Matt's Blog

This is part of one of the Medscape CME (Continuing Medical
Education) activities for health care workers. I am posting it here
for informational purposes only. The full article represents a
review of the viral hepatitis research that was submitted to the
57th Annual Meeting of the American Association for the Study of
Liver Diseases AASLD 2006 at Boston Massachusettes
The first half of this review is about Hepatitis B. I am skipping
that part and copying only the second part which deals with Hepatitis
C. If you would like to see the Hepatitis B part, let me know and
I'll post it
The source URL is: http://www.medscape.com/viewarticle/548122
AASLD 2006 - Clinical Advances in Hepatitis B and Hepatitis C
Copyright © 2006 Medscape.
Hepatitis C
Pegylated Interferon
The mainstay of treatment for patients with hepatitis C has been
combination therapy with pegylated interferon and ribavirin, which
overall yields sustained response rates in approximately 50% of
patients treated. Few options are available for those patients who do
not respond to therapy, are unable to tolerate the side effects of
the interferon or ribavirin, or who relapse after discontinuation of
the medications.
More information has been accumulated in the past several years on
early predictors of nonresponse to therapy, whereby the lack of at
least a 2-log drop in the baseline viral load at week 12 was able to
identify those patients who had little chance of responding to
therapy (early viral response [EVR] rule). Clinicians, using this EVR
rule, were able to discontinue therapy in patients earlier, sparing
them significant side effects and associated costs. More recently, a
positive 4-week hepatitis C virus (HCV) RNA level has been shown to
be predictive of higher rates of relapse post therapy, and the use of
this so-called rapid viral response (RVR) is now gaining clinical
applicability.
Shiffman and colleagues[14] reported results from the ACCELERATE
trial involving 1463 patients infected with HCV genotype 2 or 3 who
were treated with pegylated interferon alfa-2a plus ribavirin for
either 16* or 24 weeks. Currently, the standard of care is treatment
for 24 weeks for patients with HCV genotype 2 or 3. Results showed
that, overall, patients who received 24 weeks of therapy had a 90%
sustained virologic response (SVR) rate compared with 82% of patients
treated for 16 weeks. RVR and EVR rule were both highly predictive of
achieving SVR. Thus, RVR (HCV RNA undetectable at week 4 by
polymerase chain reaction [PCR]) and EVR are both highly predictive
of response to therapy in patients infected with HCV genotypes 2/3.
Decreasing duration of therapy to 16 weeks may be reasonable in
patients who achieve an RVR and have significant difficulty or side
effects with treatment.
Pearlman and colleagues[15] examined the effect of longer duration of
therapy using pegylated interferon alfa-2b plus weight-based
ribavirin dosing in patients infected with HCV genotype 1 who,
despite meeting the criteria for EVR (
RNA by PCR), were still HCV RNA PCR detectable until week 24 of
therapy. This group of "slower viral responders" was then treated for
either the usual 48 weeks or was extended to 72 weeks* of therapy.
Results showed a 39% SVR in the 72-week arm compared with 18% SVR in
the 48-week arm; treatment extension did not seem to result in an
increase in dose reductions or discontinuations. Thus, treatment of
hepatitis C has now evolved to a more individualized regimen, using
weight-based dosing of ribavirin and an adjusted duration of therapy,
depending on how rapidly patients respond to therapy. Longer duration
of therapy may improve sustained response rates in patients with
slower viral suppression.
Agents on the Horizon
Although great advances have been made with interferon and ribavirin-
based therapy, the most exciting new development on the horizon for
hepatitis C is the use of therapies that specifically target steps in
the cycle of hepatitis C replication as opposed to general
immunomodulators or antivirals. VX-950* is an oral HCV protease
inhibitor that has been shown to dramatically reduce HCV viral loads
to undetectable levels within 2-4 weeks in phase 2 trials.[16]
However, some viral variants emerged with this therapy. During this
year's AASLD meeting, Kieffer and colleagues[17] reported a detailed
analysis of these variants; data were presented on 16 patients
treated with VX-950 750 mg 3 times daily (n = 8) vs VX-950 750 mg 3
times daily plus pegylated interferon (n = 8) for 14 days. HCV RNA
was isolated after the treatment period for variants in the NS3
protease domain. Six of 8 patients treated with VX-950 monotherapy
had detectable mutations by the end of the 14 days, whereas 4 of 8 of
patients receiving combination pegylated interferon plus VX-950 also
had detectable virus (resistant or wild-type) at day 8. After the 14
days of therapy, 15 of 16 patients were treated with the standard
pegylated interferon plus ribavirin and all responded with complete
viral suppression by week 24. This suggests that although there may
be some viral resistance due to mutations with the use of the
protease inhibitor, viral suppression occurs successfully with the
addition of pegylated interferon and ribavirin.
In a late-breaking abstract presented by Roberts and colleagues,[18]
another target-specific HCV therapy, R1626*, a nucleoside analog oral
polymerase inhibitor, was administered in a phase 1b trial involving
47 treatment-naive patients infected with HCV genotype 1. Patients
were given R1626 at doses of 500, 1500, 3000, and 4500 mg twice daily
vs placebo for 14 days. The authors found that a dose-dependent viral
suppression occurred, with 5 of 9 patients in the 4500-mg treatment
arm having undetectable HCV RNA at day 15. Anemia occurred in some
patients; headache and gastrointestinal side effects were noted at
the highest dose.
New therapies targeting specific sites in the HCV replication cycle,
such as these protease or polymerase inhibitors, show early promise,
although viral resistance and side effects need further study in
larger, phase 2 trials.
Consensus Interferon
One of the most difficult clinical issues in liver transplantation is
the recurrence of hepatitis C after transplantation. Recurrence is
nearly universal, and studies have shown a more aggressive course of
HCV progression after transplant, with up to 20% of patients
developing cirrhosis by 5 years.[19] Treating the cirrhotic patient
before liver transplant may reduce the likelihood of recurrence;
however, treatment is limited by constitutional side effects, anemia,
thrombocytopenia, and neutropenia in this patient population.
Bacon and colleagues[20] presented their results from the DIRECT
(Daily-dose consensus Interferon and Ribavirin Efficacy of Combined
Therapy) trial using consensus interferon*(see note) plus ribavirin
in patients who previously failed to respond to pegylated interferon
+ ribavirin therapy. Of note, 29% of patients in this study were
cirrhotic by liver biopsy and more than 50% had bridging fibrosis.
Patients received consensus interferon at a dose of 9 micrograms
(mcg)/day or 15 mcg/day in combination with ribavirin vs no
treatment. Preliminary analysis at the end of treatment revealed a
29% end-of-treatment response in patients with greater than 80%
compliance with the 15-mcg/day consensus interferon + ribavirin
regimen. The lower dose of consensus interferon demonstrated lower
response rates (15%), and patients with cirrhosis had very low
response rates (< 8%). The most common side effects were neutropenia
and fatigue, with an overall 10% to 17% discontinuation rate.
Consensus interferon has demonstrated some moderate success in the
very difficult-to-treat group of patients who have nonresponse to
combination pegylated interferon plus ribavirin. Early treatment of
HCV infection offers more benefit, as the more advanced the
histologic disease, the lower the chance of success with any therapy
thus far.
Conclusion
Exciting new advances were presented in viral hepatitis at this
year's AASLD meeting. Our therapeutic armamentarium for hepatitis B
now includes several oral antiviral therapies, as well as
immunomodulatory agents. The major issues of viral resistance and
predictors of response and resistance are now under active study.
Hepatitis C is entering a new era of drug development with
specifically targeted therapies, although these strategies remain
very early in clinical development. Again, issues of safety and viral
resistance will come to the forefront in this arena. Individualized
therapy with the current standard of care, pegylated interferon plus
ribavirin, is key to optimizing patient outcomes.
*The US Food and Drug Administration has not approved this medication
for this use.

This is a small part of an 8 page conference report from May 2001. I
have copied only some information describing pegylated interferons
and consensus interferon (Infergen) for the purpose of information
and comparison.
Keep these notes in mind: Pegylated interferon Alpha 2a is Pegasys
by Roche. Pegylated interferon alpha 2b is PEG Intron by Schering-
Plough. Consensus Interferon or alfacon-1 has the trade name
Infergen, and is made by Valeant Pharmaceuticals
=============================================================
Report
Hepatitis C Infection: Optimizing Treatment, Patient Management, and
Basic Aspects
36th Annual Meeting of the European Association for the Study of the
Liver (EASL), April 18-22, 2001
from Medscape Gastroenterology
Posted 05/16/2001
Michael P. Manns, MD, Heiner Wedemeyer, MD, Department of
Gastroenterology and Hepatology, Medical School of Hannover,
Hannover, Germany
================
Pegylated Interferons
Polyethylene glycol (PEG) is a small molecule that can be polymerized
into long chains and attached to proteins. Two pegylated IFNs are now
undergoing clinical trials.* PegIFN alfa-2a is a modified form of IFN
alfa-2a to which a branched 40-kd methoxy PEG moiety has been
covalently attached.[14] PegIFN alfa-2b consists of IFN alfa-2b
attached to a single 12-kd PEG molecule. Both PegIFN alfa-2a and
PegIFN alfa-2b have a decreased systemic clearance rate and a
prolonged plasma half-life (approximately 10-fold) compared with
standard IFNs; this allows for once-weekly dosing with the pegylated
formulations.[15]
The 2 PegIFNs appear to have discrete characteristics -- their half-
lives are slightly different and their metabolism and elimination
rates also differ. PegIFN alfa-2a is predominantly metabolized in the
liver, whereas PegIFN alfa-2b is eliminated predominantly by the
kidney.[16] Due to these disparate properties, comparison of these 2
PegIFNs is difficult.
Initial clinical trials demonstrated that monotherapy with PegIFN
alfa-2a or PegIFN alfa-2b improved sustained response rates compared
with standard IFNs.[17,18] Even in patients with liver cirrhosis, 30%
of patients had a sustained virologic response when treated with 180
mcg PegIFN alfa-2a once weekly for 48 weeks.[19] Recently it was
shown that sustained virologic response rates could be further
enhanced to more than 50%, by combination of PegIFN with ribavirin.
[20] More detailed analysis of data from this trial were presented in
Prague, and indicated that dosing of not only PEG-IFN alfa-2b, but
also ribavirin, should be adjusted according to patient body weight
in order to achieve optimal response rates.[21] The new
recommendation is to use 1.5 mcg/kg PegIFN alfa-2b and 800 mg
ribavirin for patients who weigh less than 65 kg, 1000 mg ribavirin
for patients who weigh 65-85 kg, and 1200 mg ribavirin for patients
whose body weight exceeds 85 kg.
First data on the combination of PegIFN alfa-2a with ribavirin and
amantadine have also been presented, indicating that this combination
is safe and that its efficacy appears to be comparable to or slightly
improved over that of standard IFN alfa-2b 3 times per week plus
ribavirin combination therapy.[22]
* Editor's note: The United States FDA approved pegylated IFN alfa-2b
monotherapy in January 2001.
Consensus Interferon (CIFN)
CIFN is a novel bioengineered "consensus" molecule, composed of the
most frequently observed amino acid in each corresponding position in
the natural alpha interferons. CIFN shares an 89%, 30%, and 60%
homology with IFN alpha, IFN beta, and IFN omega, respectively. CIFN
has a 10-fold increased affinity for the type-1 IFN receptor compared
with IFN alpha-2a or IFN alpha-2b. When compared on an equal-mass
basis, CIFN displays 5-10 times greater biological activity than
other type-1 interferons.[23-25] CIFN has proven effective,
especially in difficult-to-treat patients (eg, patients infected with
HCV genotype 1.)[26]
Using a combination of CIFN and ribavirin, an Italian group achieved
a sustained virologic response in 55% of patients who were infected
with HCV genotype 1 and who had high viral load.[27] These promising
results must be confirmed in larger trials, because only 20 patients
were randomized into the combination treatment arm of this study.

