1.What are Hepatitis B and Hepatitis C?
Hepatitis is the Latin word for liver inflammation. It is characterized by the destruction of a number of liver cells and the presence of inflammatory cells in the liver tissue. Hepatitis B and C are similar clinical courses and complications of liver infection that are caused by various viruses. Hepatitis B is caused by a DNA virus and hepatitis C is caused by a RNA virus. They can be divided into two subgroups according to their duration, acute and chronic hepatitis.
2. What are the incidences of Hepatitis B or C?
Infection with HBV has a worldwide occurrence, with the highest incidence in China, Southeast Asia, most parts of Africa, most Pacific islands, parts of the Middle East, and in the Amazon Basin where infection occurs in early infancy and childhood. There are approximately 300,000 new HBV infections in the United States each year, most cases occur in young adults between 15 and 30 years of age in urban areas. Approximately 75,000 become symptomatic with jaundice, 10,000 require hospitalization, and 250 die of fulminant hepatitis.
Currently, there are about 200 million people worldwide who are infected with HCV, 4.9 million of those are in the United States (estimates go as high as 15 million) and 5 million in Western Europe. The prevalence seems to be higher in Eastern Europe than in Western Europe. In industrialized countries, HCV accounts for 20% of cases of acute Hepatitis, 70% of cases of chronic Hepatitis, 40% of cases of end-stage cirrhosis, 60% of cases of hepatocellular carcinoma and 30% of liver transplants.
3. How does a person get Hepatitis B or C?
Hepatitis B or C can be caught in different ways. Hepatitis B and hepatitis C are spread by contact with infected blood or other body fluids of people who have hepatitis B or C infection. For example, people can get hepatitis B and C by having sex with an infected person.
People who use intravenous drugs can get hepatitis B or C when they share needles with someone who has the virus. Health care workers, such as nurses, lab technicians and doctors, can get these infections if they are accidentally stuck with a needle that was used on an infected patient.
4. What are Acute Hepatitis B and Hepatitis C?
Acute hepatitis B and C are clinical symptoms onset after the period of the incubation, which is about 1-6 months for both, and lasting less than 6 months. Nearly all cases of acute viral hepatitis are benign, with most patients demonstrating normal results on liver function testing by 8-10 weeks. But fulminant hepatitis leads to submassive and massive hepatic necrosis that occurs in 1-2% of patients with hepatitis B and hepatitis C. The mortality rate varies with age and approaches 90-100%, especially in patients older than 60 years.
5. What are the symptoms of Acute Hepatitis B or C?
The symptoms of acute hepatitis vary considerable from person to person. Some patients have no symptoms at all. The symptoms of hepatitis B or C include slight fever, headache, poor appetite, nausea, vomiting, abdominal pain, muscle ache, jaundice (the skin and sclerae turn yellow), tiredness and general malaise. Pressure or pain below the right ribs caused by the enlarged liver. Bowel movements may be gray in color. The urine may be dark and look like tea.
6. What are Chronic Hepatitis B and Chronic Hepatitis C?
Chronic hepatitis B and C are long-term infections of the liver that develop after a bout of acute hepatitis and defined as elevated serum transaminase levels for a period of more than 6 months. They include chronic persistent hepatitis, chronic active hepatitis and chronic carrier state.
Chronic persistent hepatitis is usually asymptomatic, although some report fatigue, anorexia, or abdominal pain. Results of liver function testing are only mildly abnormal. The clinical course is benign.
Chronic active hepatitis features chronic inflammation, necrosis, and fibrosis bridging portal areas or between portal areas and central vein. The disease may progress to cirrhosis, and on physical examination patients may have splenomegaly, spider angiomata, caput medusae, and other signs of chronic liver disease.
Chronic carrier state for hepatitis B surface antigen exists in 0.2% of the population of the United States. A carrier state also may exist for hepatitis C since blood donated by apparently normal individuals may transmit this disease when transfused. Carriers of hepatitis B or C virus may have an increased risk of hepatoma.
