirrhosis, and appears to be effective and safe in patients with decompensated cirrhosis. The drug even suppresses hepatitis B viral replication in HIV-positive patients and liver transplant recipients. It appears to be effective for children as well as adults. It is not yet clear if it protects against liver cancer, particularly in patients who have harbored the virus since childhood.

A major problem with lamivudine is the development of mutated viral strains that become resistant to the drug, particularly in areas where the virus is common. The specific genetic hepatitis B strain may be an important marker for predicting resistance. Combinations with interferons may be able to help control viral breakthroughs from mutated viruses and help sustain its effectiveness. Other nucleosides, such as adefovir and entecavir, are proving to be effective in patients who become resistant to lamivudine.

Lamivudine causes muscle aches and chills but does not appear to have some of the distressing side effects of interferon, such as depression, hair loss, weight loss, or a drop in white blood cells (leukopenia). Of some concern, however, is eventual resistance to the drug in many patients.

Investigative Therapies. A number of drugs are being studied that boost the body's own immune system to fight the virus.

Thymosin Alpha 1 (Zadaxin), also called thymalfasin, is a synthetic version of a peptide derived from the thymus gland (which is responsible for maturation of immune factors call T-cells). It is injected and has few side effects. It appears to be safe for hepatitis B patients when used alone or in combination. Combinations with interferon and nucleoside analogues are showing promise.
Vaccines as Treatments. Some hepatitis B vaccines, including Hepagene, are being investigated for treating and preventing hepatitis B.
Some important research is targeting agents that inhibit RNA--the genetic molecules that serve as messengers for regulating cellular processes. In animal studies on hepatitis B, scientists were able to turn off viral replication by targeting HBV RNAs.

Liver Transplantation. If the disease progresses to the point where it becomes life-threatening, liver transplantation may be an option. It is not foolproof, however. Viral recurrence is high in hepatitis B patients, although it can be significantly reduced using monthly infusions of hepatitis B immune globulin (HBIg), particularly when used with lamivudine. These injections may need to be administered life long. Eventually, about 40% of patients develop resistance to lamivudine. In such events, alternative agents, such as adefovir, are proving to be effective.

Hepatitis C
Each year about 30,000 new cases of hepatitis C occur. It is the most common blood-borne infection in the country. Until blood screening began in 1990, the primary mode of known transmission was through transfusions. It is also transmitted through contaminated needles and possibly through sexual transmission. The cause of transmission is unknown in 40% of cases.




About 4 million Americans have had an initial HCV infection and an estimated 2.7 million are currently chronically infected. Hepatitis C also affects 170 million people worldwide. Most people with chronic HCV, however, are unaware that they have it and experts believe that over the next 20 years, there will be a fourfold increase in diagnosed cases in the US. It is currently not possible to predict which patients will develop the chronic form of hepatitis C.

Ethnic Groups. In general, HCV occurs most commonly in non-Caucasian men between the ages of 30 and 49 years. Over 6% of African Americans are infected with HCV, which is about two to three times the risk for Caucasians.

Other High-Risk Groups. Some other specific groups are at higher than normal risk:

Intravenous drug users. Intravenous drug use has been the greatest risk factor for HCV since the early 1980s. It accounts for 60% of new cases and 20% to 50% of chronic infections. Individuals who engage in this activity have a risk for infection that is between 50% and 80%. Intravenous drug use, particularly in people who also drink alcohol heavily, poses a higher risk for severe complications. Intranasal cocaine use also increases the danger. Needle exchange and educational programs have reduced the risk for HIV transmission and should have similar benefits for preventing HCV.
People who had transfusions before 1992. Although transfused blood has been tested for both hepatitis B and C since the early nineties, individuals given transfusions before then, even decades before, may still be at risk. Such individuals are urged to be tested. Hepatitis C can exist for decades without symptoms, and nearly 300,000 people who had transfusions before 1992, including many who were children at the time, may have been infected. Of some reassurance was a 1999 study of people who had transfusions when they were children. After an average of 20 years, only 8% tested positive for hepatitis C and only three people showed signs of any liver abnormalities. These results suggest that the virus may be less aggressive in children than adults, but further observations are needed to learn if the infection remains mild beyond age 30.
Among the homeless and people in prison the HCV prevalence may be as high as 40%.
Infants of infected mothers. The risk for transmission to an infant during pregnancy is about 2% but increases to 4% to 7% during delivery. The highest rates of infection (20%) are in mothers who are also HIV positive. It is not clear if Cesarean section delivery in infected mothers offers protection. Avoiding fetal scalp monitoring and prolonged labor may reduce the risk. (Breastfeeding does not increase the risk.)
Organ transplant recipients.
Sexual transmission. Although HCV can be transmitted sexually, the risk is much less than with hepatitis B or other sexually transmitted diseases. For example, the risk for transmitting the HCV within a monogamous relationship is only about 2% to 3%. The risk is 4% to 6% for partners of people who have high-risk sex (e.g., those with multiple partners or sex workers). Of note, the risk for women becoming infected through sexual transmission may be three times that of men.
Hospital workers. It should be strongly noted that health care providers in general are at very low risk. The risk of infection from a needle stick is now believed to be about 2%. (It is not yet clear if this poses any significant risk to patients.)
Children who survive cancer.
Possibly people who have had body piercing or tattoos with contaminated equipment.
Symptoms of Hepatitis C."


also, another simple patient handout is:
http://home.mdconsult.com/das/patient/view/53305193-2/10062/18962.html/top?sid=433409897
excerpted, "Hepatitis C: What It Is and How It's Treated
What is hepatitis C?
Hepatitis C is a virus that can infect the liver. Most people who have hepatitis C don’t feel sick when they are first infected.Instead, the virus can slowly damage the liver over many years. This can lead to serious complications such as cirrhosis (scarring of the liver) and liver cancer. People who have cirrhosis due to hepatitis C may eventually need a liver transplant.

How does a person become infected with hepatitis C?
Hepatitis C is usually spread through direct contact with the blood of a person who has the disease. Sharing a needle with an infected person when using intravenous (IV) drugs is one of the most common ways of getting hepatitis C. Less common ways of being infected with hepatitis C are:

Having received a blood transfusion or an organ transplant before 1992.
Being stuck with a dirty (used) needle that has been used on an infected person. This includes needles that are used for tattoos or body piercings.
Using personal care items that have an infected person’s blood on them (for example, a razor or toothbrush).
Having unprotected sex (without a condom) with an infected person.
Being born to an infected woman.
Hepatitis C can't be spread unless a person has direct contact with infected blood. This means a person who has hepatitis C can't pass the virus to others through casual contact such as sneezing, coughing, shaking hands, hugging,kissing, sharing eating utensils or drinking glasses, swimming in a pool, using public toilets or touching doorknobs

How is hepatitis C treated?
Good health habits are essential for those who have hepatitis C, especially avoidance of alcohol and other medications and drugs that can harm the liver. Although there is not yet a proven cure for hepatitis C, some people benefit from drug treatment. You should discuss treatment with a doctor if you have hepatitis C. Standard medicines available include the following:

pegylated interferon alfa-2b (brand name: Peg-Intron)
pegylated interferon alfa-2a (brand name: Pegasys)
These medicines are given as a weekly shot. You may or may not need to use a ribavirin supplement in pill form (some brand names: Copegus, Rebetol) along with interferon.



Other medicines available to treat hepatitis C include the following:

interferon alfa-2a (brand name:Roferon-A)
interferon alfa-2b (brand name: Intron-A)
interferon alfacon-1 (brand name: Infergen)
interferon alfa-2b plus ribavirin (brand name: Rebetron)
These medicines are given as an injection (a shot) every day, every other day or 3 times a week, for several months or longer. The length of treatment depends on how severe the infection is. Carefully following your doctor's advice and sticking with your treatment plan will reduce your risk of further liver damage.

What are the side effects of treatment?
Side effects of interferon therapy may include the following:

Weight loss
Trouble sleeping
Chest pain
Nausea/vomiting
Fever and body aches
Extreme tiredness
Irritability
Depression
Side effects of ribavirin supplements may include the following:

Decrease in red blood cells (anemia)
Skin rashes/itching
Worsening of heart/circulatory problems
Extreme tiredness
Side effects are usually worst during the first few weeks of treatment and become less severe over time. If you are having trouble dealing with the side effects of your medicine, talk to your doctor. He or she can suggest ways to relieve some of the side effects. For example, if your medicine makes you feel nauseated, it may help to take it right before you go to sleep.

If taking medicine to treat hepatitis C makes you feel worse than the actual disease does, you may be tempted to stop taking your medicine before your treatment is done. However, if you don't prevent chronic inflammation from damaging your liver, you'll be much sicker in the long run. Don't stop taking your medicine until your doctor tells you to.

Could I give hepatitis C to someone else?
Yes, as far as we know, once you have hepatitis C, you can always give it to someone else. If you have hepatitis C, you can't donate blood. You should avoid sharing personal items like razors and toothbrushes. Always use a condom when you have sex. If you have hepatitis C, your sex partners should be tested to see if they also have it.


Talk to your doctor first if you want to have children. The virus isn't spread easily by sexual contact or from a mother to her unborn baby. If you're trying to have a baby, don't have sex during the menstrual cycle, because the hepatitis C virus spreads more easily in menstrual blood."

and the last patient handout article is: Hepatitis C
What is hepatitis?
Hepatitis is an inflammation of the liver. Inflammation causes soreness and swelling. Hepatitis can be caused by many things. Drinking too much alcohol, abusing drugs and taking some medicines can cause hepatitis. Many viruses can cause hepatitis, too.

There are 2 main kinds of hepatitis, acute hepatitis and chronic hepatitis. When a person has hepatitis, the liver may become inflamed very suddenly. This is called acute hepatitis. If you have acute hepatitis, you might have nausea, vomiting, fever and body aches. Or you may not have any symptoms. Most people get over the acute inflammation in a few days or a few weeks. Sometimes, however, the inflammation doesn't go away. When the inflammation doesn't go away, the person has chronic hepatitis.

How does hepatitis affect the liver?
The liver breaks down waste products in your blood. When the liver is inflamed, it doesn't do a good job of getting rid of waste products. One waste product in the blood, called bilirubin (say "billy-roo-bin"), begins to build up in the blood and tissues when the liver isn't working right. The bilirubin makes the skin of a person with hepatitis turn a yellow-orange color. This is called jaundice (say "john-dis"). Bilirubin and other waste products may also cause itching, nausea, fever and body aches.
What is hepatitis C?
Several viruses can infect the liver. Each hepatitis virus is named with a letter of the alphabet. There are 3 main types: hepatitis A, hepatitis B and hepatitis C. Hepatitis C is usually spread through contact with blood products, like accidentally being stuck with a dirty (used) needle, using IV drugs and sharing needles, or getting a blood transfusion before 1992. Most people don't feel sick when they are first infected with hepatitis C. Instead, the virus stays in their liver and causes chronic liver inflammation.

Most people who are infected with hepatitis C don't have any symptoms for years. However, hepatitis C is a chronic illness (it doesn't go away). If you have hepatitis C, you need to be watched carefully by a doctor because it can lead to cirrhosis (a liver disease) and liver cancer.