This is the text version of a podcast which can be viewed at this url:
http://medgenmed.medscape.com/viewarticle/551113
Does Washington Care About Medical Research?
Posted 02/05/2007
Mary Woolley, MA,
President and CEO, Research!America, Alexandria, Virginia
Medical research seems like one issue everyone in Washington can "get
behind." But what is Washington doing for medical research?
Congress has cut funds for health-related research 2 years in a row,
and the funding future is not promising. Stem cell research policy is
a priority for the new Democratic leadership, but they may lack the
votes to override a veto of new legislation.
So where does research for health really fall on Washington's list of
priorities?
Without a healthy policy environment -- and strong federal funding
for basic and public health research -- potential drugs, diagnostic
tools, and prevention and intervention strategies won't make it into
the pipeline, much less to clinical practice. When will research
become a top priority? How many discoveries will we postpone? How
many more diagnoses of type 1 childhood diabetes or Alzheimer's are
we willing to accept?
Americans need more advocates telling Congress that research to
improve their health is too important to put on hold. Professional
societies and advocacy groups, like Research!America, play a role,
and patients are effective advocates -- but importantly, so are
physicians. Polls show the medical community still enjoys higher
public confidence than almost any other institution.
Physicians can be advocates for research in many ways: Encourage your
patients to participate in clinical trials; write a letter to the
editor or an op-ed for your local newspaper; and tell your senators
and representative how important research is to you and your
patients -- their constituents. Visit our Web site
http://www.researchamerica.org/ for help to get started.
Adding your physician's voice to say we need more research support
now can be one of the best things you do for your patients this year.
I'm asking you to give Washington the message that it's time to do
more to support medical research.
That's my opinion. I'm Mary Woolley, president of Research!America.

Frank there are many hep singles web sites..... I did meet people on
hepcmatch...... I think the L-rd will guide us and well...... I can get the
links...will do later... not feeling too well... very very hot here... I am
itching and down and lonely also and would like a soul mate..... but..... I,
also, do not know what to do except pray about it. blessings, sallysara
"and the beat goes on......." Sonny Bono"It's not the years in your life that
count. It's the life in your years." Abraham Lincon-----and.... "It's never too
late to have a happy childhood." Tom Robbins

POT HEAD PEOPLE WAS BORN IN OUR GENERATION.
AND NOW IS VERY POPULAR IN OUR TEENS.
I DIDN'T SEE MY SON AND DOUGHTER FOR 5 OR 6 YEARS.
FINALLY MY SON CAME TO SEE ME AND I JUST PLAYED THE GAME IN ORDER TO MAKE HIM
TO TRUST ME, SO HE WOULD OPEN HIS HEART TO TALK TO ME EVERYTHING AND IT WORKS.
BY DOING THIS (THE SAME THING) I WAS ABLE TO CONVINCE A MAN TO ACCEPT JESUS
CHRIST BY DOING THE FIRST STEP: TO FORGIVE HIS FATHER.
NOW MY WORK WITH MY SON JUST STARTED...
THIS TIME I AM GOING TO BE IN A cHRISTIAN RETREAT TO SPEND ENDLESS HOURS
PRAYING, READING THE BIBLE, SINGING, TALKING AND MEDITATING WITH GOD AS I DID IT
BEFORE FOE MANY MONTHS ALL DAY LONG.
MY SONS NEED TO CHANGE THEIR LIVE AND FIND GOD.
GOD BLESS YOU.
nmilover <nmilover@...
Hi haven't heard from you in long time.... All I can say is I was a
POT HEAD for thirty years...... now five years without....... a different
person.... but telling someone somthing that does not want to hear......
well..... doesn't really work...... I quit because it was deteriorating my
health and my closeness to the L-rd. sally
"and the beat goes on......." Sonny Bono"It's not the years in your life that
count. It's the life in your years." Abraham Lincon-----and.... "It's never too
late to have a happy childhood." Tom Robbins

Hi haven't heard from you in long time.... All I can say is I was a POT HEAD for
thirty years...... now five years without....... a different person.... but
telling someone somthing that does not want to hear...... well..... doesn't
really work...... I quit because it was deteriorating my health and my closeness
to the L-rd. sally
"and the beat goes on......." Sonny Bono"It's not the years in your life that
count. It's the life in your years." Abraham Lincon-----and.... "It's never too
late to have a happy childhood." Tom Robbins

Body Shop's Roddick has Hepatitis C
POSTED: 7:34 a.m. EST, February 14, 2007
LONDON, England (Reuters) -- The Body Shop founder Anita Roddick is suffering
from liver damage after contracting the Hepatitis C virus more than 35 years
ago, she said on her Web site on Wednesday.
Roddick, 64, one of Britain's best known businesswomen, developed the
potentially deadly disease from infected blood given to her during the birth of
her youngest daughter, Sam, in 1971.
"I have Hepatitis C -- it's a bit of a bummer but you groan and move on," she
said. "I had no idea that I had this virus. I was having routine blood tests
when it showed up."
Roddick, who agreed to sell her stake in the beauty retailer to France's L'Oreal
last year, said she faces an increased risk of liver cancer.
"I do have cirrhosis. I could still have a good few years -- even decades -- of
life left but it's hard to say," her statement said. "Having Hep C means that I
live with a sharp sense of my own mortality."
Hepatitis C is a virus that attacks the liver and can be carried in the blood
for decades. It can cause liver failure or cancer.
There are an estimated 200 million people worldwide infected with the disease,
according to the British charity, The Hepatitis C Trust.
There is no vaccine but drug treatments can help between 50 percent and 80
percent of sufferers, the Trust said.
Roddick has become a patron of the Hepatitis C Trust.
"I want to blow the whistle on the fact that Hep C must be taken seriously as a
public health challenge and must get the attention and resources that it needs,"
she said.
Roddick founded The Body Shop in Brighton in 1976, selling toiletries made from
natural ingredients, preferably sourced from the developing world.
It grew into an empire of more than 2,000 stores, selling everything from
seaweed moisturizer to ylang ylang massage oil.
http://www.cnn.com/2007/HEALTH/02/14/roddick.hepatitis.reut/index.html?section=c\
nn_latest

Send him to N.A.
florentino <lovextruth@...
him to know that it doesn't take him
anywhere but down on the road of health mental deterioriation.
I didn't know that mariguana also affects the inmune system of your
health condiions.
Please help me to help my son to quit his mariguana addiction or
habits.
Thanks to all, and God bless you.

I just want to find my new wife and soul mate in this area if God want
to.
I am in stage 0-1 with hepc type a3 or 3a.
My hepc virus disappeared after 3 months of interferon treatment for
the second time, but I honestly made it after I spent months of
praying long, long, long hours every day and, at the same time serving
Jesus Christ when I put a homeless shelter in Roswell New Mexico by
helping a woman unwilling to reach out for help or donations. My
Almighty God made the miracle in such way that it gave me also the
gift to feel love for God in the name of Jesus Christ, and get all the
donations when we needed the most.
Please give me a tip or call me at 505-840-9077 or at 505-627-0039 in
the evenings.
As for Frank.
God bless you.

My son is using it and I want him to know that it doesn't take him
anywhere but down on the road of health mental deterioriation.
I didn't know that mariguana also affects the inmune system of your
health condiions.
Please help me to help my son to quit his mariguana addiction or
habits.
Thanks to all, and God bless you.

FACTOR 8: THE ARKANSAS PRISON BLOOD SCANDAL Screening
February, 15 2007 - 7:30P
The KING Center
450 Auburn Avenue, NE
Atlanta , GA 30312
Cost: FREE
FACTOR 8 will be screening at the Martin Luther King, Jr National
Historic Site in Atlanta as part of the DREAM series.
A shocking expose of a prison blood donor program during the Clinton
governorship in Arkansas. Infected prisoners slipped through the
cracks and tainted blood made it into pharmaceuticals sold to
patients in Canada, Europe and Asia, infecting them with the deadly
diseases hepatitis C and AIDS.
Doors open at 6:45PM, screening at 7:30PM
Martin Luther King, Jr. National Historic Site
Screening Room 450 Auburn Avenue, NE
Atlanta, Georgia 30312
Admission is FREE (seating is limited, please arrive early).
Parking is FREE
For the Team at HCSP
CD Mazoff, PhD
Managing Editor, Webmaster
HCV Advocate
www.hcvadvocate.org
HBV Advocate
www.hbvadvocate.org

Pam and everyone else who responded....
Thanks! It is a little more reassuring to hear stories that are more personal
or researched. All of the information provided will help tremendously with
making a decision.
Lisa
PeachStatePam <figment@...
Slaying the Dragon
Hi Lisa. I thought you might find this story interesting. At the end is my
friend Dee's story (she is also past President of HEALS) and she did daily
Infergen back when she had to get *illegal* Ribavirin from the internet. You
probably haven't had it long enough to know that Schering was able to get the
first combo treatment *bundled together* so you had to buy their interferon in
order to get Ribavirin. You don't have to do that anymore but it used to be a
huge deal that the Hep C community tried to fight. So many people were reporting
clearing on daily Infergen even back then and only 25% were clearing on
Scherings Rebetron. Anyway....... here is a copy of the story of the Sustained
Viral Responders that was in Hepatitis Magazine not too long ago.
Also........ there is only a molecule difference in Schering's and Roche's
interferon's and 18 molecule difference in Infergen. At least that is what the
Valeant rep told me ;-)

Slaying the Dragon
Hi Lisa. I thought you might find this story interesting. At the end is my
friend Dee's story (she is also past President of HEALS) and she did daily
Infergen back when she had to get *illegal* Ribavirin from the internet. You
probably haven't had it long enough to know that Schering was able to get the
first combo treatment *bundled together* so you had to buy their interferon in
order to get Ribavirin. You don't have to do that anymore but it used to be a
huge deal that the Hep C community tried to fight. So many people were
reporting clearing on daily Infergen even back then and only 25% were clearing
on Scherings Rebetron. Anyway....... here is a copy of the story of the
Sustained Viral Responders that was in Hepatitis Magazine not too long ago.
Also........ there is only a molecule difference in Schering's and Roche's
interferon's and 18 molecule difference in Infergen. At least that is what the
Valeant rep told me ;-)