7. What are the symptoms of Chronic Hepatitis B or C?
People with chronic hepatitis B or C may not have any symptoms at all. But in some people, chronic hepatitis can lead to cirrhosis of the liver. Cirrhosis occurs when the liver cells die and are replaced by scar tissue (fibrosis) and fat. The liver stops working and can't cleanse the body of wastes. People in the early stages of cirrhosis may not have symptoms. When cirrhosis gets worse, symptoms begin. They may include weight loss, fatigue, jaundice, nausea, vomiting, ascites, encephalopathy, and variceal bleeding. Cirrhosis can lead to liver failure (the liver stops working) and liver cancer.
8. What is the difference between Acute and Chronic Hepatitis?
The acute stage can last from several weeks to several months. In some people, hepatitis B or C becomes an illness that lasts a long time (more than 6 months), a condition called chronic hepatitis. Other people recover from the infection and have no long-lasting problems.
After a person has recovered from acute hepatitis, chronic hepatitis can set in. Chronic hepatitis occurs when the liver has been damaged from the acute illness and doesn't recover. Chronic hepatitis develops in 10% to 20% of people who have hepatitis B and in 30% to 50% of people who have hepatitis C.
9. How is Chronic Hepatitis diagnosed?
Diagnosis is based on liver biopsy and blood tests. With a liver biopsy, a small piece of the liver is removed through a needle and looked at under a microscope, which shows an excessive portal lymphocytic infiltrate that spreads to adjacent liver parenchyma. Other features are piecemeal necrosis and bridging fibrosis. The serum transaminases are persistently elevated to level that often are 10 times the normal levels. Blood tests can also tell whether the liver is working properly. They can also be used to monitor the liver function and health condition during treatment.
The blood test is used to screen and monitor the liver function including aminotransferase and viral antigen and/or antibody tests. Abnormal elevations in SGOT (ALT) and SGPT (AST) indicate liver inflammation. The other blood tests are necessary to determine that the hepatitis is due to hepatitis B or C infection.
The normal reference range of SGOT (ALT) is 8 – 20 U/L, and SGPT (AST) is also 8 – 20 U/L. They may vary with different laboratory.
10. Can Hepatitis B or C be prevented?
The best way to prevent hepatitis B or hepatitis C is to avoid sharing needles and having unprotected sex (without a condom). A vaccine is available to prevent hepatitis B. This vaccine should be given to people who are at high risk for this illness, such as health care workers, all children, drug users, people who get tattoos or body piercing, and those with multiple sex partners. No vaccine is available for hepatitis C.
11. What is the relationship of Chronic Viral Hepatitis and Cirrhosis to Liver Cancer?
Patients with chronic viral hepatitis had a 34-fold greater risk for liver cancer as compared with the general population. Patients with both chronic viral hepatitis and cirrhosis, however, had a much greater increase in the development of liver cancer--118-fold. (Presumably the cirrhosis was caused by the chronic hepatitis.) Clearly, the combination of chronic viral hepatitis and cirrhosis has a very strong association with the development of liver cancer. This association is much stronger than the association of the combination of alcoholism and cirrhosis with liver cancer. A stronger association with viral hepatitis than alcohol supports a greater role for the hepatitis viruses as compared with alcohol in promoting liver cancer.
12. How are Chronic Hepatitis B and C treated?
Alpha-interferons were the first drugs approved in the United States for the treatment of chronic hepatitis B and hepatitis C. Interferon alpha is a naturally occurring glycoprotein that is secreted by cells in response to viral infections. It exerts its effects by binding to a membrane receptor. Receptor binding initiates a series of intracellular signaling events that ultimately leads to enhanced expression of certain genes. This leads to the enhancement and induction of certain cellular activities including augmentation of target cell killing by lymphocytes and inhibition of virus replication in infected cells. The length of treatment depends on how severe the chronic infection is. Six months of treatment was originally recommended for interferons alpha, however, several studies have shown that treatment for a year or longer may be more effective. The patient must be monitored carefully during the treatment period for side effects including flu-like symptoms, depression, rashes, other reactions and abnormal blood counts.
Because interferons must be administered by subcutaneous or intramuscular injection with high cost and side effects, many people are looking for better option. In recent years, matrine and oxymatrine have been recommended for treating chronic hepatitis B and chronic hepatitis C in China. They have been shown comparably effective with interferons in clinical practice, but cost less and have fewer side effects.