I've never used IV drugs or been stuck with a dirty needle. How did I get hepatitis C?
Many times, the cause of hepatitis C is never found. This virus may be transmitted through sex. It may also be passed from one person to another by living in the same house with someone who has hepatitis C. Sharing razors or toothbrushes may transmit the hepatitis C virus. It can be transmitted by tattoo needles. It can even be passed from a mother to her unborn baby. All of these ways of catching hepatitis C are uncommon, but they do occur.
Could I give hepatitis C to someone else?
Yes, as far as we know, once you have hepatitis C, you can always give it to someone else. If you have hepatitis C, you can't donate blood. You should avoid sharing personal items like razors and toothbrushes. Always use a condom when you have sex. If you have hepatitis C, your sex partners should be tested to see if they also have it.

Talk to your doctor first if you want to have children. The virus isn't spread easily by sexual contact or from a mother to her unborn baby. If you're trying to have a baby, don't have sex during the menstrual cycle, because the hepatitis C virus spreads more easily in menstrual blood.

How should I take care of myself if I have hepatitis C?
You should eat a healthy diet and start exercising regularly. A dietitian can help you plan a diet that is healthy and practical. Talk to your doctor about medications that you are taking, including over-the-counter medications. Many medicines, including acetaminophen (brand name: Tylenol) are broken down by the liver and may increase the speed of liver damage. It is very important that you drink only a minimal amount of alcohol. An occasional alcoholic drink is probably OK, but check with your doctor first.
Is there a vaccine for hepatitis C?
No, not for hepatitis C. There are vaccines for hepatitis A and hepatitis B. If you have hepatitis C, your doctor may want you to take the vaccine for hepatitis B (and maybe the vaccine for hepatitis A), if you don't already have these viruses. If you have hepatitis C, you are more likely to catch hepatitis A or hepatitis B, and that would cause more damage to your liver.
Is there a treatment for hepatitis C?
Medicines available for hepatitis C include interferon alfa-2a (brand name: oferon-A), interferon alfa-2b (brand names: Intron-A), interferon alfacon-1 (brand name: Infergen), interferon alfa-2b plus ribavirin (brand name: Rebetron), and interferon alfa-n1 (brand name: Wellferon). These medicines are given as an injection (a "shot") every day, every other day, or 3 times a week for several months, and sometimes longer. About 1/4 of the people who take interferon for hepatitis C feel better. These medicines don't cure hepatitis C, but they do make people feel better and may prevent future liver problems.
What should I know about interferon?
Before you can start taking interferon, you will have a liver biopsy. A tiny bit of your liver will be taken out in a surgical operation. The doctor will check this sample of your liver to see how much damage there is. Younger patients with mild liver disease and fewer virus particles in the liver have a better response to interferon.

Interferon is expensive. It costs about $6,000 a year. You should check with your health insurance provider to see if your medical insurance will cover the cost.

What side effects will I have from taking interferon?
The most common side effect feels like having the flu. Some people taking interferon have fevers, body aches, headaches, fatigue, irritability, nausea, vomiting, loss of sleep, sleep disturbance or changes in their blood. If you take interferon, your doctor will want to examine you regularly to keep track of the side effects. If they get too bad, you may have to stop taking interferon.
Do I have to take interferon?
The choice is up to you and your doctor. Some people with hepatitis C don't have any symptoms. They only have a little inflammation of their liver. If you have hepatitis C but no symptoms, your doctor will want to keep a close watch on you. This is done by checking your blood at least once a year, and maybe 3 times a year. Your doctor will check the level of 2 enzymes that are made in your liver. Your doctor might decide to give you medicine for hepatitis C only if these enzymes reach a certain level.

The decision to use interferon therapy can be hard to make because of the expense and the side effects. Your doctor will pay attention to the type of the virus and the amount of the virus in your body. Your overall health and the results of your blood tests and the liver biopsy are also important to know about before your doctor gives you interferon treatment."


specific search was:
http://home.mdconsult.com/das/clinics/view/53305193-2/N/14946564?ja=433694&PAGE=1.html&sid=433409939&source=

excerpted:
"Hepatitis C is the most common blood-borne infection in the United States and is the leading indication for liver transplantation [1] . The prevalence of serum antibodies to the hepatitis C virus is 1.8% in the general United States population, and the majority of these patients have a chronic infection [2] . This disease was initially classified as non-A, non-B hepatitis; natural history studies and treatment trials were started in patients with post-transfusion non-A, non-B hepatitis even before the virus was identified [3] [4] [5] . The hepatitis C virus was identified in 1989 as a small single-stranded RNA virus encoding approximately 3000 amino acids. This virus is classified in the Flaviviridae family, and diagnostic tests for antibodies to the virus became available in 1992 [6] [7] [8] . In the last decade, there has been tremendous growth in the knowledge regarding this increasingly common infection. Two National Institutes of Health consensus conferences in 1997 and 2002 discussed the progress in combating this infection and planned future efforts in its prevention [1] [9] . Despite the marked improvement in diagnostic testing and treatment, many patients with hepatitis C develop cirrhosis and hepatocellular carcinoma and ultimately require liver transplantation.

1. Epidemiology
Approximately 3.9 million Americans have serologic evidence of hepatitis C infection [2] . Based on data from the National Health and Nutrition Examination Survey, 74% of patients with anti-hepatitis C antibodies have actively circulating virus. The disease has been found to be most common in the 30- to 49-year-old age group, and men are more likely to be infected than women. The prevalence in men ages 30 to 49 approaches 4%, whereas the prevalence in women in this age range is approximately 1.5%. Hepatitis C is more prevalent in African Americans and Hispanics than in Caucasians [2] .

2. Risk factors
The majority of hepatitis C-positive patients have significant parenteral risk factors [10] . The most common modes of acquisition include intravenous and intranasal drug use, vertical transmission during childbirth, transmission via sexual intercourse, transfusion of blood and blood products before 1992, and occupational exposures (Table 1 ) [11] . Intravenous and intranasal drug use is the major risk factor for the development of hepatitis C in patients infected before or after 1992. The main difference between patients infected before 1992 and those infected after 1992 is the contribution of contaminated blood and blood products. Since the institution of mandatory testing by the American Red Cross, the risk of transmission of hepatitis C is <1:100,000 units of transfused blood [12] [13] ."

Sunday, December 11, 2005

almost done - information is there but needs to be proofread - 58b no. 9 cam and natural standards database

9. Completmentary medicine alternative therarpies
(a.) get it from the other books in ccsf catalog or already copied books.

(b.)CAM

by the way, the web site is: http://www.nlm.nih.gov/nccam/camonpubmed.html

and it brings students to: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?CMD=search&DB=PubMed

I searched on the Pub med database with Cam, using the search term Hepatitis C. and I found a totla of 359 resutls, 61 of which were reviewed. The 3rd article on the list, "Silymarin treatment of viral hepatitis: a systematic review.
J Viral Hepat. 2005 Nov;12(6):559-67.
PMID: 16255756 [PubMed - in process]" seems interesting to look at as well as, the 5th one, "Natural healing for HCV.
Body Posit. 2005;18(1):18-20. No abstract available.
PMID: 16193567 [PubMed - indexed for MEDLINE]." and the 6th one, "Dhiman RK, Chawla YK. Herbal medicines for liver diseases.
Dig Dis Sci. 2005 Oct;50(10):1807-12.
PMID: 16187178 [PubMed - in process." and the 10th article, "Melhem A, Stern M, Shibolet O, Israeli E, Ackerman Z, Pappo O, Hemed N, Rowe M, Ohana H, Zabrecky G, Cohen R, Ilan Y. Treatment of chronic hepatitis C virus infection via antioxidants: results of a phase I clinical trial.J Clin Gastroenterol. 2005 Sep;39(8):737-42.
PMID: 16082287 [PubMed - in process]."


As for the reviewed articles, the 2nd article in the review search about support groups seems good





(c.)Natural Standards

by the way, the web site is: http://www.naturalstandard.com/


I searched on the Natural Standards database, using the search term "Hepatitis C." and I found an article from August 2004, about "Herbal Medication use in Veterans with Chronic Hepatitis C - Siddiqui et al prospectively studied the proportion of US veterans with chronic hepatitis C that were currently taking vitamins and herbal medications to evaluate factors associated with use of herbal preparations. Patients with hepatitis C who were seen in the gastroenterology, infectious disease and primary care clinics at the VA New York Harbor Healthcare System were invited to participate. To be included patients had to be both Hep C antibody and viral RNA positive. Exclusion criteria included patients with comorbid medical condition, coinfection with HIV or hep B or other chronic liver disease. Healthy hep C antibody negative patients were enrolled for comparison. Use of vitamin C (34.8% vs. 19.6%, p< 0.001), vitamin E (25.8% vs. 13.2%, p <0.001), multivitamins (43.6% vs. 28.0% p<0.001), and herbal therapies (21.0% vs. 10.4%, p<0.001) were all significantly higher in the patients with hep C (n=500). The most common herbal medications taken by hep C patients were milk thistle (12.2%), ginseng (4.6%), and Echinacea (3.0%). In a multivariate logistic regression model adjusting for age and gender, 12 or more years of education (OR 2.7, 95% CI 1.6-4.3), and annual income of at least $20 000 (OR 2.0, 95% CI 1.3-3.2) were significant predictors of herbal medication use in patients with hep C. Study results are difficult to generalize, as the population was predominantly male veterans of lower than average level of income, from one medical centre in New York." (by Siddiqui U, Weinshel EH, Bini EJ. Prevalence and predictors of herbal medication use in veterans with chronic hepatitis C. J Clin Gastroenterol. 2004 Aug;38(7):605-10)

There was also a link that brought me to a pubmed article, called, "Prevalence and predictors of herbal medication use in veterans with chronic hepatitis C.

Siddiqui U, Weinshel EH, Bini EJ.

Division of Gastroenterology, VA New York Harbor Healthcare System, and NYU School of Medicine, New York, NY 10010, USA." (from the website: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15232366) that appears to be where the natural standard author cited for his article.


These articles are relevant to the topic of altetnative medicines for the treatment o heptatitis c. 4 of the first 5 articles on this website are pertinent as alternative therapies to help people treat Hepatitis C.

"1. Siddiqui U, Weinshel EH, Bini EJ. Prevalence and predictors of herbal medication use in veterans with chronic hepatitis C. J Clin Gastroenterol. 2004 Aug;38(7):605-10"


"2. Orally Administered Kampo Medicine, Juzen-Taiho-To, Ameliorates Anemia During Interferon Plus Ribavirin Therapy in Patients with Chronic Hepatitis C - BACKGROUND: Interferon plus ribavirin (IFN/Rib) therapy is currently standard treatment for chronic hepatitis C. Hemolytic anemia, however, is a serious side effect of this treatment, requiring reductions in or complete withdrawal of ribavirin. METHODS: We retrospectively investigated the effect of the Kampo medicine Juzen-taiho-to (TJ-48), which contains bone marrow-stimulating compounds, on anemia in 67 patients with chronic hepatitis C, who received IFN/Rib therapy. RESULTS: The reduction in hemoglobin levels was significantly ameliorated in TJ-48-treated patients (P<0.05). Consequently, only 13% (4/32) of TJ-48-treated patients received altered doses of ribavirin, while the ribavirin dose had to be reduced or withdrawn in 43% (15/35) of patients in the absence of TJ-48 administration (P<0.001). CONCLUSIONS: These results indicate the possibility that oral administration of TJ-48 supports IFN/Rib therapy without necessitating ribavirin reduction or withdrawal."