Medical Marijuana Might Reduce Nerve Pain Among People Living With HIV/AIDS,
Study Says
[Feb 13, 2007]
Medical marijuana might reduce the pain of peripheral neuropathy, a type
of nerve damage, among people living with HIV/AIDS, according to a study
published in the Feb. 13 issue of the journal Neurology, the Washington Post
reports (Weiss, Washington Post, 2/13). Donald Abrams of the University of
California-San Francisco and colleagues examined the effects of smoking
medicinal marijuana among people living with HIV/AIDS during a two-year period
beginning in May 2003, the San Francisco Chronicle reports (Russell, San
Francisco Chronicle, 2/13). Researchers enrolled 50 HIV-positive participants
who reported severe foot pain caused either by HIV/AIDS or their medications,
according to the Post (Washington Post, 2/13). The participants each spent a
week at a secure laboratory at San Francisco General Hospital and were required
to stop marijuana use before the start of the study (San Francisco Chronicle,
2/13). The researchers measured baseline pain among the participants by asking
them to rank their pain on a scale of one to 100 and by administering two
standardized tests involving a small hot iron applied to the skin and hot chili
pepper cream (Washington Post, 2/13). Twenty-five participants were randomly
chosen to receive active marijuana cigarettes with 3.5% THC, the drug's active
ingredient, and 25 received a placebo (San Francisco Chronicle, 2/13). The
participants smoked three times daily -- at 8 a.m., 2 p.m. and 8 p.m. -- for
five days (Washington Post, 2/13). The study found that after the first
cigarette on the first day, at least 50% of participants who received active
marijuana reported a 72% reduction in pain (San Francisco Chronicle, 2/13). The
researchers recorded a 15% reduction in pain among those who received the
placebo cigarette (Vesely, Oakland Tribune, 2/12). Over five days, the median
reduction in pain reported by the active marijuana smokers was 34%, compared
with 17% in the placebo group, the study found (San Francisco Chronicle, 2/13).
The researchers took steps to ensure that the marijuana in the study -- which
was grown on the government's official marijuana farm in Mississippi and stored
in a locked freezer -- was not used for recreational purposes, according to the
Post (Washington Post, 2/13).
Comments, Reaction
The results are "evidence, using the gold standard for clinical research, that
cannabis has some medical benefits for a condition that can be severely
debilitating," Abrams said (San Francisco Chronicle, 2/13). He added, "I think
that there are people out there who say there is no evidence that marijuana is
medicine, that this is all just a smoke screen." David Murray, chief scientist
for the White House Office of National Drug Control Policy, said the physical
pain of people living with HIV/AIDS is an issue of great concern. However, "this
particular study is not terribly convincing" because of methodological problems,
Murray said (Dunham, Reuters, 2/12). He added, "People who smoke marijuana are
subject to bacterial infections in the lungs. Is this really what a physician
who is treating someone with a compromised immune system wants to prescribe?"
(Elias, AP/Casper Star-Tribune, 2/13). Barbara Roberts -- former interim
associate deputy director in the Office of National Drug Control Policy and now
with Americans for Safe Access -- said, "This should be a wake-up call for
Congress to hold hearings to investigate the therapeutic use of cannabis and to
encourage more research" (Washington Post, 2/13). Igor Grant -- director of the
University of California Center for Medicinal Cannabis Research, which funded
the study -- said that although the study's finding are "very promising," they
are not definitive (San Francisco Chronicle, 2/13).
The study is available online.
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=42883

If you live in Florida or Georgia and are interested in information on the
upcoming Hepatitis Awareness Days please go to www.HEALSoftheSouth.com and check
out the appropriate links for both States. If you live in Georgia and want to
participate and speak to your Legislators about Hepatitis C and what you have
been dealing with PLEASE email me with your info ASAP as the day is getting
closer. THANK YOU!

Hello Lisa,
Thank you for the compliments. Back in the mid 1970's through early
1980's I became comletely obsessed with my own education. I pushed
myself relentlessly to the point of physical and emotional collapse a
few times. It was during that time that I began reading various
sorts of scientific and medical research abstracts and had become
pretty good at it. I had very seriously wanted to become a cancer
researcher, (Leukemia). However I did not have the educational
opportunities that most people pursuing such a field would have. I
could not get what I wanted (medical school for example), so I took
EVERYTHING ELSE that I could possibly get. (which involved everything
you could imagine. I really was obsessed, I studied constantly, at
least 16 hrs per day every day!! I pushed myself beyond limits and
reason for years!
around 1977-78 I registered in a Medical Lab Specialist program.
WOW, this is right where I wanted to go. However, at the last minute
I discovered that a computer error had placed me in Environmental
Health Tech. I looked at the books which included epidemiology and
microbiology, pharmacy, water treatment, sewage treatment and I other
stuff and I thought, hey this is pretty cool and usable stuff. Back
in those days I was also much interested in alternative and remote
lifestyle technologies including designing and building small
community infrastructure so the parts of the program that included
water treatment systems and sewage treatment systems were very
important. Environmental health is very important to any remote
living situation or community. SO, I decided to accept the
Environmental Health Tech program instead of the Medical Lab Spec.
program.
It is because of that background that I still have an interest in
reading and interpreting research on Hep-c. I don't do it nearly as
often or as in depth as I did, say 5 or 6 years ago. I think I have
decided to do stuff that is more enjoyable to me now, like my music
hobby. Also the brain fog makes tis sort ofv technical reading more
difficult. I have always been a technical reader and that requires
alot of concentration, so it takes alot more energy for me to do it
now than it used to.
There was a time when I felt that I was aware and had read about all
of the research available on hep-c and I began looking into related
diseases and conditions to find new stuff. Sometimes I did find new
stuff that cold be applied to hep-c. I don't spend so much time on
it these days and I am presently really not up on all of the
research. I just keep track of the major reports that come up.
Once in awhile I go on a little research binge and catch up on all of
the hep-c research. Maybe every 6 to 8 months or so. The research has
become increasingly complex over the past 10 years and to be able to
keep up with understanding it requires alot of additional study, in
genetics for one example. I have more or less decided to just take
it easy and let the competent researchers do all the work and catch
up now and then on the important stuff.
In my condition with the cognitive impairment from hep-c I must admit
that the research has become a bit too mind boggling for me. I DO
however read medical research as a cognitive therapy excercise which
forces me to concentrate and focus. With regard to cognitive
abilities, using the mind, I feel that if I don't use it I will lose
it. It is sort of like physical therapy to improve ones physical
condition after an injury or illness. forcing myself to read and
comprehend technical literature is cognitive therapy. Incidently,
the condition gets worse as the disease (hep-c) progresses.
I wrote too much on that subject- wandering off course and wasting my
mental energy.
I agree with the doctor who recommended vegetarian diet. It can be
done as a slow transition rather than abruptly but I know it has alot
of benefits. I was a vegetarian (for spiritual reasons) for a few
years long ago and I know it is a good thing. I am an avowed
vegetarian because I belive in it but I am NOT a practicing
vegetarian because I just don't have that incorporated into my
lifestyle and cooking/preparing food is not one of my interests. I
am pretty lame in that regard, so my comment probably sounds
hipocrytical(however that is spelled). I want to move back in that
direction foir sure though!
I'll comment on the Infergen in a reply to your specific post. My
answer is YES, do the Infergen maintenance above the options for
pegylated IFN. I'll explain in my reply to that post.
Later,
Dennis

hi sonny... please write me off list to discuss this more thoroughly........
thanks, sally, nmilover@.... thanks,
"and the beat goes on......." Sonny Bono"It's not the years in your life that
count. It's the life in your years." Abraham Lincon-----and.... "It's never too
late to have a happy childhood." Tom Robbins

Has anyone in the group tried the Infergen. My doctor discussed the possibility
of trying it but I'm so sick of enduring treatments without success and wonder
if it is truly worth it. I was non-detectable for awhile after the first round
and then it returned. I couldn't even clear the virus the second round. Both
times I was really ill, lost my hair, energy, weight, constant flu-like symptoms
and sleep deprivation. My platelets also dropped dangerously low as did the RBC
and WBC.
I want so badly to be rid of the virus. So if anyone has had success with
Infergen or tried it, please let me know about your experience with it.
Thanks. Lisa
PeachStatePam <figment@...
Help for Hep C
RICHMOND, Va. (Ivanhoe Broadcast News) -- Nearly 4 million Americans are living
with hepatitis C, and more than a quarter million of them have failed standard
treatment options. Now, a newer, tougher drug is curing the virus in more
people.
For six years, Louise Overman has battled hepatitis C -- a virus that killed the
only two people she ever knew who had it. "To clear the hepatitis C was
paramount to me," she says. Her first treatment -- a year-long ordeal -- didn't
work. Her second treatment also fell short, but her goal has remained unchanged.
"Cure it. Kill the monster."
Hepatologist Mitchell Shiffman, M.D., says that's a tough job, but it's
possible. "It is the only virus that we are aware of that can actually be cured.
It can be completely eradicated from the body," he tells Ivanhoe.
But less than half of people with the most common type of hepatitis C are cured.
Now, a drug called Infergen is changing the future for patients who fail
standard treatment.
"Re-treatment with Infergen at a daily does can render an additional 25 percent
of these resistant patients virus undetectable," Dr. Shiffman, of Virginia
Commonwealth University in Richmond, says. Drugs called interferons are commonly
used to fight hepatitis C. Infergen is a highly potent interferon that is
injected once a day for one year.
Dr. Shiffman says Infergen is FDA-approved and would likely be offered to
patients who have failed previous treatments rather than given as a first
treatment. That's because Infergen needs to be taken every day as opposed to a
once a week with other interferons.
Despite failing two different treatments, Shiffman was ready for round three.
She was right. After just three months on Infergen, her virus was gone.
"That's just wonderful news. That is really amazing," Overman says. And she says
it's a relief to finally put her six-year battle behind her and get on with her
life.
This article was reported by Ivanhoe.com, which offers Medical Alerts by e-mail
every day of the week. To subscribe, click on: http://www.ivanhoe.com/newsalert
.
If you would like more information, please contact:
Virginia Commonwealth University Health System
Physician Referrals
(800) 762-6161
http://www.wsiltv.com/p/news_details.php?newsID=1769&type=local

sorry for the multiple posts don't know what I did wrong
"and the beat goes on......." Sonny Bono"It's not the years in your life that
count. It's the life in your years." Abraham Lincon-----and.... "It's never too
late to have a happy childhood." Tom Robbins

"and the beat goes on......." Sonny Bono"It's not the years in your life that
count. It's the life in your years." Abraham Lincon-----and.... "It's never too
late to have a happy childhood." Tom Robbins
----- Forwarded Message ----
From: Sally Roberts <sallyrob@...
To: Sally nmilover <nmilover@...
Sent: Sunday, February 11, 2007 9:28:53 PM
Subject: PLEASE READ....NOT A JOKE--this is sallysara
Someone told me if I googled myself I could see so much stuff and I did not
believe them. Well, I just did it and I could see everything about me... every
post to every group, everywhere I have ever lived, personal stuff about myu
family and get this..... MY MOTHERS MAIDEN NAME....... so be careful and go make
up a new mothers maiden name at your banks and stuff..... try it you will get
about fifty pages but you will see everything you have done or written almost on
computer and everything about YOU... not kidding, just did it..... wow, think I
will throw this thing out.. Big Brother isHERE......
Sally Roberts
sallyrob@...

Vitamin C (ascorbic acid) analysis in foodstuffs
The Metrohm Food Titrino is a compact titrator with an LCD screen for real-time
curve display, and has the standard method for vitamin C analysis already loaded
in it.
Scurvy, the disease caused from a lack of Vitamin C, was rampant many years ago
among sailors. Around the year 1600, citrus fruits were introduced to cure the
disease. Sailors from other parts of the world never got scurvy because they
brought other vitamin C rich foods along with them.
The Vikings ate sauerkraut and the Chinese grew their own bean sprouts.
Both of these foods are high in vitamin C.
The chemical name for vitamin C is ascorbic acid.
'A' means not or without, and 'scorbutus' means scurvy, and because it is an
acid, it was called ascorbic acid.
Vitamin C can help you look younger, as it encourages growth of the protein
chains in collagen, which is the main ingredient in all fibrous tissue.
Fibrous tissue is your bone matrix, cartilage, tooth dentin (right under the
enamel), skin, tendons, ligaments, and all other connective tissue.
Collagen is what keeps your cells bound together.
You can't make collagen without vitamin C.
Vitamin C also builds up natural body defenses.
When a cell becomes infected by a virus it produces interferon, which inhibits
the reproduction of other viruses.
Interferon has to be activated by vitamin C before it can do its job.
Vitamin C helps your immune system in another way, too.
It is hard for viruses, bacteria, and their harmful byproducts to get through a
tight meshwork of protein, which is what collagen is.
If the collagen is loose, the bacteria can get to underlying connective tissue
and healthy cells much easier.
When your immune system is stronger, you don't get sick as easily.
Vitamin C also increases the number of lymphocytes that your body produces.
Lymphocytes eat unhealthy cells, debris, bacteria, and viruses.
A high amount of vitamin C is naturally present in citrus fruits, strawberries,
green and red peppers, broccoli, spinach, tomatoes, potatoes, kiwi, guava and
parsley, as well as in processed food where it is added artificially.
The Metrohm Food Titrino is a compact titrator with an LCD screen for real-time
curve display, and has the standard method for vitamin C analysis already loaded
in it.
It is intended for universal use as it offers all the important basic methods
used in food processing and manufacturing including the following industries:.
Drinking water and mineral waters.
Milk and dairy products, edible fats and oils.
Cereals, dry pasta.
Honey, sugar and sweets.
Soft drinks, lemonades Fruit and vegetable juices, jams.
Fruit, vegetable and mushroom preserves.
Table salt, spices, pickling salt, seasoning salt, herbal salt and flavoured
salt.
Meat products, meat extracts, consomme cubes, jellied meat, seasonings, soups,
sauces.
Beer, vinegar, liquor and wine.
Coffee, cocoa and chocolate Sweeteners, gelling and thickening agents.
The increasing number of foodstuff labels appearing on the market demonstrates
that quality is the decisive purchasing factor. Request a free brochure from
Metrohm UK....
http://www.laboratorytalk.com/news/mea/mea588.html

Help for Hep C
RICHMOND, Va. (Ivanhoe Broadcast News) -- Nearly 4 million Americans are living
with hepatitis C, and more than a quarter million of them have failed standard
treatment options. Now, a newer, tougher drug is curing the virus in more
people.
For six years, Louise Overman has battled hepatitis C -- a virus that killed the
only two people she ever knew who had it. "To clear the hepatitis C was
paramount to me," she says. Her first treatment -- a year-long ordeal -- didn't
work. Her second treatment also fell short, but her goal has remained unchanged.
"Cure it. Kill the monster."
Hepatologist Mitchell Shiffman, M.D., says that's a tough job, but it's
possible. "It is the only virus that we are aware of that can actually be cured.
It can be completely eradicated from the body," he tells Ivanhoe.
But less than half of people with the most common type of hepatitis C are cured.
Now, a drug called Infergen is changing the future for patients who fail
standard treatment.
"Re-treatment with Infergen at a daily does can render an additional 25 percent
of these resistant patients virus undetectable," Dr. Shiffman, of Virginia
Commonwealth University in Richmond, says. Drugs called interferons are commonly
used to fight hepatitis C. Infergen is a highly potent interferon that is
injected once a day for one year.
Dr. Shiffman says Infergen is FDA-approved and would likely be offered to
patients who have failed previous treatments rather than given as a first
treatment. That's because Infergen needs to be taken every day as opposed to a
once a week with other interferons.
Despite failing two different treatments, Shiffman was ready for round three.
She was right. After just three months on Infergen, her virus was gone.
"That's just wonderful news. That is really amazing," Overman says. And she says
it's a relief to finally put her six-year battle behind her and get on with her
life.
This article was reported by Ivanhoe.com, which offers Medical Alerts by e-mail
every day of the week. To subscribe, click on: http://www.ivanhoe.com/newsalert
.
If you would like more information, please contact:
Virginia Commonwealth University Health System
Physician Referrals
(800) 762-6161
http://www.wsiltv.com/p/news_details.php?newsID=1769&type=local

Foundation built on a promise
By Jennifer Roy/Daily News staff
Friday, February 09, 2007 - Updated: 01:23 AM EST
WALTHAM - Scott E. Chapman was a warm, kind, intelligent man who would give you
the shirt off his back and the last dime in his pocket - if he hadn't just spent
it on booze.
He couldn't hold a job, despite studying radiology at Bunker Hill Community
College, slept wherever he could find a bed and died a painful, ugly death at
the age of 34.
He began drinking when he was a high school student in Melrose, and despite the
help and pleading of family and friends, just couldn't stop, his brother,
Christopher Chapman, a Waltham resident, said yesterday.
"He was a functioning alcoholic," he said. "His apartment was stacked with empty
beer cans."
Almost two years ago, as Scott lay dying in the intensive care unit at
Melrose-Wakefield Hospital, his sister-in-law, Michelle, made him a promise.
"I promised him I would try to make a difference, so no other family has to go
through it," she said. "I didn't know alcohol could do this to someone."
Michelle and Christopher made good on her promise in January 2006, when they
started the Scott E. Chapman Foundation.
"I think he always helped everyone else because he didn't know how to help
himself," she said.
Money raised through the foundation has been used to assist local recovery
(sober) homes and charities. The Chapmans hope to also team with local police
departments and schools to bring alcohol education to children.
Chapman said his alcoholism buffeted his brother about. Scott slept on their
mother's couch after he lost his apartment, stayed in sober houses, had been
hospitalized, and even tried to detox on his own three times. He had cirrhosis
of the liver and hepatitis C.
He died at Melrose-Wakefield Hospital May 1, 2005, after slipping into a coma, a
few months before his brother's second child was born.
Doctors told the family Scott had the body of a 60- to 70-year old alcoholic
man.
Michelle Chapman said Scott was like a brother to her, and even kept his promise
to remain sober for the couple's wedding in 2000.
"If he wanted to be best man, he had to be sober," Michelle said. "He stayed
sober for a year."
She said Scott even attended Christopher's bachelor party and didn't drink, and
began attending Alcoholics Anonymous meetings.
He hit the bottle again after meeting up with an old flame in Las Vegas. The
couple became engaged and split a short time later, Christopher said.
"It was the beginning of the end," he said. "We look at it as a blessing, he
didn't want to live that way."
Scott lived with the couple in Waltham briefly, but was told he had to leave
after coming home drunk one night.
"The deal was, if he drank while he was here, he was out," Michelle said.
She said he started with beer, then often drank cheap booze or mouthwash,
anything that would give him a buzz.
He also passed out drunk one night while baby sitting his young half-siblings,
who are now ages 12 and 14.
"When he was sober, he was shaking. It was never totally out of his system,"
Christopher said. "He'd come home stumbling."
Alcoholism runs in both of their families, they said.
"The foundation is only a year old, but we have helped people in that short
amount of time, and hope to help so many more," Michelle said. "We need to try
to do something, especially before my kids go to school."
The couple has two young sons - Kyle, 4, and Chase, 15 months.
Michelle said she often talks to Christopher's 14-year-old half-brother about
what he encounters at school or at parties.
"I had my first drink way before I was 21," she said.
Christopher said sober houses are located throughout Massachusetts, and are
often unwelcome by their neighbors. Many are non-profit.
Michelle said they are "impeccably" clean, and residents - who can stay up to
two years - must pay weekly rent, obey curfew, and, above all else, stay sober.
She said she wants to tell Scott's story because, "it could happen to anybody."
"I didn't want his story to just end that way," she said. "We're just hoping we
can make a difference."
For more information, visit www.secfoundation.com or e-mail
michelle@... . Checks made payable to The Scott E. Chapman
Foundation can be sent to PO Box 550135, North Waltham, MA, 02455, or sign up to
donate at www.igive.com/secfoundation .
Jennifer Roy is a Daily News staff writer. She can be reached at 781-398-8005 or
jroy@....
http://www.townonline.com/homepage/8998945328795222015