"3. Initial Results Reported in Clinical Study of Honso Sho-saiko-to (H09) for Hepatitis C

Phoenix, Arizona, Nov 28, 2004. A Japanese herbal product, Sho-saiko-to (H09), is under a clinical phase II trial by Memorial Sloan- Kettering Cancer Center to determine its effect on hepatitis C patients. The preliminary results of the trial have been reported at the 1st Annual Society of Integrative Oncology Conference in New York on November 18th, 2004. The testing herbal product, Honso Sho-saiko-to (H09), is manufactured and supplied by Honso Pharmaceutical Co., Ltd. headquartered in Nagoya Japan and branched in Phoenix, Arizona."




Number 4 is not.


"5. Sho-Saiko-To and Hepatitic C

Memorial Sloan-Kettery Cancer Center is conducting a clinical phase II trial on Sho-saiko-to (H09) to determine its effect on hepatitis C patients who are non-responsive to the interferon therapy. The preliminary results of the trial were reported at the Annual Society of Integrative Oncology Conference in New York on November 18, 2004."

51#2

rewrite them and make them different from the first 8 to diversify them too.

did 8 and two more on websites, Boxer and Feinstein, so about 10 done, just need 5 more.


now, 5 total = online articles, and websites, so 2 online articles and 3 websites maybe, one definitely on Senator John Edwards, and the other on Senator Byrd maybe.



STARTS HERE:

almost done but needs to proo58b no.10 literature - need to proofread this one - 58b no.10 literature search f.g.h.- using pub med. - partially done

10. (a.) Pub Med

By the way the website is: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?CMD=search&DB=pubmed

I typed out my search strategy along with my limits being, Hepatitis C in all fields, with no limits to start out with. I came away with 1 results out of 32847 records. I didn't think this type of search was effective at all.

Printed out here:

The result I found was:

1: Loza Munarriz C, Depaz Dolores M, Suarez Jara M, Loza Munarriz R, Valenzuela Cordova R, Bravo Tejada J, Valencia Rodriguez J, Miyahira Arakaki J, Cieza Zevallos J. Related Articles, Links
[RATE OF SEROLOGICAL MARKERS OF HEPATITIS B AND C VIRUSES IN FIRST-TIME USERS OF THE HEMODYALISIS PROGRAM AT HOSPITAL NACIONAL CAYETANO HEREDIA (HNCH).]
Rev Gastroenterol Peru. 2005 OCTOBER-DECEMBER;25(4):320-327. Spanish.
PMID: 16333386 [PubMed - as supplied by publisher]
2: Verbeeck J, Maes P, Wollants E, Van der Merwe S, Song E, Nevens F, Van Ranst M. Related Articles, Links
Use of a Commercially Available Line Probe Assay for Genotyping of Hepatitis C Virus 5a Strains.
J Clin Microbiol. 2005 Dec;43(12):6117-6119.
PMID: 16333107 [PubMed - as supplied by publisher]
3: Munakata T, Nakamura M, Liang Y, Li K, Lemon SM. Related Articles, Links
Down-regulation of the retinoblastoma tumor suppressor by the hepatitis C virus NS5B RNA-dependent RNA polymerase.
Proc Natl Acad Sci U S A. 2005 Dec 6; [Epub ahead of print]
PMID: 16332962 [PubMed - as supplied by publisher]
4: Kanda T, Yokosuka O, Imazeki F, Arai M, Saisho H. Related Articles, Links
Enhanced Sensitivity of Human Hepatoma Cells to 5-Fluorouracil by Small Interfering RNA Targeting Bcl-2.
DNA Cell Biol. 2005 Dec;24(12):805-809.
PMID: 16332177 [PubMed - as supplied by publisher]
5: Murakami Y, Yasuda T, Saigo K, Urashima T, Toyoda H, Okanoue T, Shimotohno K. Related Articles, Links
Comprehensive analysis of microRNA expression patterns in hepatocellular carcinoma and non-tumorous tissues.
Oncogene. 2005 Dec 5; [Epub ahead of print]
PMID: 16331254 [PubMed - as supplied by publisher]
6: Reigadas S, Pacheco A, Ramajo J, de Quinto SL, Martinez-Salas E. Related Articles, Links
Specific interference between two unrelated internal ribosome entry site elements impairs translation efficiency.
FEBS Lett. 2005 Nov 28; [Epub ahead of print]
PMID: 16330032 [PubMed - as supplied by publisher]
7: Frustaci A, Pieroni M, Chimenti C. Related Articles, Links
Immunosuppressive treatment of chronic non-viral myocarditis.
Ernst Schering Res Found Workshop. 2006;(55):343-51.
PMID: 16329671 [PubMed - in process]
8: Matsumori A. Related Articles, Links
Role of hepatitis C virus in cardiomyopathies.
Ernst Schering Res Found Workshop. 2006;(55):99-120.
PMID: 16329660 [PubMed - in process]
9: Sudo K, Yamaji K, Kawamura K, Nishijima T, Kojima N, Aibe K, Shimotohno K, Shimizu Y. Related Articles, Links
High-throughput screening of low molecular weight NS3-NS4A protease inhibitors using a fluorescence resonance energy transfer substrate.
Antivir Chem Chemother. 2005;16(6):385-92.
PMID: 16329285 [PubMed - in process]
10: Nicolo' M, Artioli S, La Mattina GC, Ghiglione D, Calabria G. Related Articles, Links
Branch retinal artery occlusion combined with branch retinal vein occlusion in a patient with hepatitis C treated with interferon and ribavirin.
Eur J Ophthalmol. 2005 Nov-Dec;15(6):811-4.
PMID: 16329072 [PubMed - in process]


There were only 5136 of those 332847 that were reviewed on pub med:



1: Berenguer M. Related Articles, Links
Recurrent allograft disease: viral hepatitis.
Acta Gastroenterol Belg. 2005 Jul-Sep;68(3):337-46. Review.
PMID: 16268421 [PubMed - indexed for MEDLINE]
2: Verslype C, Michielsen P, Adler M, Orlent H, Sprengers D, Delwaide J, D'heygere F, Langlet P, Brenard R, Colle I, Reynaert H, Starkel P, Henrion J; Steering Committee of the Belgian Association for the Study of the Liver. Related Articles, Links
The management of patients with mild hepatitis C.
Acta Gastroenterol Belg. 2005 Jul-Sep;68(3):314-8. Review.
PMID: 16268417 [PubMed - indexed for MEDLINE]
3: Adler M, Goubau P, Leroux-Roels G, Sprengers D, Pawlotsky JM. Related Articles, Links
Practical use of hepatitis C and B molecular tools: Belgian guidelines.
Acta Gastroenterol Belg. 2005 Jul-Sep;68(3):308-13. Review.
PMID: 16268416 [PubMed - indexed for MEDLINE]
4: Moss SF, Blaser MJ. Related Articles, Links
Mechanisms of disease: Inflammation and the origins of cancer.
Nat Clin Pract Oncol. 2005 Feb;2(2):90-7; quiz 1 p following 113. Review.
PMID: 16264881 [PubMed - indexed for MEDLINE]
5: Brok J, Gluud LL, Gluud C. Related Articles, Links
Effects of adding ribavirin to interferon to treat chronic hepatitis C infection: a systematic review and meta-analysis of randomized trials.
Arch Intern Med. 2005 Oct 24;165(19):2206-12. Review.
PMID: 16246984 [PubMed - indexed for MEDLINE]
6: Thybo S. Related Articles, Links
[Screening of apparently healthy people returning from "the tropics"]
Ugeskr Laeger. 2005 Oct 17;167(42):3997-4001. Review. Danish.
PMID: 16232400 [PubMed - indexed for MEDLINE]
7: Vazquez Martul E, Tettamazzi F, Mosquera J. Related Articles, Links
[Glomerular pathology and HCV]
Nefrologia. 2005;25(4):345-9. Review. Spanish. No abstract available.
PMID: 16231499 [PubMed - indexed for MEDLINE]
8: Afford SC, Adams DH. Related Articles, Links
Following the TRAIL from hepatitis C virus and alcohol to fatty liver.
Gut. 2005 Nov;54(11):1518-20. Review. No abstract available.
PMID: 16227354 [PubMed - indexed for MEDLINE]
9: Ghosn J, Leruez-Ville M, Chaix ML. Related Articles, Links
[Sexual transmission of hepatitis C virus]
Presse Med. 2005 Aug 27;34(14):1034-8. Review. French.
PMID: 16225259 [PubMed - indexed for MEDLINE]
10: Guilpain P, Servettaz A, Tamby MC, Chanseaud Y, Le Guern V, Guillevin L, Mouthon L. Related Articles, Links
[Pathogenesis of primary systemic vasculitides (II): ANCA-negative vasculitides]
Presse Med. 2005 Aug 27;34(14):1023-33. Review. French.
PMID: 16225258 [PubMed - indexed for MEDLINE]


10 (b.) second pub med search on my topic with MeSH

I typed out my search strategy along with my limits being, the MeSh term was simply Hepatitis C, with subheadings drug therapy, prevention and control, and lastly diagnosis which came out like this, "("Hepatitis C/diagnosis"[MeSH] OR "Hepatitis C/drug therapy"[MeSH] OR "Hepatitis C/prevention and control"[MeSH])" The results were 11405 total results and 2303 of those reviewed.

: Verslype C, Michielsen P, Adler M, Orlent H, Sprengers D, Delwaide J, D'heygere F, Langlet P, Brenard R, Colle I, Reynaert H, Starkel P, Henrion J; Steering Committee of the Belgian Association for the Study of the Liver. Related Articles, Links
The management of patients with mild hepatitis C.
Acta Gastroenterol Belg. 2005 Jul-Sep;68(3):314-8. Review.
PMID: 16268417 [PubMed - indexed for MEDLINE]
2: Adler M, Goubau P, Leroux-Roels G, Sprengers D, Pawlotsky JM. Related Articles, Links
Practical use of hepatitis C and B molecular tools: Belgian guidelines.
Acta Gastroenterol Belg. 2005 Jul-Sep;68(3):308-13. Review.
PMID: 16268416 [PubMed - indexed for MEDLINE]
3: Dusheiko G, Danta M. Related Articles, Links
Can Peg-IFN alpha-2a plus ribavirin be used to treat patients with chronic hepatitis C and normal alanine aminotransferase levels?
Nat Clin Pract Gastroenterol Hepatol. 2005 Mar;2(3):130-1. No abstract available.
PMID: 16265150 [PubMed - indexed for MEDLINE]
4: Brok J, Gluud LL, Gluud C. Related Articles, Links
Effects of adding ribavirin to interferon to treat chronic hepatitis C infection: a systematic review and meta-analysis of randomized trials.
Arch Intern Med. 2005 Oct 24;165(19):2206-12. Review.
PMID: 16246984 [PubMed - indexed for MEDLINE]
5: Cuadra-Sanchez C, Moronta-Pinango R, Cordova-Villanueva E, Mindiola-Morles R, Araujo-Soto M, Callejas-Monsalve D, Porto-Espinoza L. Related Articles, Links
[Seroprevalence of Hepatitis C Virus (HCV) in patients of the Regional Viral Reference Laboratory (Maracaibo, Venezuela)]
Rev Gastroenterol Peru. 2005 Jul-Sep;25(3):248-53. Spanish.
PMID: 16237468 [PubMed - indexed for MEDLINE]
6: Lopez-Medrano F, Lizasoain M, Aguado JM. Related Articles, Links
A fractured diagnosis.
N Engl J Med. 2005 Oct 20;353(16):1747; author reply 1747. No abstract available.
PMID: 16236751 [PubMed - indexed for MEDLINE]
7: Thybo S. Related Articles, Links
[Screening of apparently healthy people returning from "the tropics"]
Ugeskr Laeger. 2005 Oct 17;167(42):3997-4001. Review. Danish.
PMID: 16232400 [PubMed - indexed for MEDLINE]
8: Fischer B, Vasdev S, Haydon E, Baliunas D, Rehm J. Related Articles, Links
[Willing to undergo hepatitis C treatment in a sample of injection drug users in Toronto, Canada]
Presse Med. 2005 Oct 8;34(17):1209-12. French.
PMID: 16230960 [PubMed - indexed for MEDLINE]
9: Bonkovsky HL, Salek J. Related Articles, Links
No role of the -2518 promoter polymorphism of monocyte chemotactic protein-1 in chronic hepatitis C.
Gastroenterology. 2005 Oct;129(4):1361-2. No abstract available.
PMID: 16230097 [PubMed - indexed for MEDLINE]
10: Lebray P, Nalpas B, Vallet-Pichard A, Broissand C, Sobesky R, Serpaggi J, Fontaine H, Pol S. Related Articles, Links
The impact of haematopoietic growth factors on the management and efficacy of antiviral treatment in patients with hepatitis C virus.
Antivir Ther. 2005;10(6):769-76.
PMID: 16218177 [PubMed - indexed for MEDLINE]
from overall search