Viral Hepatitis: Symptoms And Cure [ 2007-2-9 ]
By Sushil Rijal
Generally hepatitis means inflammation of the liver or malfunctioning of
liver. There are many types of hepatitis and each of them has peculiar mode of
transmission, common name and specific characters. All sorts of hepatitis are
not fatal. Moreover, all of them do not have preventive measures like drugs and
vaccine. Nowadays many hospitals and health organizations are conducting
vaccination programme against hepatitis. On the one hand they are preventing
people from such a hazardous disease and on the other they are creating
awareness. But, before rushing towards campaign area one must know about the
disease of which they are worrying about. Here is some clues and short
information about different types of hepatitis.
1. The causative agent of Hepatitis A is a RNA virus (genetic material is
coded by RNA). This virus generally attacks long travelers. It is commonly
called "travelers hepatitis". Vaccine is available for this hepatitis.
2. The causative agent of Hepatitis B is a DNA virus (genetic material is
coded by DNA). And it is a serum hepatitis (transmitted through blood, semen).
Needless to say, it is 100 per cent fatal and more dangerous than HIV/AIDS and
the chance of transmission of this disease is 100 times more than HIV/AIDS. The
period between entrance of virus (causative agent) into body and first symptom
shown by patient is termed as incubation period. The incubation period of
hepatitis B is six weeks to six months. It is believed that the number of death
caused by HIV in one year is numerically equal to that by hepatitis B in single
day. Vaccine is available for this and it is of three doses. Second dose should
be given within one month, and third should be given within six month from that
of first dose. The booster dose can be given after five year.
3. Hepatitis C is also called a silent killer. It is a chronic disease
that causes cirrhosis of liver. It is as dangerous as hepatitis B. This
hepatitis is commonest in intra venous (I-V) drug users. It is also transmitted
by blood and unprotected sex.
4. Hepatitis D is common in those who do have hepatitis B or it is
dependent on hepatitis B. It is caused by virus called delta virus.
5. The causative agent of Hepatitis E is RNA virus. Among all kinds of
hepatitis, it is most common in Kathmandu. It generally attacks pregnant ladies
so commonly called "infectious hepatitis" or "notorious hepatitis". It is not as
fatal as hepatitis B and C. Drugs are available for it.
6. Hepatitis A and E is endemic in Katmandu and can be prevented by
personal hygiene and sanitation. They are infective hepatitis. The rout of
transmission is feco-oral rout. Use of polluted water and lack of proper use of
toilets are the main cause.
7. Hepatitis A and B can be prevented by vaccination. Vaccines are
available for these two hepatitis.
8. Hepatitis B and C have parental transmission and mostly transmitted by
unprotected sexual intercourse. Thus, these can be prevented by safe sex,
screening of the blood and blood products, avoidance of the sharing of needles
among drug abusers. This hepatitis can lead to cirrhosis of liver and
hepato-cellular cancer.
9. The chance of transmission of hepatitis is more than that of HIV/AIDS
during tattooing.
10. The general clinical feature for all this hepatitis is jaundice,
fever, anorexia, abdominal pain and hepatomegaly.
People who work in health center or hospitals should be more careful as
single contact with non-sterilized syringe and infection due to infected blood
can be the sole cause of death. The chances of cause of hepatitis are fully
dependent on your life style. How you live your life and how you lead your life
determine whether you are conscious of hepatitis or not. But, who knows, what is
happening in next moment? So it is better to be vaccinated against this fatal
disease.
http://www.gorkhapatra.org.np/content.php?nid=12255

Sydney beats London in hep C stakes
By Tamara McLean
February 12, 2007 12:28am
Article from: AAP
HEPATITIS C rates among young Sydney drug users are now among the highest in the
world following the release of figures showing one in two contract the disease
each year.
The city has outstripped London's alarming rates of infection, with the NSW
research team warning that the "extremely high" numbers need the urgent
attention of Australian policy makers.
"We obviously had an idea it was a problem but we had no idea it was going to be
this high," said Professor Lisa Maher from the National Centre in HIV
Epidemiology and Clinical Research.
The team studied more than 200 addicts who were either younger than 30 or who
had been injecting for less than three years, in Sydney's southwest.
They found that for every 100 new users followed for a year, 46 had the
infection by the end.
Rates were highest among women, under 20-year olds, people originally from South
East Asia, cocaine injectors and those who had been using for less than a year.
Prof Maher said these statistics, published in the Australian and New Zealand
Journal of Public Health, and unpublished figures collected from two other NSW
sites, painted a grim of rates in the state.
They exceed London which recently recorded a rate of 42 per 100 new users.
http://www.news.com.au/story/0,10117,21210034-1702,00.html?from=public_rss

That was interesting Dennis. Thanks for posting! :-)
Pambi :-)

30pc of prisoners have hepatitis C
11th February 2007, 9:45 WST
One in three inmates of Australian prisons have hepatitis C, new statistics
show.
A sample of prisoners from Western Australia, NSW, Queensland and Tasmania
returned rates of 34 per cent for the blood-borne disease.
Infection numbers were almost double this among inmates who regularly injected
drugs before they were incarcerated.
Previous estimates have put the prison infection rate at between 40 and 60 per
cent.
The study, lead by the University of NSW Centre of Health Research in Criminal
Justice, also found that one in five had hepatitis B but only one per cent were
HIV positive.
Researchers tested almost 500 volunteers from a cross-section of Australia's
25,000-strong prison population.
Results showed NSW inmates were "significantly more likely" to test positive to
hepatitis C than prisoners in other states.
Most sufferers were aged over 30 and had been in prison before.
Lead researcher Tony Butler said the findings, published in the Australian and
New Zealand Journal of Public Health, show the need for better harm minimisation
practices in prisons.
Authorities should also consider routinely including prisoners in the national
surveillance of hepatitis and HIV, he said.
"That would provide a more complete picture of blood-borne virus epidemiology in
Australia," Dr Butler said.
http://www.thewest.com.au/default.aspx?MenuID=28&ContentID=21079

I first saw mention of this report in a google health news section. I
then read a number of different news articles about it and they all
seemed to be amiss. Something just wasn't right with the various news
articles, so I searched out the original source, the full report.
I posted the full report so everyone who reads it will know the facts
behind the news articles.
Originally I wrote alot more in this post, about very poor journalism
in the mass media (especially when it comes to medical research) and
then about the DEA and how that agency is involved in pressuring
researchers. Also about how the Bush Administration has long been
censoring, editing and in effect rewriting research findings to suit
their policy goals rather than changing their policies to fit the
research findings. Anyhow, I've decided to set it all aside for now.
(too long of a rant) I'll think it over and maybe post it another time.
Dennis near Seattle

Source: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5605a1.htm
Unintentional Poisoning Deaths --- United States, 1999--2004
In 2004, poisoning was second only to motor-vehicle crashes as a
cause of death from unintentional injury in the United States (1).
Nearly all poisoning deaths in the United States are attributed to
drugs, and most drug poisonings result from the abuse of prescription
and illegal drugs (2). Previous reports have indicated a substantial
increase in unintentional poisoning mortality during the 1980s and
1990s (2,3). To further examine this trend, CDC analyzed the most
current data from the National Vital Statistics System. This report
summarizes the results of that analysis, which determined that
poisoning mortality rates in the United States increased each year
from 1999 to 2004, rising 62.5% during the 5-year period. The largest
increases were among females (103.0%), whites (75.8%), persons living
in the southern United States (113.6%), and persons aged 15--24 years
(113.3%). Larger rate increases occurred in states with mostly rural
populations. Rates for drug poisoning deaths increased 68.3%, and
mortality rates for poisonings by other substances increased 1.3%.
The largest increases were in the "other and unspecified,"
psychotherapeutic, and narcotic drug categories. The results suggest
that more aggressive regulatory, educational, and treatment measures
are necessary to address the increase in fatal drug overdoses.
Mortality data for 2004 were collected from the National Vital
Statistics System (1). Unintentional poisoning deaths that occurred
during 1999--2004 were defined as those with underlying cause-of-
death codes X40--X49 from the International Classification of
Diseases, Tenth Revision (ICD-10). This category included overdoses
of illegal drugs and legal drugs taken for nonmedical reasons,
poisoning from legal drugs taken in error or at the wrong dose, and
poisoning from other substances (e.g., alcohol, pesticides, or carbon
monoxide). Adverse effects of legal drugs taken in the proper doses
and as directed are coded elsewhere in ICD-10 and were not included
in this analysis. Rates were age adjusted to the 2000 U.S. Census
population using bridged-race* population figures. Information on the
percentage of the population that was rural, defined as the
percentage living in census blocks below a certain population
density, was derived from U.S. Census data for 2000 (4).
The number of unintentional poisoning deaths increased from 12,186 in
1999 to 20,950 in 2004. The annual age-adjusted rate increased 62.5%,
from 4.4 per 100,000 population in 1999 to 7.1 in 2004. The increase
among females, from 2.3 to 4.7 per 100,000 population (103.0%), was
twice the increase among males, from 6.5 to 9.5 per 100,000
population (47.1%) (Table 1). Among males, rates among whites,
American Indians/Alaska Natives, and Asians/Pacific Islanders all
increased approximately 50%. Rates among black males were highest in
1999 but did not increase. Among females, rates among whites more
than doubled, whereas nonwhites had smaller increases or decreased.
Overall, rates increased 75.8% among whites, 55.8% among American
Indians/Alaska Natives, 27.4% among Asians/Pacific Islanders, and
11.2% among blacks. Rates among non-Hispanics increased more than
rates among Hispanics for both sexes. Among all sex and racial/ethnic
groups, the largest increase (136.5%) was among non-Hispanic white
females. Among all age groups, the largest increase occurred among
persons aged 15--24 years (113.3%). In 2004, the highest rates were
among persons aged 35--54 years, who accounted for 59.6% of all
poisoning deaths that year.
From 1999 to 2004, rates increased by less than one third in the
Northeast and West but more than doubled in the South and nearly
doubled in the Midwest. Delaware, Maryland, New York, and Rhode
Island had decreases in rates, and California had the smallest
increase (4.0%) (Figure). States with the largest relative increases
were West Virginia (550%), Oklahoma (226%), Maine (210%), Montana
(195%), and Arkansas (195%). Increases of 100% or more occurred in 23
states: 11.8% (two of 17) of states§ in the most urban tertile, 41.2%
(seven of 17) of those in the middle tertile, and 82.4% (14 of 17) of
those in the most rural tertile (extended Mantel-Haenszel chi-square
for linear trend across the tertiles = 15.4, p<0.001).
The increase in poisoning mortality occurred almost exclusively among
persons whose deaths were coded as unintentional drug poisoning (X40--
X44), for which the rate increased 68.3% (Table 2). The rate for
poisoning deaths attributed to other substances (X45--X49) increased
1.3%. By 2004, drug poisoning accounted for 19,838 deaths, 94.7% of
all unintentional poisoning deaths. Among types of drug poisoning,
the greatest increases were in the "other and unspecified" drug,
psychotherapeutic drug, and "narcotic and hallucinogen" drug
categories.
Reported by: L Paulozzi, MD, Div of Unintentional Injury Prevention;
J Annest, PhD, Office of Statistics and Programming, National Center
for Injury Prevention and Control, CDC.
Editorial Note:
Unintentional drug poisoning mortality rates increased substantially
in the United States during 1999--2004. Previous studies, using
multiple cause-of-death data, have indicated that the trend described
in this report can be attributed primarily to increasing numbers of
deaths associated with prescription opioid analgesics (e.g.,
oxycodone) and secondarily to increasing numbers of overdoses of
cocaine and prescription psychotherapeutic drugs (e.g., sedatives),
and cannot be attributed to heroin, methamphetamines, or other
illegal drugs (3,5).
The mortality increases might be the result of greater use and abuse
of potentially lethal prescription drugs in recent years, behaviors
that are more common among whites than nonwhites (6,7). The
substantial increase in deaths among persons aged 15--24 years is
consistent with substantial recent increases in recreational
prescription drug and cocaine use among adolescents and young adults
(8).
Studies by state health agencies have reported recent increases in
prescription-drug--poisoning mortality in rural communities (9,10),
despite historically higher rates in urban areas. The South and
Midwest regions, which had the largest relative and absolute
increases among regions in this study, are the most rural regions of
the country (4). Further research is needed to determine how
differences in drug use, drug-abuse--control measures, and
demographic characteristics (e.g., race/ethnicity) contribute to this
pattern.
The findings in this report are subject to at least three
limitations. First, mortality coding assigns the underlying cause of
death to broad drug categories rather than to specific drugs. Second,
death certificates do not reveal the circumstances of drug use.
Third, determining the intent of a person who took a drug is often
difficult for a coroner or medical examiner and might result in
misclassification; some of these deaths might have been suicides,
although not classified as such, and some deaths categorized as
suicides or of undetermined intent might have been unintentional and
therefore not analyzed in this study. The extent of this error is not
known.
Effective response to increasing fatal drug overdoses requires
strengthening regulatory measures to reduce unsafe use of drugs,
increasing physician awareness regarding appropriate pharmacologic
treatment of pain and psychiatric problems, supporting best practices
for treating drug dependence, and potentially modifying prescription
drugs to reduce their potential for abuse. State agencies that manage
prescription-monitoring programs should use such systems to
proactively identify 1) patients who abuse drugs and fill multiple
prescriptions from different health-care providers and 2) providers
whose prescribing practices are outside the standards of appropriate
medical care. Both federal and state prevention measures should be
evaluated periodically to determine their effectiveness.
References
1) CDC. Web-based Injury Statistics Query and Reporting System
(WISQARS) [Online]. Available at http://www.cdc.gov/ncipc/wisqars.
2) Paulozzi LJ, Ballesteros MF, Stevens JA. Recent trends in
mortality from unintentional injury in the United States. J Safety
Res 2006; 37:277--83.
3) Paulozzi LJ, Budnitz DS, Xi Y. Increasing deaths from opioid
analgesics in the United States. Pharmacoepidemiol Drug Safety
2006;15:618--27.
4) US Department of Commerce, Census Bureau. 2000 Census: summary
file 3, table P.5 urban and rural. Available at
http://www.nemw.org/poprural.htm.
5) Fingerhut LA. Increases in methadone-related deaths: 1999--2004.
Health E-Stats. Hyattsville, MD: National Center for Health
Statistics; 2006. Available at
http://www.cdc.gov/nchs/products/pubs/pubd/hestats/methadone1999-
04/methadone1999-04.htm.
6) Simoni-Wastila L. The use of abusable prescription drugs: the role
of gender. J Womens Health Gend Based Med 2000;9:289--97.
7) Simoni-Wastila L, Ritter G, Strickler G. Gender and other factors
associated with the nonmedical use of abusable prescription drugs.
Subst Use Misuse 2004;39:1--23.
8) US Department of Health and Human Services, Substance Abuse and
Mental Health Services Administration Office of Applied Studies.
Results from the 2005 National Survey on Drug Use and Health:
national findings. Rockville, MD: Substance Abuse and Mental Health
Services Administration; 2006. Available at
http://www.oas.samhsa.gov/nsduh/2k5nsduh/2k5results.htm.
9) CDC. Increase in poisoning deaths caused by non-illicit drugs---
Utah, 1991--2003. MMWR 2005;54:33--6.
10) CDC. Unintentional deaths from drug poisoning by urbanization of
area---New Mexico, 1994--2003. MMWR 2005;54:870--3.
* Information about bridged-race categories is available at
http://www.cdc.gov/nchs/about/major/dvs/popbridge/popbridge.htm.
Northeast: Connecticut, Maine, Massachusetts, New Hampshire, New
Jersey, New York, Pennsylvania, Rhode Island, and Vermont; Midwest:
Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri,
Nebraska, North Dakota, Ohio, South Dakota, and Wisconsin; South:
Alabama, Arkansas, Delaware, District of Columbia, Florida, Georgia,
Kentucky, Louisiana, Maryland, Mississippi, North Carolina, Oklahoma,
South Carolina, Tennessee, Texas, Virginia, and West Virginia; West:
Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana,
Nevada, New Mexico, Oregon, Utah, Washington, and Wyoming.
§ Includes the District of Columbia.
Table 1
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5605a1.htm
Table 2
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5605a1.htm
Use of trade names and commercial sources is for identification only
and does not imply endorsement by the U.S. Department of Health and
Human Services.