and down below the 10 citations from the reviewed articles, http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?CMD=DisplayFiltered&DB=pubmed

Items 1 - 20 of 2303 of 116 Next

1: Verslype C, Michielsen P, Adler M, Orlent H, Sprengers D, Delwaide J, D'heygere F, Langlet P, Brenard R, Colle I, Reynaert H, Starkel P, Henrion J; Steering Committee of the Belgian Association for the Study of the Liver. Related Articles, Links
The management of patients with mild hepatitis C.
Acta Gastroenterol Belg. 2005 Jul-Sep;68(3):314-8. Review.
PMID: 16268417 [PubMed - indexed for MEDLINE]
2: Adler M, Goubau P, Leroux-Roels G, Sprengers D, Pawlotsky JM. Related Articles, Links
Practical use of hepatitis C and B molecular tools: Belgian guidelines.
Acta Gastroenterol Belg. 2005 Jul-Sep;68(3):308-13. Review.
PMID: 16268416 [PubMed - indexed for MEDLINE]
3: Brok J, Gluud LL, Gluud C. Related Articles, Links
Effects of adding ribavirin to interferon to treat chronic hepatitis C infection: a systematic review and meta-analysis of randomized trials.
Arch Intern Med. 2005 Oct 24;165(19):2206-12. Review.
PMID: 16246984 [PubMed - indexed for MEDLINE]
4: Thybo S. Related Articles, Links
[Screening of apparently healthy people returning from "the tropics"]
Ugeskr Laeger. 2005 Oct 17;167(42):3997-4001. Review. Danish.
PMID: 16232400 [PubMed - indexed for MEDLINE]
5: Perelson AS, Herrmann E, Micol F, Zeuzem S. Related Articles, Links
New kinetic models for the hepatitis C virus.
Hepatology. 2005 Oct;42(4):749-54. Review.
PMID: 16175615 [PubMed - indexed for MEDLINE]
6: Moreno R, Berenguer M. Related Articles, Links
[Liver transplantation in patients with chronic viral hepatitis]
Rev Gastroenterol Mex. 2005 Apr-Jun;70(2):180-91. Review. Spanish.
PMID: 16167494 [PubMed - indexed for MEDLINE]
7: Chuang WL, Yu ML, Dai CY, Chang WY. Related Articles, Links
Treatment of chronic hepatitis C in southern Taiwan.
Intervirology. 2006;49(1-2):99-106. Review.
PMID: 16166797 [PubMed - indexed for MEDLINE]
8: Lai MY. Related Articles, Links
Combined interferon and ribavirin therapy for chronic hepatitis C in Taiwan.
Intervirology. 2006;49(1-2):91-5. Review.
PMID: 16166795 [PubMed - indexed for MEDLINE]
9: Lee CM, Hung CH, Lu SN, Wang JH, Tung HD, Huang WS, Chen CL, Chen WJ, Changchien CS. Related Articles, Links
Viral etiology of hepatocellular carcinoma and HCV genotypes in Taiwan.
Intervirology. 2006;49(1-2):76-81. Review.
PMID: 16166793 [PubMed - indexed for MEDLINE]
10: Suh DJ, Jeong SH. Related Articles, Links
Current status of hepatitis C virus infection in Korea.
Intervirology. 2006;49(1-2):70-5. Review.
PMID: 16166792 [PubMed - indexed for MEDLINE]



10c. 3rd pub med search using clinical filters.


I typed out my search strategy, Hepatitis C into the search by clinical study category and I clicked therapy as a limit and I clicked narrow, specific search and clicked go. The search strategy was: "(hepatitis c) AND (randomized controlled trial[Publication Type] OR (randomized[Title/Abstract] AND controlled[Title/Abstract] AND trial[Title/Abstract]))" I came away with 841 results and only 17 reviewed results.
(http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?termClinical=hepatitis+c&precision=specificity&strategy=therapy&filters=&orig_db=PubMed&db=PubMed&cmd=Search&term=%28hepatitis+c%29+AND+%28randomized+controlled+trial%5BPublication+Type%5D+OR+%28randomized%5BTitle%2FAbstract%5D+AND+controlled%5BTitle%2FAbstract%5D+AND+trial%5BTitle%2FAbstract%5D%29%29) All the articles were clinical studies and some of them weren't even in english.

The web address is: http://www.ncbi.nlm.nih.gov/entrez/query/static/clinical.shtml


These were the first ten from the 841 results.

": Dusheiko G, Danta M. Related Articles, Links
Can Peg-IFN alpha-2a plus ribavirin be used to treat patients with chronic hepatitis C and normal alanine aminotransferase levels?
Nat Clin Pract Gastroenterol Hepatol. 2005 Mar;2(3):130-1. No abstract available.
PMID: 16265150 [PubMed - indexed for MEDLINE]
2: Gunsar F, Akarca US, Ersoz G, Kobak AC, Karasu Z, Yuce G, Ilter T, Batur Y. Related Articles, Links
Two-year interferon therapy with or without ribavirin in chronic delta hepatitis.
Antivir Ther. 2005;10(6):721-6.
PMID: 16218171 [PubMed - indexed for MEDLINE]
3: Nunez M, Camino N, Ramos B, Berdun MA, Barreiro P, Losada E, Santos I, Echevarria S, Ocampo A, Miralles C, Arazo P, Martin-Carbonero L, Romero M, Garcia-Samaniego J, Soriano V. Related Articles, Links
Impact of ribavirin exposure on early virological response to hepatitis C therapy in HIV-infected patients with chronic hepatitis C.
Antivir Ther. 2005;10(5):657-62.
PMID: 16152759 [PubMed - indexed for MEDLINE]
4: McHutchison JG, Shiffman ML, Cheung RC, Gordon SC, Wright TL, Pottage JC Jr, McNair L, Ette E, Moseley S, Alam J. Related Articles, Links
A randomized, double-blind, placebo-controlled dose-escalation trial of merimepodib (VX-497) and interferon-alpha in previously untreated patients with chronic hepatitis C.
Antivir Ther. 2005;10(5):635-43.
PMID: 16152757 [PubMed - indexed for MEDLINE]
5: Lalezari J, Thompson M, Kumar P, Piliero P, Davey R, Patterson K, Shachoy-Clark A, Adkison K, Demarest J, Lou Y, Berrey M, Piscitelli S. Related Articles, Links
Antiviral activity and safety of 873140, a novel CCR5 antagonist, during short-term monotherapy in HIV-infected adults.
AIDS. 2005 Sep 23;19(14):1443-8.
PMID: 16135896 [PubMed - in process]
6: Gilleece YC, Browne RE, Asboe D, Atkins M, Mandalia S, Bower M, Gazzard BG, Nelson MR. Related Articles, Links
Transmission of hepatitis C virus among HIV-positive homosexual men and response to a 24-week course of pegylated interferon and ribavirin.
J Acquir Immune Defic Syndr. 2005 Sep 1;40(1):41-6.
PMID: 16123680 [PubMed - indexed for MEDLINE]
7: Lodato F, Azzaroli F, Brillanti S, Colecchia A, Tame MR, Montagnani M, Muratori R, Giovanelli S, Feletti V, Bacchi Reggiani ML, Roda E, Mazzella G. Related Articles, Links
Higher doses of peginterferon alpha-2b administered twice weekly improve sustained virological response in difficult-to-treat patients with chronic hepatitis C: results of a pilot randomized study.
J Viral Hepat. 2005 Sep;12(5):536-42. Erratum in: J Viral Hepat. 2005 Nov;12(6):663.
PMID: 16108771 [PubMed - indexed for MEDLINE]
8: Inati A, Taher A, Ghorra S, Koussa S, Taha M, Aoun E, Sharara AI. Related Articles, Links
Efficacy and tolerability of peginterferon alpha-2a with or without ribavirin in thalassaemia major patients with chronic hepatitis C virus infection.
Br J Haematol. 2005 Aug;130(4):644-6.
PMID: 16098081 [PubMed - indexed for MEDLINE]
9: von Wagner M, Huber M, Berg T, Hinrichsen H, Rasenack J, Heintges T, Bergk A, Bernsmeier C, Haussinger D, Herrmann E, Zeuzem S. Related Articles, Links
Peginterferon-alpha-2a (40KD) and ribavirin for 16 or 24 weeks in patients with genotype 2 or 3 chronic hepatitis C.
Gastroenterology. 2005 Aug;129(2):522-7.
PMID: 16083709 [PubMed - indexed for MEDLINE]
10: Zeuzem S, Pawlotsky JM, Lukasiewicz E, von Wagner M, Goulis I, Lurie Y, Gianfranco E, Vrolijk JM, Esteban JI, Hezode C, Lagging M, Negro F, Soulier A, Verheij-Hart E, Hansen B, Tal R, Ferrari C, Schalm SW, Neumann AU; DITTO-HCV Study Group. Related Articles, Links
International, multicenter, randomized, controlled study comparing dynamically individualized versus standard treatment in patients with chronic hepatitis C.
J Hepatol. 2005 Aug;43(2):250-7.
PMID: 16082736 [PubMed - indexed for MEDLINE] "

These below are from the reviewed list of 17.