Hi Everybody!!!!!!! Where are you??????????????
http://www.cafeoflifepikespeak.com/Videos/Licensed%20To%20Pill.swf
"and the beat goes on......." Sonny Bono"It's not the years in your life that
count. It's the life in your years." Abraham Lincoln and.... "It's never
too late to have a happy childhood." Tom Robbins

Lichen planus (pronounced LY-kin-PLAN-us)
Introduction:
Lichen Planus, an obstinate skin disorder has baffled not only the patients
but also the practitioners equally. The cases of Lichen Planus have been
observed all over the world, irrespective of the race, skin color and
culture. The medical field today finds little help for this chronic disease.
Fortunately, homeopathy, the fast growing alternative medicine has a
definite, promising treatment for Lichen Planus.
Lichen Planus: What is it?
It is a recurring, chronic, non-allergic, non-infectious, non-contagious
disease of the skin, of which the exact cause is not yet fully understood. It
has a tendency to relapse after some months or years. Females are more
frequently affected as compared to the male counterpart, however, uncommon to
find it in children. Over 1.9% of the total population is affected by Lichen
Planus.
Signs and symptoms:
The typical appearance of the Lichen Planus eruption: round or irregular
shape, raised slightly above the skin level, brown or pinkies or black in
color. The typical text-book description goes: Flat-topped shiny polygonal
eruptions. Small in size, thickened eruptions, rough and/or oily to touch,
dirty look at times. You may find spots either in groups, a few or numerous
in number and very often bilateral symmetrical ( on both the side of the
body, say legs).
Lichen Planus and Hepatitis:
Some of the latest studies have shown a co-association of Lichen Planus with
a rare variety of Hepatitis C. It may be noted that the exact connection and
causative link has not been established between the two entities. It may be
of interest to the readers that like Hepatitis A and Hepatitis B, the variety
C also finds a promising treatment with homeopathy. All the three varieties
of Hepatitis are caused by virus.
They have a tendency to start slowly, gradually and spread in the same
fashion. Intense itching on the parts affected is the most annoying symptom
of this condition. Itching may be so severe that it often leads to bruise or
bleeding.
Clinically, a peculiar appearance classically described as Wickham's striae
is considered diagnostic of Lichen Planus. (Please see the picture.) At
times, one also observes the Lichen Planus eruptions appearing along the line
of a scratch mark, called as Koebner's phenomenon.
The body parts affected:
Any part of the body may be affected. However, it has a tendency to involve
the skin of the lower limbs, legs and the mucous membrane of the mouth. The
flexors of the legs, inner thighs, front of the wrists, skin on the lower
back are affected in many cases. It has an affinity for the genitals are
involved. In males, the glans ; while in females the vulva may be affected.
The nails when affected, tend to become deformed.
In short, Lichen Planus affecting the skin, mouth (Oral Lichen Planus) and
vaginal LP are some of the most common variants.
When the oral mucosa or the genitals are affected, this condition is often
neglected, reported late or incorrectly diagnosed.
What cases Lichen Planus?
It is one of those conditions where the exact cause remains unknown till the
date. There are theories. In some cases there are obvious links with the
facts such as :
1. Contact with certain chemicals (paraphenylenediamine), drugs (Arsenic
compounds, certain metals such as Gold, Bismuth, Quinacrine), exposure to
light by photography development) etc.
2. Certain modern medicines such as non-steroidal anti-inflammatory pain
killers (NSAID), antihypertensive medicines, amalgamated dental filling, etc
are known to induce Lichen Planus, which has a tendency to persist despite
the discontinuation.
It may be of interest to list the common modern medicines which are know to
induce Lichen Planus:
~NSAID
~Tetracycline
~Kaptopril
~Propranolol
~Sulfonamide
~Dapson
~Furosemid
~Klorokin
~Penicillamin
~Metyldopa
~Enalapril
2. In our in-depth studies, we have observed that certain intense and
prolonged emotional stress such as anxiety, shock, traumatic childhood,
sadness, disappointment, failure, humiliation, etc. often initiate the
process of Lichen Planus. It may be noted that this information is derived
from the study at our center and may not be found in the standard
dermatological text books.
3. Hereditary tendency
How to diagnose LP? :
It can be diagnosed clinically by experienced eyes. Sometimes the LP
eruptions resemble other skin conditions such as atopic dermatitis,
psoriasis, candidiasis(in mouth), Leukoplakia (mouth), apthous ulcers
(mouth). The final diagnosis may be done, less often indicated; though, with
histopathological study with biopsy.
Variants of Lichen Planus:
· Lichen Planus Hypertrophicus: It looks like a keloid or hypertrophied scar,
often found on the ankles.
· Lichen Planus Actinus:
· Lichen Nitidus: Observed along with regular eruptions of LP, more on the
light-exposed body parts.
· Lichen Sclerosus et Atrophics: A rare condition affecting the vulva, male
genitals. With tremendous itching, there is atrophy and scaring of the
affected organ.
· Lichen Planus Linearis : More closely aggregated eruptions, extending along
the entire limb, seen in children.
· Lichen Planus Annularis: Often affecting the genitals and scrotum.
· Lichen Planus Follicularis: Observed in the hear-bearing areas such as
scalp, pubic region.
· Lichen Planus Atrophicus :
· Bullous Lichen Planus : Bullous eruption and vesicles.
· Lichen Planus Pigmentosus: As the name suggests, there is a kind of
hyper-pigmentation which is grayish in color. Seen more in females in the
western countries.
MORE INFORMATION
Lichen Planus
Is a rather common disease that affects the skin, the mouth, or both. It
affects about one percent of the general population.
What is lichen planus? How do you get the disease? Can it be cured? This
brochure will help answer these and other questions by taking a closer look
at the disease.
What the Disease Is Not
To understand what lichen planus (LP) is, it's important to note what the
disease is not. Lichen planus is not an infectious disease. It is impossible
to "catch" lichen planus from someone who has it or to give it to someone
else. The disease is not a form of cancer, it does not appear to be
inherited, and it is not related to nutrition.
What It Is.
Lichen planus is an inflammatory disease that usually affects the skin, the
mouth, or sometimes both. It may affect the genital skin as well. The cause
of lichen planus is not known. There are cases of lichen planus-type rashes
occurring as allergic reactions to medications for high blood pressure, heart
disease and arthritis. In those cases, identifying and stopping the use of
the drug helps clear up the condition within a few weeks. Some people with
lichen planus can also have hepatitis C and your dermatologist may want to
check you for this. Lichen planus affects men and women equally, and occurs
most often in middle-aged adults.
Lichen Planus of the Skin
Lichen planus of the skin is characterized by reddish-purple, flat-topped
bumps that may be very itchy. They can be anywhere on the body, but seem to
favor the inside of the wrists and ankles. The disease can also occur on the
lower back, neck, legs, genitals, and in rare cases, the scalp and nails.
Thick patches may occur, especially on the shins. Blisters are rare. While
the typical appearance of lichen planus makes the disease somewhat easy to
identify, a skin biopsy may be needed to confirm the diagnosis. Lichen planus
on the wrist. Sometimes, lichen planus of the skin causes few problems and
needs no treatment. However, in many cases there is severe itching. Most
cases of lichen planus go away within two years. As it heals, lichen planus
often leaves a dark brown discoloration on the skin. Like the bumps
themselves, these stains may eventually fade with time without treatment.
About one out of five people will have a second attack of lichen planus.
There is no known cure for lichen planus but treatment is often effective in
relieving itching and in improving the appearance of the rash until it goes
away. Since every case of lichen planus is different, no one treatment is
perfect. The two most common treatments include the use of topical
corticosteroid creams and antihistamine drugs taken by mouth. Both work to
help itching. More severe cases of lichen planus may require stronger
medications such as cortisone taken internally or a specific form of
ultraviolet light treatment called PUVA. Remember to discuss any potential
drug side effects with your dermatologist prior to filling prescriptions. As
with other skin disorders, patience - and following your doctor's advice - is
the best medicine for dealing with lichen planus. You should, however, be
careful not to injure your skin, since new areas of lichen planus can form in
the damaged skin.
Lichen planus on the ankles Lichen Planus of the Mouth Lichen planus of the
mouth most commonly affects the inside of the cheeks, gums and tongue.
Oral lichen planus is more difficult to treat and typically lasts longer than
skin lichen planus. Fortunately, many cases of lichen planus of the mouth
cause minimal problems. About one in five people who have oral lichen planus
also have skin lichen planus. Oral lichen planus typically appears as patches
of fine white lines and dots. These changes usually do not cause problems.
Dentists during routine checkups often find them. More severe forms of oral
lichen planus can cause painful sores and ulcers in the mouth. Often a biopsy
of affected tissue is needed to confirm a diagnosis of lichen planus. Your
doctor may have to make sure that the sores are not caused by a yeast or an
infection and are not canker sores. Sometimes, several biopsies are needed at
various times, along with blood tests. There have been cases of lichen
planus-type allergic reactions to dental materials but they are very rare.
When an allergy by dental material has been proven, removing dental material
is recommended. The smooth white patches on the tongue are lichen planus.
There is no known cure for oral lichen planus although there are many
treatments that eliminate the pain of sores. When the disease causes no pain
or burning, treatment may not be needed. More severe forms of lichen planus -
those with pain, burning, redness, blisters, sores and ulcers - can be
treated with a variety of medications, both applied to the sores (topical)
and taken by mouth (oral). As with any disease of the lining of the mouth,
lichen planus can lead to poor dental hygiene and gum disease. The American
Academy of Dermatology recommends regular visits to the dentist for
examinations and cleaning at least twice a year. Lichen planus of the gums
produces redness and yellowish ulcerations.
Lichen Planus of the Genitals.
About one in five women with oral lichen planus will have lichen planus in
the vaginal area. If it is mild, vaginal lichen planus may cause no problems,
but red areas or open sores may cause pain, especially with sexual
intercourse. Lichen planus of the genitals is fortunately much less common in
men than women.
Are You at Risk?
Patients with oral lichen planus may be at a slightly increased risk of
developing oral cancer. Because of this increased risk, the American Academy
of Dermatology recommends discontinuing the use of alcohol and tobacco
products, which also increase the risk. Regular visits to the dermatologist -
every six to twelve months - for oral cancer screening are also recommended.
Food for Thought
Spicy foods, citrus juices, tomato products, caffeinated drinks like coffee
and cola, and crispy foods like toast and corn chips can aggravate lichen
planus especially if there are open sores in the mouth.
Nail Involvement
Nail changes have been observed in lichen planus cases. The majority of nail
changes result from damage to the nail matrix, or nail root. Usually only a
few fingernails or toenails are involved, but occasionally all are affected.
Lichen planus affecting the fingernails shows thinning and surface roughness
of the nail plate with longitudinal ridges. Nail changes associated with
lichen planus include longitudinal ridging and grooving, splitting, nail
thinning and nail loss. In severe cases, the nail may be temporarily or
permanently destroyed. Hair Involvement In rare cases, lichen planus can
affect hairy areas such as the scalp. This is called lichen planopilaris, and
can lead to redness, irritation, and in some cases, permanent hair loss.
Lichen planus of the scalp causes inflammation, hair loss and scarring.
More on Lichen Planus
Lichen planus is a stable condition - the severity and distribution of the
disease rarely changes after the first two months. While there are many
theories to explain lichen planus, many dermatologists believe it can be
classified as an autoimmune disease. This means that white blood cells, which
usually fight germs, begin to attack the normal parts of the skin, mucous
membranes, hair and nails. Locate a dermatologist in your area.

6 Must-Ask Questions About Medications
What do good mystery novels and new prescriptions have in common? Both can keep
you guessing.
Doctors should communicate six basic points whenever they prescribe a new
medication. Unfortunately, research shows they usually deliver only about four
of them. For the full story, ask these six critical questions when you're given
a new drug:
1. What's the name (trade or generic) of the medication?
2. Why are you prescribing it for me?
3. What are the potential side effects?
4. How much should I take (how many pills, squirts, teaspoons, etc.)?
5. How many doses do I need each day, and what time should I take them?
6. How long should I take the medication?
Not taking your medication correctly can make you as much as 4.5 years older,
not to mention it can lead to some serious health trouble, such as a hospital
stay for side effects, an unintentional overdose, or a relapse of your original
condition. Nevertheless, about 50 percent of people who need medications for the
long term to manage health conditions stop taking them within 6 months of their
last doctor's appointment -- a major no-no.
Whether you quit your pills because you didn't know the answer to question 6, or
because you feel better, experience side effects, or want to save money, there's
really only one good reason you should ever stop taking your medication: Your
doctor tells you to.
So help your doctor help you. Jot down notes about your medications, ask for
printed information -- do whatever it takes to make instructions crystal clear.
Then, follow doctor's orders.
http://www.realage.com/news_features/tip.aspx?cid=17682&#MI

Philippine Medical group hosting hepatitis forum
Advertiser Staff
The new president of the Philippine Medical Association of Hawai'i will be the
lead speaker tonight at an open forum regarding "Anything you wanted to know
about Hepatitis B or C (but were afraid to ask!)."
The forum is from 6 to 7:30 p.m. at the Life Foundation, 677 Ala Moana Blvd.,
Suite 226. The Life Foundation is in the Gold Bond building, near Comp USA.
Dr. Fernando Ona will answer questions about the "silent epidemics" hepatitis B
and C, and what treatments are available in the state. He'll also discuss plans
for PMAH in 2007. According to a PMAH news release, Hawai'i has the highest rate
of liver cancer in the U.S. Overall, 10,000 to 12,000 people across the U.S. die
from liver diseases caused by hepatitis C.
The news release also states that Hepatitis C is the most common chronic
blood-borne viral infection in Hawai'i, with an estimated 22,000-plus residents
currently infected.
http://the.honoluluadvertiser.com/article/2007/Feb/08/br/br9034258167.html

Bands play to help hepatitis C patient
By Brian Bowling
TRIBUNE-REVIEW
Thursday, February 8, 2007
A Penn Hills father of four has faced one surprise after another since he was
diagnosed with hepatitis C in 2000, but the biggest surprise has been the
support he's received from relatives, friends and neighbors.
"You don't know how many friends you have until something like this happens,"
said Tony Aleprete, 50.
Aleprete received a liver transplant in 2001, but needs a second one.
Some of his support comes from The Businessmen, a local rock band whose benefit
concerts have raised more than $150,000 for local medical, anti-poverty, and
literacy programs. The band has scheduled a benefit for Aleprete starting at 7
p.m. on Feb. 23 at Zanderz Sports Bar & Night Club, 951 Old Frankstown Road,
Plum. James, another charity rock band, is scheduled to open for The
Businessmen. The $10 admission will help defray Aleprete's medical costs.
Bob Lokar, manager for The Businessmen, said Aleprete is a lifelong friend to
many of the band members, and is known in the community as someone who is always
willing to help out.
"He's done so much for other people. It's just his turn," he said.
Aleprete's first surprise came in 2000 when he was diagnosed. A Navy veteran,
the welder said he suspects he contracted the disease while he was in the
service in the early 1970s.
The virus that causes hepatitis C wasn't discovered until 1989. It is mainly
spread through contact with the blood of someone already infected. Aleprete said
he could have gotten the virus during the assembly line-like vaccinations the
military conducted on recruits, but some of his family members also suspect it
could have happened in a Rhode Island bar.
"It was not the cleanest place," he said. "They were offering tattoos. I was 18,
drunk, so I said, 'OK, put one on.' "
Regardless of where the virus came from, it nearly killed him before he received
the first transplant. Aleprete said he was surprised how many people turned out
to help his family after the operation. In particular, members of the Rosedale
Beach Club took turns cooking dinners for his family for the first month.
"It was getting ridiculous after a while because we couldn't eat it all," he
said. "I will never forget the kindness of everyone."
Aleprete's most recent surprise came in October when a routine checkup revealed
he needed a new liver.
"I cleared (the virus) for six months, and then it came back," he said. "I was
shocked when the doctor told me he was going to put me on the (transplant) list
again. I thought that day would never come," he said.
Brian Bowling can be reached at bbowling@... or (412) 320-7910.
http://pittsburghlive.com/x/pittsburghtrib/news/rss/s_492014.html