"1: Jones EA. Related Articles, Links
Fatigue complicating chronic liver disease.
Metab Brain Dis. 2004 Dec;19(3-4):421-9. Review.
PMID: 15554432 [PubMed - indexed for MEDLINE]
2: Brau N. Related Articles, Links
Epoetin alfa treatment for acute anaemia during interferon plus ribavirin combination therapy for chronic hepatitis C.
J Viral Hepat. 2004 May;11(3):191-7. Review.
PMID: 15117320 [PubMed - indexed for MEDLINE]
3: Weinrieb RM, Auriacombe M, Lynch KG, Chang KM, Lewis JD. Related Articles, Links
A critical review of selective serotonin reuptake inhibitor-associated bleeding: balancing the risk of treating hepatitis C-infected patients.
J Clin Psychiatry. 2003 Dec;64(12):1502-10. Review.
PMID: 14728113 [PubMed - indexed for MEDLINE]
4: Gavin PJ, Katz BZ. Related Articles, Links
Intravenous ribavirin treatment for severe adenovirus disease in immunocompromised children.
Pediatrics. 2002 Jul;110(1 Pt 1):e9. Review.
PMID: 12093990 [PubMed - indexed for MEDLINE]
5: Kubo S, Nishiguchi S, Hirohashi K, Tanaka H, Shuto T, Takemura S, Shiomi S, Kinoshita H. Related Articles, Links
[Clinical significance of interferon therapy in treatments for hepatitis C virus-related hepatocellular carcinoma]
Gan To Kagaku Ryoho. 2001 Dec;28(13):1975-9. Review. Japanese.
PMID: 11791377 [PubMed - indexed for MEDLINE]
6: Ancell CD, Phipps J, Young L. Related Articles, Links
Thymosin alpha-1.
Am J Health Syst Pharm. 2001 May 15;58(10):879-85; quiz 886-8. Review.
PMID: 11381492 [PubMed - indexed for MEDLINE]
7: Par A, Telegdy L, Gogl A, Muller E. Related Articles, Links
[Interferon therapy of chronic viral hepatitis in Hungary: 5-year experience. A multicenter study]
Orv Hetil. 1999 May 30;140(22):1227-33. Review. Hungarian.
PMID: 10377733 [PubMed - indexed for MEDLINE]
8: Viviani S, Jack A, Bah E, Montesano R. Related Articles, Links
[Hepatocellular carcinoma: a preventable cancer]
Epidemiol Prev. 1997 Apr-Jun;21(2):129-36. Review. Italian.
PMID: 9378180 [PubMed - indexed for MEDLINE]
9: Liaw YF. Related Articles, Links
Current therapeutic trends in therapy for chronic viral hepatitis.
J Gastroenterol Hepatol. 1997 Oct;12(9-10):S346-53. Review.
PMID: 9407357 [PubMed - indexed for MEDLINE]
10: Alberti A, Chemello L, Noventa F, Cavalletto L, De Salvo G. Related Articles, Links
Therapy of hepatitis C: re-treatment with alpha interferon.
Hepatology. 1997 Sep;26(3 Suppl 1):137S-142S. Review.
PMID: 9305679 [PubMed - indexed for MEDLINE]"










10. (d.) What is systematic review.

Well, a systematic review as defined by the Pub Med glossary is, "the strategy used intended to retrieve citations identified as systematic reviews, meta-analyses, reviews of clinical trials, evidence-based medicine, consensus development conferences, guidelines, and citations to articles from journals specializing in review studies of value to clinicians. This subset can be used in a search through the Clinical Queries screen or as systematic [sb].(from the website: http://www.nlm.nih.gov/bsd/pubmed_tutorial/glossary.html)

In the pub med systematic review search, I typed out my search strategy along with my limits being, Hepatitis C and systematic (sb). I came away with 487 non-reviewed total results and 241 reviewed results from this systematic review search. The search terms cut and pasted are: "(hepatitis c) AND systematic[sb]"
The web address is: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?termClinical=hepatitis+c&filters=&orig_db=PubMed&db=PubMed&cmd=Search&term=%28hepatitis+c%29+AND+systematic%5Bsb%5D

The first 10 from the 487 results are:

1: Hutchinson SJ, Bird SM, Goldberg DJ. Related Articles, Links
Influence of alcohol on the progression of hepatitis C virus infection: a meta-analysis.
Clin Gastroenterol Hepatol. 2005 Nov;3(11):1150-9.
PMID: 16271348 [PubMed - in process]
2: Ramos-Casals M, Pares A, Jara LJ, Solans R, Vinas O, Vazquez P, Sanchez-Tapias JM, Rodes J, Font J; HISPAMEC Study Group*. Related Articles, Links
Antimitochondrial antibodies in patients with chronic hepatitis C virus infection: description of 18 cases and review of the literature.
J Viral Hepat. 2005 Nov;12(6):648-54.
PMID: 16255767 [PubMed - in process]
3: Mayer KE, Myers RP, Lee SS. Related Articles, Links
Silymarin treatment of viral hepatitis: a systematic review.
J Viral Hepat. 2005 Nov;12(6):559-67.
PMID: 16255756 [PubMed - in process]
4: Wagner GJ, Ryan GW. Related Articles, Links
Hepatitis C virus treatment decision-making in the context of HIV co-infection: the role of medical, behavioral and mental health factors in assessing treatment readiness.
AIDS. 2005 Oct;19 Suppl 3:S190-8.
PMID: 16251817 [PubMed - in process]
5: Kontorinis N, Agarwal K, Dieterich DT. Related Articles, Links
Treatment of hepatitis C virus in HIV patients: a review.
AIDS. 2005 Oct;19 Suppl 3:S166-73.
PMID: 16251814 [PubMed - in process]
6: Brok J, Gluud LL, Gluud C. Related Articles, Links
Effects of adding ribavirin to interferon to treat chronic hepatitis C infection: a systematic review and meta-analysis of randomized trials.
Arch Intern Med. 2005 Oct 24;165(19):2206-12. Review.
PMID: 16246984 [PubMed - indexed for MEDLINE]
7: Brok J, Gluud L, Gluud C. Related Articles, Links
Ribavirin monotherapy for chronic hepatitis C.
Cochrane Database Syst Rev. 2005 Oct 19;4:CD005527.
PMID: 16235408 [PubMed - as supplied by publisher]
8: Malone DC, Tran TT, Poordad FF. Related Articles, Links
Cost-efficacy analysis of peginterferon alfa-2b plus ribavirin compared with peginterferon alfa-2a plus ribavirin for the treatment of chronic hepatitis C.
J Manag Care Pharm. 2005 Oct;11(8):687-94.
PMID: 16194133 [PubMed - in process]
9: Renz JF, Kin C, Kinkhabwala M, Jan D, Varadarajan R, Goldstein M, Brown R Jr, Emond JC. Related Articles, Links
Utilization of extended donor criteria liver allografts maximizes donor use and patient access to liver transplantation.
Ann Surg. 2005 Oct;242(4):556-63; discussion 563-5.
PMID: 16192816 [PubMed - indexed for MEDLINE]
10: Tang S, Lai KN. Related Articles, Links
Chronic viral hepatitis in hemodialysis patients.
Hemodial Int. 2005 Apr;9(2):169-79.
PMID: 16191066 [PubMed - in process] "


The first 10 from the 241 reviewed articles.

": Brok J, Gluud LL, Gluud C. Related Articles, Links
Effects of adding ribavirin to interferon to treat chronic hepatitis C infection: a systematic review and meta-analysis of randomized trials.
Arch Intern Med. 2005 Oct 24;165(19):2206-12. Review.
PMID: 16246984 [PubMed - indexed for MEDLINE]
2: Simmonds P, Bukh J, Combet C, Deleage G, Enomoto N, Feinstone S, Halfon P, Inchauspe G, Kuiken C, Maertens G, Mizokami M, Murphy DG, Okamoto H, Pawlotsky JM, Penin F, Sablon E, Shin-I T, Stuyver LJ, Thiel HJ, Viazov S, Weiner AJ, Widell A. Related Articles, Links
Consensus proposals for a unified system of nomenclature of hepatitis C virus genotypes.
Hepatology. 2005 Oct;42(4):962-73. Review.
PMID: 16149085 [PubMed - indexed for MEDLINE]
3: Haute Autorite de Sante. Related Articles, Links
[Indications for hepatic transplantation -- January 19 and 20, 2005, Lyon (Palais des congres)]
J Chir (Paris). 2005 May-Jun;142(3):177-83. Review. French. No abstract available.
PMID: 16142083 [PubMed - indexed for MEDLINE]
4: Brok J, Gluud LL, Gluud C. Related Articles, Links
Ribavirin plus interferon versus interferon for chronic hepatitis C.
Cochrane Database Syst Rev. 2005 Jul 20;(3):CD005445. Review.
PMID: 16034976 [PubMed - in process]
5: European AIDS Clinical Society; European Association for the Study of the Liver; Societe de Pathologie Infectieuse de Langue Francaise; Agence national de recherches sur le sida et les hepatites virales; European AIDS Treatment Group; International AIDS Society; European Society of Clinical Microbiology and Infectious Diseases; European Federation of Internal Medicine; Association francaise pour l'etude du foie; Societe national francaise de medecine interne; Ministere des Solidarites, de la Sante et de la Famille. Related Articles, Links
[Short statement of the first European consensus conference on the treatment of chronic hepatitis C and B in HIV co-infected patients]
Med Mal Infect. 2005 Mar;35(3):109-20. Review. French. No abstract available.
PMID: 16013095 [PubMed - indexed for MEDLINE]
6: Miro JM, Torre-Cisnero J, Moreno A, Tuset M, Quereda C, Laguno M, Vidal E, Rivero A, Gonzalez J, Lumbreras C, Iribarren JA, Fortun J, Rimola A, Rafecas A, Barril G, Crespo M, Colom J, Vilardell J, Salvador JA, Polo R, Garrido G, Chamorro L, Miranda B. Related Articles, Links
[GESIDA/GESITRA-SEIMC, PNS and ONT consensus document on solid organ transplant (SOT) in HIV-infected patients in Spain (March, 2005).]
Enferm Infecc Microbiol Clin. 2005 Jun-Jul;23(6):353-62. Review. Spanish.
PMID: 15970168 [PubMed - indexed for MEDLINE]
7: Zeuzem S. Related Articles, Links
[Treatment of hepatitis C virus infection]
Schweiz Rundsch Med Prax. 2005 May 4;94(18):721-6. Review. German.
PMID: 15938383 [PubMed - indexed for MEDLINE]
8: Alberti A, Clumeck N, Collins S, Gerlich W, Lundgren J, Palu G, Reiss P, Thiebaut R, Weiland O, Yazdanpanah Y, Zeuzem S; ECC Jury. Related Articles, Links
Short statement of the first European Consensus Conference on the treatment of chronic hepatitis B and C in HIV co-infected patients.
J Hepatol. 2005 May;42(5):615-24. Review. No abstract available.
PMID: 15916745 [PubMed - indexed for MEDLINE]
9: Lameire N, Eknoyan G, Barsoum R, Eckardt KU, Levin A, Levin N, Locatelli F, MacLeod A, Vanholder R, Walker R, Wang H. Related Articles, Links
A new initiative in nephrology: 'Kidney disease: improving global outcomes'.
Contrib Nephrol. 2005;149:90-9. Review.
PMID: 15876832 [PubMed - indexed for MEDLINE]
10: Kirkham C, Harris S, Grzybowski S. Related Articles, Links
Evidence-based prenatal care: part II. Third-trimester care and prevention of infectious diseases.
Am Fam Physician. 2005 Apr 15;71(8):1555-60. Review.
PMID: 15864896 [PubMed - indexed for MEDLINE]."