Lower risk of elevated cholesterol for HIV/HCV coinfected patients
Michael Carter, Thursday, February 08, 2007
HIV-positive individuals who are coinfected with hepatitis C virus are
significantly less likely to have elevated cholesterol levels than patients who
are HIV-monoinfected, according to a study published in the November edition of
HIV Medicine.
Liver disease, often caused by hepatitis C virus, and cardiovascular illness,
due to some anti-HIV drugs, are emerging as major causes of illness and death in
HIV-positive individuals and investigators from Texas wished to establish the
effect of hepatitis C infection on the lipid profiles of HIV-positive patients.
They therefore performed a retrospective analysis of the records of 359
HIV-positive patients (25% of whom were coinfected with hepatitis C virus) and
112 hepatitis C monoinfected individuals to determine the effect of hepatitis C
infection on total triglycerides, total cholesterol, LDL ("bad") cholesterol and
HDL ("good") cholesterol. The patients were receiving their HIV or hepatitis C
care from the US Department of Veterans' Affairs and were seen between 2003 and
2004.
Data were obtained on all patients' demographic characteristics. Information on
HIV-positive patients' type and duration of antiretroviral therapy was also
extracted from medical records, as were data regarding CD4 cell count and viral
load. The investigators also noted if HIV-positive patients had been diagnosed
with body fat changes (lipodystrophy).
The median age of the study population was 51 years, 98% were male, and 53% were
white.
Amongst the HIV-positive patients, infection with hepatitis C was associated
with a significantly reduced risk of increased total cholesterol (p < 0.0001)
and triglycerides (p = 0.031). The investigators also found that coinfected
patients had significantly lower mean LDL cholesterol (p < 0.001) and higher
mean HDL cholesterol (p = 0.015) than HIV-moninfected patients.
After controlling for the use of anti-HIV therapy, gender and race, coinfection
with hepatitis C remained significantly associated a reduced risk of increased
cholesterol, but not elevated triglycerides.
Further analysis was performed to take account of the use of lipid lowering
therapy. This too showed that coinfected patients were less likely to have
dyslipidaemia or to require lipid lowering therapy (p = 0.002).
The investigators then compared rate of lipodystrophy between patients who had
only HIV and those who were also infected with hepatitis C. HIV-monoinfected
patients had a significantly higher rate of lipodystrophy (28%) than coinfected
patients (17%, p = 0.015). However, this difference disappeared in multivariate
analysis.
Comparisons were then made between the lipid profiles of the HIV/hepatitis C
coinfected patients and the HIV-negative, but hepatitis C-infected patients
included in the study. There was no significant difference in the proportion of
coinfected and hepatitis C-monoinfected patients with increased cholesterol. But
significantly more of the coinfected patients had elevated triglycerides (48%
versus 16% of hepatitis C monoinfected, p < 0.0001). In addition, fewer
hepatitis C-monoinfected patients than coinfected individuals were taking
lipid-lowering therapy or had dyslipidaemia ( 30% versus 51%, p = 0.002).
A set of multivariate analyses were then performed by the investigators. These
showed that being hepatitis C-negative (p = 0.019), older age (p = 0.041) and
white race (p = 0.001) all predicted dyslipidaemia and the use of lipid lowering
drugs. Predictors of lower rates of elevated cholesterol were infection with
hepatitis C virus (p = 0.01) and shorter duration of treatment with a protease
inhibitor (p = 0.03). White race was the only factor associated with an
increased risk of elevated triglycerides (p < 0.0001).
The investigators believe that their findings "significantly strengthen the
hypothesis of an apparent protective effect of hepatitis C virus infection on
the development of dyslipidaemia."
They draw three conclusions:
a.. Hepatitis C infection is associated with lower rates of dyslipidaemia
among HIV-infected patients;
a.. Hepatitis C infection does not independently affect the risk of
lipodystrophy in multivariate analysis, and
a.. Black race and hepatitis C are associated with lower rates of
dyslipidaemia among HIV-positive patients.
Although the patient population was larger than in previous studies looking at
the link between HIV/hepatitis C coinfection and lipids, the investigators note
that there is still a need for larger, prospective studies to confirm their
findings.
They speculate that hepatitis C might occupy LDL receptors on cells, preventing
the entry of LDL cholesterol. However, they think that a more plausible
explanation could be that hepatitis interferes in the dysregulation of the lipid
metabolism caused by HIV.
Reference
Bedimo R et al. Lipid abnormalities in HIV/hepatitis C virus-coinfected
patients. HIV Med 7: 530 - 536, 2006.
http://www.aidsmap.com/en/news/2697422B-D831-47B9-A144-CD0FCE861BE7.asp

Dirty equipment risk for babies at hospital
a.. By Kate Corbett
b.. February 08, 2007
THE Canberra Hospital is searching for dozens of former infant patients who may
have been infected with potentially deadly disease through inadequate
sterilisation of equipment.
ACT Health says it has concerns that 97 babies may have been infected with
Hepatitis B, Hepatitis C or HIV when they had a biopsy of the colon between
February 1987 and mid-October last year.
About half have already been contacted and given blood tests but the results of
the tests are not yet known.
The hospital is now trying to contact all of the others and their parents so
they too can have tests to check if they have been infected.
Acting Chief Health Officer Dr Charles Guest says the chances of infection are
slim, but the patients must be tested.
"The risks of disease transmission in this instance are remote, but it was
important that the patients and their parents were informed that this breach had
occurred and that their minds really be set at rest by offering them this
testing," he said.
The problem was first noted in October last year when a staff member noticed the
biopsy forceps had not been sterilised properly.
"These instruments have usually been cleaned with what's called an enzymatic
cleaner and so they've looked clean all these years but on this one occasion
late last year it was found that they looked dirty," Dr Guest told ABC Radio
today.
He said about half of the patients had already been contacted and the results
from their tests should be back in a matter of hours or days.
"We're very aware that this process is likely to raise anxiety, we're very sorry
for that, but we consider it a necessary step to ensure that people know what
risks have occurred or haven't occurred."
Dr Guest said the patients and their parents had not been notified sooner as it
was not considered a matter of emergency public safety.
ACT Health Minister Katy Gallagher said that was a wise decision as it was
important to understand all the facts before the patients were notified.
"These are very sensitive issues - it would be much worse if we got only a
handful of people that we knew about and rang them with only half of the
information," the minister told ABC radio.
Ms Gallagher commended the hospital for informing the patients at all.
"I think it would've been must more distressing for the hospital to have found
out and done nothing because the risk is so low and then have people find out
perhaps down the track."
http://www.theaustralian.news.com.au/story/0,20867,21191722-29277,00.html

U.S. Department of Health and Human Services
NATIONAL INSTITUTES OF HEALTH
NIH News
National Institute of Allergy and Infectious Diseases (NIAID)
<http://www.niaid.nih.gov/
FOR IMMEDIATE RELEASE: Thursday, February 8, 2007
CONTACT: NIAID News Office, Anne Oplinger, 301-402-1663, <e-mail:
aoplinger@...
FIRST LARGE-SCALE HIV VACCINE TRIAL IN SOUTH AFRICA OPENS
A large-scale clinical trial of a candidate HIV vaccine -- which previously
showed promise in smaller studies in the United States and elsewhere -- has now
opened in South Africa. The study plans to enroll up to 3,000 HIV-negative men
and women, making it the largest African HIV vaccine trial to date.
Conducted jointly by the South African AIDS Vaccine Initiative (SAAVI) and the
HIV Vaccine Trials Network (HVTN), the trial is supported by the National
Institute of Allergy and Infectious Diseases (NIAID), part of the National
Institutes of Health (NIH). The study vaccine, provided by Merck & Co. Inc.
(Whitehouse Station, NJ), contains copies of only three HIV genes, not the
entire virus, so it is impossible for a trial volunteer to become infected from
the vaccine.
"Our best hope of ending the AIDS epidemic is a safe and effective vaccine,"
says NIH Director Elias A. Zerhouni, M.D. "To achieve that goal requires the
concerted effort of governments, scientists and private industry as well as
participation by well-informed volunteers."
"We applaud the South Africans for bringing this important trial to fruition.
This international partnership exemplifies the model of collaboration needed to
defeat HIV/AIDS," says NIAID Director Anthony S. Fauci, M.D.
In South Africa the trial is called "Phambili" ("moving forward"). Also known as
HVTN 503, it is a Phase IIb "test-of-concept" trial, the first such vaccine
study in South Africa. This type of trial is designed to provide preliminary
information on vaccine efficacy and thus enable researchers to decide whether or
not to conduct a larger Phase III efficacy trial that could lead to licensure.
In smaller trials, the vaccine was found to be safe and to stimulate cellular
immune responses against HIV in more than half of volunteers. To date, more than
1,800 people have received at least one injection. Two years ago, the first
Phase IIb trial of the vaccine opened at sites in the United States, Canada,
South America, Australia and the Caribbean see
<http://www3.niaid.nih.gov/news/newsreleases/2005/mercktrial.htm
subtype of HIV called clade B predominates. That trial is ongoing.
As in that study, the main objectives of HVTN 503 are to determine whether the
candidate vaccine can prevent HIV infection or, in those who do become infected,
lower the level of HIV early on. Additionally, the new trial will determine if
the vaccine, which is based on clade B HIV, has the potential to protect against
the HIV clade C subtype prevalent in South Africa. Immune responses in the first
several hundred volunteers will be assessed to ensure the vaccine induces
promising immune responses in this population against the clade C virus before
proceeding to full enrollment.
Study volunteers must be healthy, sexually active, HIV-negative men and women,
ages 18 to 35 years old. Investigators will assign them at random to receive
either the test vaccine or an inactive placebo injection. The trial is
double-blind, meaning that neither the researchers nor the volunteers know which
a participant has received. All volunteers will be regularly counseled about
ways to reduce their risk of acquiring HIV, and they will be given condoms.
Access to care and treatment for sexually transmitted infections will be
provided, and because recent findings indicate that medical circumcision can
reduce the risk of HIV transmission from women to men, access to medical
circumcision will also be provided to male participants who desire it.
In South Africa, the trial is led by Glenda Gray, MBBCH, FCPaeds (SA), of the
Perinatal HIV Research Unit, University of the Witwatersrand, based at the Chris
Hani Baragwanath Hospital in Soweto. James Kublin, M.D., M.P.H., of Fred
Hutchinson Cancer Research Center, Seattle, serves as study co-chair. The study
is expected to recruit volunteers at five sites in South Africa, located in
Soweto, Cape Town, Klerksdorp, Medunsa and Durban.
According to Dr. Gray, the study team has actively sought community endorsement
of and support for this clinical trial, both of which are critical to its
success. "Our communities here in South Africa are faced with the burden of HIV
on a daily basis, and the trial investigators and study team have spent years
developing a rapport with the community so that together we can move forward in
our quest to identify improved approaches to prevent new HIV infections."
The test vaccine contains a weakened adenovirus that serves as a carrier for
three clade B HIV genes. Adenoviruses are among the main causes of upper
respiratory tract ailments such as the common cold. Because the vaccine contains
only three HIV genes housed in weakened adenoviruses, study participants cannot
become infected with HIV or get a respiratory infection from the vaccine. The
study aims to determine if the HIV genes will induce a cellular immune response,
producing immune cells that recognize and kill cells infected with HIV.
The South African Medicines Control Council, the South African Department of
Agriculture and the U.S. Food and Drug Administration have reviewed the trial
and allowed the study to proceed. In order to conduct the trial, sites also are
required to obtain institutional ethics and biosafety committee approvals.
NIAID is a component of the National Institutes of Health. NIAID supports basic
and applied research to prevent, diagnose and treat infectious diseases such as
HIV/AIDS and other sexually transmitted infections, influenza, tuberculosis,
malaria and illness from potential agents of bioterrorism. NIAID also supports
research on basic immunology, transplantation and immune-related disorders,
including autoimmune diseases, asthma and allergies. News releases, fact sheets
and other NIAID-related materials are available on the NIAID Web site at
<http://www.niaid.nih.gov
The National Institutes of Health (NIH) -- The Nation's Medical Research Agency
-- includes 27 Institutes and Centers and is a component of the U.S. Department
of Health and Human Services. It is the primary federal agency for conducting
and supporting basic, clinical and translational medical research, and it
investigates the causes, treatments, and cures for both common and rare
diseases. For more information about NIH and its programs, visit <www.nih.gov
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