In particular, the number 4 article under the review section seemed pretty good,

": Brok J, Gluud LL, Gluud C. Related Articles, Links
Ribavirin plus interferon versus interferon for chronic hepatitis C.
Cochrane Database Syst Rev. 2005 Jul 20;(3):CD005445. Review.
PMID: 16034976 [PubMed - in process]
Hepatitis C is a major cause of liver-related morbidity and mortality. The disease progresses without symptoms for several decades and most patients are diagnosed based on the presence of hepatitis C virus ribonucleic acid and elevated transaminases. OBJECTIVES: To assess the beneficial and harmful effects of ribavirin and interferon combination therapy versus interferon monotherapy for chronic hepatitis C. SEARCH STRATEGY: We identified trials through electronic databases, manual searches of bibliographies and journals, approaching authors of trials and pharmaceutical companies, until May 2004. SELECTION CRITERIA: We included randomised trials, irrespective of blinding, language, or publication status, comparing ribavirin plus interferon versus interferon alone for treatment of chronic hepatitis C. DATA COLLECTION AND ANALYSIS: The primary outcome measures were the sustained loss of hepatitis C virus and liver-related morbidity plus all-cause mortality. We separately analysed patients who were naive, relapsers, or non-responders to previous antiviral treatment. Random-effects and fixed-effect model meta-analyses were performed for all outcomes. We used Peto odds ratios (OR) with 95% confidence intervals (CI) for analysis of morbidity plus mortality. The remaining outcomes were presented as relative risks (RR). MAIN RESULTS: We included 72 randomised trials with 9991 patients. Most trials had low methodological quality but we did not find any significant influence of quality on our results. Compared with interferon, combination therapy had a significant beneficial effect on sustained virological response (RR 0.73, 95% CI 0.71 to 0.75) and in subgroups of naive patients (RR 0.72, 95% CI 0.68 to 0.76), relapsers (RR 0.63, 95% CI 0.54 to 0.73), and non-responders (RR 0.89, 95% CI 0.84 to 0.94) individually. Combination therapy significantly reduced morbidity plus mortality (Peto OR 0.46, 95% CI 0.22 to 0.96), but not in naive, relapsers, or non-responders individually. Combination therapy also had a significant beneficial effect on the histological response. Combination therapy significantly increased the risk of anaemia (RR 10.48, 95% CI 5.34 to 20.55), which occurred in 22% of patients on combination therapy. Combination therapy also significantly increased the risk of dermatological, gastrointestinal, infectious, and miscellaneous (cough, dyspnea, fatigue) adverse events. Accordingly, combination therapy significantly increased the risk of treatment discontinuation (RR 1.19, 95% CI 1.01 to 1.39). AUTHORS' CONCLUSIONS: Compared with interferon alone, ribavirin plus interferon is more effective in clearing hepatitis C virus and improving liver histology. This may lead to reduced morbidity and mortality. However, combination therapy significantly increased the risk of several adverse events.
"(from the website: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16034976&query_hl=9)
because it was a review on what happens when using a particular drug cocktail to treat hepatitis C, which might be useful information for people researching about how to treat Hepatitis C or trying to find information on how to get people close to them that have Hepatitis C.








10. (e.) Cochrane Database -
I typed out my search strategy along with my limits being, Hepatitis C in all fields, with limits alterantive therapies in record title, and hepatitis c in keywords. I came away with 1 results out of 5585 records. But, the articles I found was exactly the one I wanted and had been missing in parts of my annotated bibliography before. The result I found was:
"Complementary and alternative therapies in the treatment of chronic hepatitis C: a systematic review (Provisional record)Original Author(s): J T Coon, E Ernst Year: 2004 Record"

The web address is: http://www.mrw.interscience.wiley.com/cochrane/cochrane_search_fs.html


This cochrance database brought me to a pubmed database, (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=search&db=PubMed&doptcmdl=citation&term=J+HEPATOL%5Bta%5D+AND+40%5Bvi%5D+AND+491%5Bpg%5D) that had a review of the article, ("Complementary and alternative therapies in the treatment of chronic hepatitis C: a systematic review.

Coon JT, Ernst E.

Complementary Medicine, Peninsula Medical School, Universities of Exeter and Plymouth, 25 Victoria Park Road, Exeter EX2 4NT, UK. jo.thompson-coon@pms.ac.uk

BACKGROUND/AIMS: Hepatitis C is an escalating global health problem. The recommended treatment regimen is associated with considerable expense, adverse effects and poor efficacy in some patients. Complementary therapies are widely promoted for and used by patients with hepatitis C. The aim is to systematically assess the efficacy of complementary therapies in treating chronic hepatitis C. METHODS: Systematic searches were conducted in six databases, reference lists of all papers were checked for further relevant publications and information was requested from experts. No language restrictions were imposed. RESULTS: Twenty-seven eligible randomised clinical trials were located involving herbal products and supplements. No randomised clinical trials were identified for any other complementary therapy. In 14 of the trials, patients received interferon-alpha in combination with the complementary therapy. Less than half the trials (11/27) were of good methodological quality. Compared with the control group, significant improvements in virological and/or biochemical response were seen in trials of vitamin E, thymic extract, zinc, traditional Chinese medicine, Glycyrrhiza glabra and oxymatrine. CONCLUSIONS: We identified several promising complementary therapies, although extrapolation of the results is difficult due to methodological limitations. More research is warranted to establish the role of these and other therapies in the treatment of hepatitis.")

and that pubmed database had a link to a full-text article through the Journal of Hepatology that has the complete review on file, "Complementary and alternative therapies in the treatment of chronic hepatitis C: a systematic review.Abstract
Background/Aims

Hepatitis C is an escalating global health problem. The recommended treatment regimen is associated with considerable expense, adverse effects and poor efficacy in some patients. Complementary therapies are widely promoted for and used by patients with hepatitis C. The aim is to systematically assess the efficacy of complementary therapies in treating chronic hepatitis C.


Methods

Systematic searches were conducted in six databases, reference lists of all papers were checked for further relevant publications and information was requested from experts. No language restrictions were imposed.


Results

Twenty-seven eligible randomised clinical trials were located involving herbal products and supplements. No randomised clinical trials were identified for any other complementary therapy. In 14 of the trials, patients received interferon-α in combination with the complementary therapy. Less than half the trials (11/27) were of good methodological quality. Compared with the control group, significant improvements in virological and/or biochemical response were seen in trials of vitamin E, thymic extract, zinc, traditional Chinese medicine, Glycyrrhiza glabra and oxymatrine.


Conclusions

We identified several promising complementary therapies, although extrapolation of the results is difficult due to methodological limitations. More research is warranted to establish the role of these and other therapies in the treatment of hepatitis C."(In sciencedirect - journal of hepatology: http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6W7C-4BRRC3V-R&_coverDate=03%2F31%2F2004&_alid=345086016&_rdoc=1&_fmt=&_orig=search&_qd=1&_cdi=6623&_sort=d&view=c&_acct=C000059594&_version=1&_urlVersion=0&_userid=4430&md5=d252aded0aa23fa55d6b4bc8bcf59c46)
"1. Introduction
Hepatitis C is a global health problem; the World Health Organization has estimated that approximately 3% of the world population (170 million people) have been infected with the virus [1]. In England approximately 27 000 individuals have been diagnosed with hepatitis C. However, many people do not develop symptoms of clinically evident acute viral hepatitis at the time of infection and prevalence studies suggest that 0.4% of the population (200 000 individuals) may be chronically infected with the hepatitis C virus [2]. The long-term effects of persistent hepatitis C infection include chronic hepatitis, cirrhosis and hepatocellular carcinoma [1]; consequently hepatitis C is amongst the leading causes of liver transplantation. It has been suggested that without effective treatment strategies the morbidity and mortality associated with hepatitis C may increase three-fold by the year 2015 [3].

Currently recommended treatment for previously untreated and relapsed patients is a combination of pegylated interferon and ribavirin, resulting in a sustained virological response in approximately 50–60% of patients [4]. However, this regimen is expensive, adverse effects are frequent [5] and large numbers of patients are not suitable candidates for treatment for a variety of reasons [6]. Complementary and alternative medicine (CAM) is therefore popular amongst patients with hepatitis C; a recent survey conducted in liver disease outpatient clinics in the US found that 41% had used some form of CAM at least once during the preceding 4 weeks [7].

The aim of this review is to systematically assess the evidence from randomised clinical trials for the efficacy of complementary therapies in the treatment of chronic hepatitis C. Whilst such treatment may have a number of major goals, such as decreasing the incidence of hepatocarcinoma or cirrhosis, amelioration of symptoms and treatment of extra-hepatic complications, this review will focus on the effects of treatment on viral replication and eradication of the hepatitis C virus.

2. Methods
2.1. Identification of clinical trials
In order to identify clinical trials involving complementary and alternative therapies in the treatment of hepatitis C, systematic literature searches were conducted in the following electronic databases: Medline (via Pubmed), Embase, CINAHL, Amed (Alternative and Allied Medicine Database, British Library Medical Information Centre), The Cochrane Library and the British Library Index of Conference Proceedings (all from their inception to October 2002).

The search terms used were: hepatitis; hepatitis, chronic; hepatitis, viral, human; hepatitis C; complementary therapies; acupuncture; acupressure; phytotherapy; phytomedicine; medicine, Chinese traditional; medicinal plant; herb; leaf; seed; extract; medicine, kampo; hozai; ayurvedic medicine; homeopathy; essential oil; dietary supplement; vitamin; mineral; manipulative therapy; manipulation; chiropractic; osteopathy; biofeedback; Alexander technique; craniosacral therapy; shiatsu; massage; Qi Gong; reiki; spiritual healing; aromatherapy; reflexology; hydrotherapy; music therapy; meditation; yoga; autogenic training; guided imagery; hypnotherapy; hypnosis; tai chi; milk thistle; Silybum marianum; silymarin; silybinin; licorice; glycyrrhizin; glycyrrhiza; glycyrrhizic acid; stronger neominophagen C; Panax ginseng; ginseng; Plantago asiatica; aucubin; Curcuma longa; turmeric; Camellia sinensis; green tea; Phyllanthus amarus; Picrorhiza kurroa; kutaki; picroside; catechin; green tea; catergen; cyanidanol-3; vitamin E; tocopherol; NAC; N-acetyl cysteine; antioxidant; selenium; thiamine; vitamin B; phosphatidylcholine; IdB1016; thymic extract; thymosin; thymostimulin; complete thymic formula; thymic protein A; SAMe; S-adenosyl methionine; TJ9; TJ108; sho-saiko-to; bin gang ling; bin gan; gansu; yi er gan; ting gan; qing gan; Qi Zhi; Yizhou; kalamalhar; mistletoe; Viscum album; Iscador Qu; hypericin; schizandra; Sophora japonica; matrine; vitamin C; ascorbic acid; bursal virus vaccine; MTH-68/B; oral enzyme therapy; phlogenzym; rutosid; Panax pseudoginseng; magnesium; alpha lipoic acid; amino acids; probiotics; spirulina; chlorella; lecithin; dandelion; slippery elm; St John's wort; Hypericum perforatum; echinacea; olive leaf; goldenseal; Hydrastis canadensis; garlic; Allium sativum; astragalus; psyllium; fenugreek; Trigonella foenum graecum; evening primrose; aloe vera; ginger and Zingiber officinale.

Further relevant papers were located by hand searching the reference lists of all papers. In addition experts in the field were contacted to provide published and unpublished material. Finally our own extensive files were hand searched for further relevant publications.

2.2. Inclusion/exclusion criteria
Only randomised clinical trials of complementary therapies administered to patients with a diagnosis of hepatitis C or non-A, non-B chronic hepatitis were included. Trials in which several subgroups of patients with different hepatitis aetiologies were studied and those in which the hepatitis virus was not specified were excluded. Both placebo controlled and comparative trials were considered. All retrieved data including uncontrolled trials, case reports, pre-clinical and observational studies were reviewed for safety information. No language restrictions were imposed.

2.3. Data extraction and quality assessment
All articles were read in full. Data relating to sample size, diagnosis, genotype and gender of patients, previous interferon exposure, intervention and control, treatment duration, primary outcome measures and results were extracted by the first author and validated by the second. The methodological quality of each clinical trial was assessed using the Jadad scoring system [8]. This scale ranges from 0 (poorest) to 5 (highest) and assesses methods of randomisation and blinding and descriptions of withdrawals and dropouts.

3. Results
The search strategy generated a total of 3085 references, of which 142 were considered to be potentially relevant. We did not locate any unpublished trials. A total of 67 clinical trials were retrieved for further evaluation of which 27, involving 1709 patients, were eligible for inclusion (Table 1). Reasons for exclusion included no specific hepatitis diagnosis, trials in which patients with both hepatitis B and C were included, trials in which only interim results have been published, or which did not measure clinical endpoints and trials which were not randomised...
1. Supplements
3.1.1. Antioxidants
Seven randomised clinical trials of antioxidants were located including a total of 463 patients [9, 10, 11, 12, 13, 14 and 15]. In six trials, antioxidants were administered in combination with interferon-α No significant differences in virological response were seen between treatment regimens in any of the trials. Details of biochemical parameters were not provided in all reports but appear to correlate with virological responses. One trial compared vitamin E treatment with placebo; statistically significant reductions in alanine aminotransferase (ALT) were seen during treatment but reductions did not occur in all patients nor did complete normalisation of ALT levels occur. No virological effects were seen.

3.1.1.1. Safety
At the doses studied, these antioxidants appear to be well tolerated, with no specific adverse events reported in any of the trials. However, very large oral doses of N-acetyl cysteine used to treat paracetamol overdose are commonly associated with nausea and vomiting [16] and intravenous administration of N-acetyl cysteine can result in anaphylactoid reactions, which may be more common in patients with chronic liver disease [17]. Over a prolonged period, selenium at doses as low as 900 mg/day can produce signs of toxicity, such as depression, nervousness, emotional instability, nausea and vomiting, in some people [18]. In extreme cases excess levels of selenium have been associated with pathologic nail bed changes and the loss of finger nails, temporary hair loss and fatigue [19]. No further information regarding adverse events associated with vitamin E was identified.

3.1.2. Thymic extracts
A total of five trials (n=256) of thymic extracts were identified [20, 21, 22, 23 and 24]; four involved the synthetic polypeptide thymosin alpha 1 (Tα1) and in one, patients received Complete Thymic Formula which contains bovine glandular extracts of thymosin, thymopoeitin and thymic humoral factors with various herbs, vitamins, enzymes and minerals.

Of the three trials in which patients received Tα1 in combination with interferon, the number of patients experiencing a complete virological or biochemical response at the end of treatment was significantly higher during treatment with the combination than with either interferon alone or placebo. There were also significant differences in the number of patients with a sustained response at 6 or 12 months after cessation of treatment. However, there were no significant differences in biochemical or virological response between treatment and placebo groups in the two trials in which patients received Tα1 or Complete Thymic Formula alone.

3.1.2.1. Safety
Treatment with thymic extracts appears to be well tolerated. It is possible that administering two drugs with potential immunostimulatory properties might increase the incidence of immune-associated adverse events, but there does not appear to be any evidence of this from the literature. Adverse events were reported in detail in one trial; whilst the frequency of adverse events was high, only nausea and vomiting were more common with combination treatment than with interferon-α. In another study, Tα1 was associated with local discomfort at the injection site in two patients [23], and complete thymic extract was associated with severe thrombocytopenia in one patient who was also receiving naproxen [24].

3.1.3. Zinc
One clinical trial of zinc supplementation in combination with interferon-α was identified [25]. Overall significantly more patients in the combination group were complete or incomplete responders (18/32 vs 8/36; P<0.006) with the effect being most evident in those patients with less than 5×105 copies of HCV RNA/ml, although there were far more patients with a higher viral load in the interferon-only group (23 vs 8).

3.1.3.1. Safety
In this trial, a total of seven patients withdrew because of side effects; four from the interferon-α-alone group (erythema multiforme, severe fatigue with headache and an attack of loss of consciousness) and three from the combination group (loss of sleep, serious headache and interstitial pneumonia). The side-effect profile was similar in both groups and included flu-like symptoms and a mild reduction in platelet and white blood cell counts. Toxic effects of zinc supplementation tend to occur following prolonged intake at levels greater than 150 mg/day; effects can include copper deficiency anemia, reduced HDL cholesterol levels and depressed immune function [26].

3.2. Other supplements
One randomised clinical trial was identified involving Adelavin (an injectable hepatoprotective mixture containing liver extract and flavin adenin dinucleotide) [27]. The trial was of poor methodological quality and whilst the results appear promising, no statistical analyses were performed.

One randomised clinical trial of oral enzyme therapy was identified, again this trial was of poor methodological quality [28]. The lack of methodological, analytical and statistical details provided makes interpretation of the results very difficult.

No data relating to the safety profile of these supplements was located.

3.3. Herbal medicinal products
3.3.1. Traditional Chinese medicine
We located a total of seven randomised clinical trials of traditional Chinese medicine in the treatment of hepatitis C [29, 30, 31, 32, 33, 34 and 35]. The methodological quality of six of the trials was considered poor, scoring only one out of a maximum of five on the Jadad scale.

In two trials of herbal formulations in combination with interferon-α, there was some suggestion of greater clearance of HCV RNA and ALT normalisation with the combination treatment compared with patients receiving monotherapy. In the only placebo-controlled trial of sole therapy with traditional Chinese medicine, there was a significant reduction in ALT levels during treatment in those receiving the herbal compound. No virological effects were seen. Two studies compared a traditional Chinese medicine with interferon-α; there were no significant differences between groups in either study. The remaining studies used less common treatment regimens in the control group. Although these results are promising, interpretation is difficult due to the unknown effects of the control treatment regimens.

3.3.1.1. Safety
Detailed descriptions of adverse events were not provided. In the only placebo-controlled trial [31], four patients experienced adverse events: palpitations [36], diarrhoea [37], abdominal discomfort [36]; all of them were taking the herbal formulation. Further assessment of the safety of these medicines is complicated, due to the individualised nature of many of the herbal compounds involved, the large number of different herbs in each formulation and the relatively small number of patients within each clinical trial.

3.3.2. Glycyrrhiza glabra (licorice)
Four randomised clinical trials of glycyrrhizin (all administered as Stronger Neo Minophagen C (SNMC) comprising of 0.2% glycyrrhizin, 0.1% cysteine and 2.0% glycine in physiological saline solution) were located. In two trials, patients received SNMC in combination with interferon-α [38 and 39]; there were no significant differences between treatments in the number of patients achieving biochemical or virological response in either study. In the only European randomised clinical trial of glycyrrhizin, there were some reductions in ALT levels during treatment, compared with placebo but this was not sustained after cessation of treatment and there were no significant effects on HCV RNA levels [40]. In the final trial, there were statistically significant differences in liver enzyme levels between treatment groups during treatment, however, these were not sustained at follow-up and there were no virological effects [41]. There was no placebo group in this trial; the comparison treatment was a combination of SNMC and ursodeoxycholic acid, the effects of which are unknown. These results are therefore difficult to interpret.

3.3.2.1. Safety
Hypokalemia, sodium retention, increase in body weight, elevated blood pressure and retention of sodium are all expected adverse effects of glycyrrhizin treatment [42]. However, there is no evidence for an increased occurrence of these during SNMC treatment in these studies. Two publications provide a thorough analysis of the adverse events experienced during the trial [40]; there were no significant differences between groups in the number of patients reporting an adverse event, although in the study by van Rossum et al. significantly more patients reported cold/flu symptoms in the 160 mg group compared with placebo. Suzuki et al. reported one adverse event (bleeding in the fundus) which occurred during combination treatment with glycyrrhizin and interferon-α [39]. In the final study, no patients complained of drug related symptoms or developed signs of an adverse reaction during the treatment period [41].

3.3.3. Oxymatrine (derived from Sophora japonica)
One open, randomised, parallel group clinical trial of mediocre methodological quality in which patients were treated with oxymatrine or with general liver protective agents was identified [43]. At the end of treatment there were statistically significant differences in the number of patients with normalised HCV RNA levels between groups. No further information regarding the safety of oxymatrine was located.

4. Discussion
Several herbal medicinal products and supplements have been identified with potential virological and/or biochemical effects in the treatment of chronic hepatitis C infection. Studies of thymic extract, zinc and Bing Gan decoction in combination with interferon-α and oxymatrine alone have demonstrated greater clearance of the hepatitis C virus than control treatment. Normalisation of liver enzymes has been greater during treatment with vitamin E, Glycyrrhiza glabra, CH100, Yi Zhu decoction and Yi Er Gan Tang decoction than with the control treatment.

However, interpretation and extrapolation of the results is difficult for several reasons.

First, few of the studies measured the sustained virological response at 6 months after cessation of treatment. This has become the optimum outcome measure in trials of conventional therapy since studies of interferon-α treatment indicate that 92% of patients with a sustained virological response at 6 months will remain seronegative for up to 6 years [44]. There is also evidence that a sustained virological response may be associated with regression of fibrosis [45]. Of the studies that did include this endpoint, only one trial, of the combination of interferon-α and zinc, reported a significant effect above interferon-α alone [25]. Secondly, the current recommended duration of interferon-α treatment is 48 weeks in patients with hepatitis virus genotype 1 [46], none of the trials included a treatment period of longer than 26 weeks and some were as short as 4 weeks. The control group did not receive currently accepted optimum interferon-α treatment in many of the comparative studies; therefore results from these trials cannot be extrapolated to standard treatment comparisons. Thirdly, it is recognised that an individual's response to interferon-α treatment will be affected by several factors e.g. hepatitis C virus genotype, gender, baseline viral level and previous exposure to interferon-α therapy [47]. Whether these are also important for predicting treatment response to complementary interventions is unclear, but they may have influenced the selection of patients for inclusion into trials with included patients already having failed to respond to a course of interferon-α, for example. And finally, there were methodological limitations with over half the trials, the most common being lack of blinding and incomplete reporting of randomisation methods and withdrawals.

Attempts were made to obtain data from unpublished trials and we are aware of several studies which have not been published in full, however, we were not able to obtain the unpublished results. There is evidence to suggest that studies with significant positive results are more likely to be published [48] and this may be more pronounced with unfamiliar complementary therapies [49]. It is possible that we did not locate all the trials on traditional Chinese medicine, as we did not search any Chinese language databases. A recent systematic review of herbal medicinal products for the treatment of hepatitis B located an additional 18 trials from Chinese language sources [50]. We decided not to perform searches in Chinese language databases as previous experience suggests that the resulting references do not provide sufficient detail to reliably assess methodological quality and consequently do not add significantly to the evidence base [51].

Disappointingly, we found no evidence for the use of complementary therapies in clinically important subgroups of patients who have often been denied access to therapy with interferon-alpha in the past (e.g. patients with HIV co-infection or psychiatric problems). Nor were we able to locate any randomised clinical trials of any other complementary therapies, including several herbal medicinal products such as Silybum marianum which are very popular with patients. A survey of patients with hepatitis C attending an out-patient clinic found that 36% (42/117) were taking herbs, of which 14 (33%) were taking Silybum marianum; 67% of responders attributed benefit to their herbal therapy [52].

The safety profiles of the interventions discussed within this systematic review look encouraging at the doses studied. However, the long-term safety for use in the treatment of hepatitis C, either alone or in combination with conventional medicines, has not been established. Comparative and placebo-controlled trials suggest that patients experience no more adverse events with these interventions than with placebo or comparative medications, although short-term clinical trials are not designed to detect rare or delayed adverse events.

There is an undoubted need for further research into the treatment of hepatitis C, and this review has identified several promising interventions. A more detailed understanding both of the pharmacology of herbal medicinal products and supplements in relation to the hepatitis C virus and of the patient characteristics which might be important in predicting a favourable response to treatment would facilitate the design of future clinical trials. Anecdotal evidence suggests that many more complementary therapies are currently available to and popular with patients and further research into these interventions is warranted to establish their role in the treatment of chronic hepatitis C infection." ( http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6W7C-4BRRC3V-R&_coverDate=03%2F31%2F2004&_alid=345086016&_rdoc=1&_fmt=&_orig=search&_qd=1&_cdi=6623&_sort=d&view=c&_acct=C000059594&_version=1&_urlVersion=0&_userid=4430&md5=d252aded0aa23fa55d6b4bc8bcf)














10. (f.) CINAHL I typed out my search strategy along with my limits being, Hepatitis C, with limits English. Then I went to the next page where it asked me to narrow down some more, so I narrowed down by clicking focus and Hepatitis C. Then the next page came and I clicked the specific categories of symptons and therapy and came away with 64 results. Some of the articles were relevant to my biblopgraphy such as the article on, "The experience of fatigue for people living with hepatitis C." because I know people who have dealt with Hepatitis C and this might be helpful for them to read and compare their experiences to the experiences talked about in the article. Also, the article, "Treating chronic diseases with Asian medicine. Chinese medicine and CAM therapies: dealing with side-effects of interferon therapy in hepatitis C" because it seems to be talking about the different therapies being used today to treat hepatitis c. In addition, the articles,"Advisor forum. Can hepatitis C ever be cured," "Managing hepatitis C today," and "Hepatitis C: a silent epidemic." all seem to be interesting articles about the subject. By the way, all of the articles I mentioned were published in the past year, 2004, although the search is not done by reverse chronological order. I mostly got journal articles and one case study. I believe I did a free-text search. The total number of citations retrieved was 64 and some of them seemed relevant to me and things I might be able to read and understand as well.

The web address is: http://gateway.ut.ovid.com/gw2/ovidweb.cgi



10 (g.) Biosis
I decided to go with Biosis, so I went on Galen Search, and entered Ovid. I typed out my search strategy, "hepatitis C" along with my limits being, english, human, and article. Then 13594 citations retrieved.

By the way the web address I went on was this: http://gateway.ut.ovid.com/gw2/ovidweb.cgi

Printed out here:
1.Seeger, Christoph [Author, Reprint Author; E-mail: Seeger@fccc.edu]. Salient molecular features of hepatitis C virus revealed [Article] Trends in Microbiology. 13(11). NOV 2005. 528-534.
2. Encke, Jens [Author, Reprint Author; E-mail: jens_encke@med.uni-heidelberg.de]; Kraus, Thomas [Author]; Mehrabi, Arianeb [Author]; Stremmel, Wolfgang [Author]; Sauer, Peter [Author]. Treatment of hepatitis C virus reinfection after liver transplantation [Article] Transplantation. 80(1, Suppl. S). SEP 27 2005. S125-S127.
3. Palekar, Nicole A. [Author, Reprint Author; E-mail: nicole.palekar@cen.ameed.army.mil]; Harrison, Stephen A. [Author]. Extrahepatic manifestations of hepatitis C [Article] Southern Medical Journal. 98(10). OCT 2005. 1019-1023.
4. Trapero, M. [Author]; Garcia-Buey, L. [Author]; Munoz, C. [Author]; Viton, M. [Author]; Moreno-Monteagudo, J. A. [Author]; Borque, M. J. [Author]; Quintana, N. E. [Author]; Moreno-Otero, R. [Author, Reprint Author; E-mail: mtraperomarugan@terra.es]. Maintenance of T1 response as induced during PEG-IFN alpha plus ribavirin therapy controls viral replication in genotype-1 patients with chronic hepatitis C [Article] Revista Espanola de Enfermedades Digestivas. 97(7). JUL 2005. 481-485.
5. de Albuquerque, Ana Cecilia C. [Author, Reprint Author; E-mail: aceciliaca@yahoo.com.br]; Coelho, Maria Rosangela C. D. [Author]; Lopes, Edmundo P. A. [Author]; Lemos, Marcilio Figueiredo [Author]; Moreira, Regina Celia [Author]. Prevalence and risk factors of hepatitis C virus infection in hemodialysis patients from one center in Recife, Brazil [Article] Memorias do Instituto Oswaldo
6. Sakisaka, Shotaro [Author, Reprint Author]. Series introduction: New ultrastructural discoveries in the pathophysiology of liver diseases [Article] Medical Molecular Morphology. 38(3). SEP 2005. 135.
7. Gerlach, J. T. [Author, Reprint Author; E-mail: Tilman.Gerlach@usz.ch]; Ulsenheimer, A. [Author]; Gruener, N. H. [Author]; Jung, M.-C. [Author]; Schraut, W. [Author]; Schirren, C.-A. [Author]; Heeg, M. [Author]; Scholz, S. [Author]; Witter, K. [Author]; Zahn, R. [Author]; Vogler, A. [Author]; Zachoval, R. [Author]; Pape, G. R. [Author]; Diepolder, H. M. [Author]. Minimal T-cell-stimulatory sequences and spectrum of HLA restriction of immunodominant CD4(+) T-cell epitopes within hepatitis C virus NS3 and NS4 proteins [Article] Journal of Virology. 79(19). OCT 2005. 12425-12433.
8. Meier, Ute-Christiane [Author]; Owen, Rachel E. [Author]; Taylor, Elizabeth [Author]; Worth, Andrew [Author]; Naoumov, Nikolai [Author]; Willberg, Christian [Author]; Tang, Kwok [Author]; Newton, Phillipa [Author]; Pellegrino, Pierre [Author]; Williams, Ian [Author]; Klenerman, Paul [Author]; Borrow, Persephone [Author, Reprint Author; E-mail: persephone.borrow@jenner.ac.uk]. Shared alterations in NK cell frequency, phenotype, and function in chronic human immunodeficiency virus and hepatitis C virus infections [Article] Journal of Virology. 79(19). OCT 2005. 12365-12374.
9. Khan, Sabeena Jalal [Author, Reprint Author]; Anjum, Qudsia [Author]; Khan, Najib Ullah [Author]; Nabi, Faiza Ghulam [Author]. Awareness about common diseases in selected female college students of Karachi [Article] JPMA - Journal of the Pakistan Medical Association. 55(5). MAY 2005. 195-198.
10. Zhu, Haizhen [Author]; Nelson, David R. [Author]; Crawford, James M. [Author]; Liu, Chen [Author, Reprint Author; E-mail: Liu@pathology.ufl.edu]. Defective Jak-Stat activation in hepatoma cells is associated with hepatitis C viral IFN-alpha resistance [Article] Journal of Interferon & Cytokine Research. 25(9). SEP 2005. 528-539.



















(10g. continued) All and all, this search was not so relevant to me, although I realized that I have found one particular article now in 3 separate incidences of searching, (Encke, Jens et al. Treatment of hepatitis C virus reinfection after liver transplantation Transplantation. 80(1, Suppl. S). SEP 27 2005. S125-S127.), which is somewhat interesting to note.


10 (h.) Expanded Academic Asap
By the way, the web address is: http://find.galegroup.com/itx/paginate.do?subjectParam=Locale%2528en%252C%252C%2529%253AFQE%253D%2528su%252CNone%252C11%2529hepatitis%2Bc%253AAnd%253ALQE%253D%2528RE%252CNone%252C3%2529ref%253AAnd%253ALQE%253D%2528DA%252CNone%252C10%2529%253E%2B20000101%2524&sort=DateDescend&tabID=T002&sgCurrentPosition=0&subjectAction=DISPLAY_SUBJECTS&searchId=R1&prodId=EAIM¤tPosition=1&userGroupName=ucsanfrancisco&sgHitCountType=None&qrySerId=Locale%28en%2C%2C%29%3AFQE%3D%28SU%2CNone%2C11%29hepatitis+c%3AAnd%3ALQE%3D%28RE%2CNone%2C3%29ref%3AAnd%3ALQE%3D%28DA%2CNone%2C10%29%3E+20000101%24&inPS=true&searchType=BasicSearchForm&displaySubject=
I typed out my search strategy in the basic search menue, "hepatitis C" along with my limits being, (SU (hepatitis c))LIMITS:( (peer-reviewed)) And (DA (> 20000101))
peer-reviewed and dated after 1/1/2000. Then 1895 citations were retrieved. My search results differed from the other searches primarily becasue my search limits were different this time. By-the-way the articles that showed up here seem to be using an implicit boolean search as opposed to an explicit boolean search. The first few articles on this database for whatever reasons seemed to be better first articles than the other searches in my opinon, such as: ". Chronic hepatitis C in childhood: an 18-year experience.(MAJOR ARTICLE). Raffaele Iorio, Antonietta Giannattasio, Angela Sepe, Luigi Maria Terracciano, Raffaella Vecchione and Angela Vegnente. Clinical Infectious Diseases 41.10 (Nov 15, 2005): p1431(7). (5689 words) (from the website: http://find.galegroup.com/itx/retrieve.do?subjectParam=Locale%2528en%252C%252C%2529%253AFQE%253D%2528su%252CNone%252C11%2529hepatitis%2Bc%253AAnd%253ALQE%253D%2528RE%252CNone%252C3%2529ref%253AAnd%253ALQE%253D%2528DA%252CNone%252C10%2529%253E%2B20000101%2524&) From Expanded Academic ASAP." seemed to be along the lines of articles or rather websites I have been visiting to learn more about how hepatitis c really effects peoople on a personal level. Although when I went and saw the full text of this article, it was not all that I had envisioned, as it was written more for people working in the scientific field than I would like, it was an interesting title that drew me to it, just like the websites I first visited to learn about Hepatitis C had interesting titles that happened to draw me to gravitate towards them because I was curious and wanted to learn a personal perspective of how this disease would impact a person on a first-hand level as that was why I originally picked this topic for the medical resources annotated bibliography because I knew people very close to me who had suffered from this disease in the past and I saw this annotated bibliography as something that I could make for them too and give to them to be used as a tool to be more informed and to learn about their disease so as to be proactive and solution-oriented against this sometimes chronic disease as it has become a global epidemic that we can not ignore.



1.