13. What are Matrine and Oxymatrine?
Matrine and oxymatrine are the two major alkaloid components found only in Sophora species so far. These unique tetracyclo-quinolizindine alkaloids were first isolated and identified in 1958, although sophora japonica (kushen) has been used as a Chinese herbal medicine for thousands year. The crude herb and crude hot-water extracts of sophora have been available in the West for more than 25 years. An intensive investigation into the pharmacology and clinical applications of these alkaloids has gone on for the past decade and remains one of the focal points of the Chinese medical research. The main clinical applications are treatment of people with cancer, viral hepatitis, gastroenteritis, cardiac diseases (such as viral myocarditis), and skin problems (psoriasis and eczema etc.).
14. How can Proteliv(Oxymatrine) treat Hepatitis B and C?
Proteliv(oxymatrine) has been approved in China to treat chronic hepatitis B and chronic hepatitis C. According to Chinese clinical research in relation to viral hepatitis, Proteliv(oxymatrine) appears to inhibit the viral replication, reduce destruction of liver cells, protect against fibrosis, and also promote the flow of bile. These effects were comparable to those attained with interferon therapy, except that adverse reactions were avoided.
15. What is the new discovery of Pharmacologic Effects of Proteliv (Oxymatrine)?
After observations and studies on many cases with oxymatrine therapy for years, Chinese researchers and doctors have discovered that oxymatrine may have following pharmacologic effects.
• Reduce collagen activity and prevent liver fibrosis
• Inhibit the viral replication and against HCV, HBV etc.
• Double-directs immunology adjustment (depress higher immune response and promote lower immune function)
• Protect liver cells from many damaging factors and stops dying liver cells.
• Prevent chronic hepatitis B and chronic hepatitis C in developing into cirrhosis and liver cancer
• Reduce inflammation factors in serum and pancreas tissue
• Inhibit the growth of the blood vessel endoderm cells which induced by lung and stomach cancer cells
16. What results can be expected by Proteliv(Oxymatrine) therapy?
According to Chinese clinical researchers, people can expect to see the following symptoms improved with continual taking Proteliv(oxymatrine) for 3 – 6 months.
• About 90 – 94% of patients have improved their general symptoms such as fatigue and poor appetite, etc.
• About 99% of patients have improved the pressure or pain below the right ribs.
• About 71.4 – 81.6% of patients, abnormal SGOT (ALT) returns to normal.
• About 61.9 – 71.8% of patients, abnormal SGPT (AST) returns to normal.
• About 44.4 – 50.0% of patients, positive HBeAg is changed back to negative (46.0% negative change rate under interferon-alpha therapy).
• About 45.3 – 50.0% of patients, positive HBV DNA returns to negative (48.0% negative change rate under interferon-alpha therapy).
• About 47.1% of patients, positive HCV returns to negative (44 – 47% negative change rate under standard interferon with ribavirin therapy. The rate can be increased to 54 –56% by using the high dose of interferon with ribavirin, but the rate is only 16% if using interferon alone)
• About 69.9 – 99% of patients, Serum Bilirubin (SB) returns to normal.
17. Are there any side effects from Oxymatrine?
Generally oxymatrine is very safe extract of natural sophora with low toxicity. Side effects such as dizziness or gastric upset are evident only at unusually high dosage levels. Also at very high dosage levels, there is some evidence of immunosuppression from animal and in vitro studies.
Most people may take these natural products without any side effects but gain some extra benefits. People who are allergic to these products and have severe renal failure are not recommended to take it. Also people with severe liver failure should consult their physicians or other health care professionals. Women during pregnancy or nursing are better to avoid using it.
18. How long do you need to take Proteliv(Oxymatrine)?
Six months of treatment was originally recommended for interferons alpha and ribavirin therapy, however, several studies have shown that treatment for a year or longer may be more effective. Some patients cannot receive interferon and ribavirin therapy that long because of adverse reactions. Unfortunately, most patients relapse and have recurrent liver inflammation after the treatment is discontinued.
For chronic hepatitis B and chronic hepatitis C, the treatment times of Proteliv(oxymatrine) therapy are varied dependent on patients' responses. Theoretically, patients can take that as long as need. In general, most patients can see the improvements of symptoms and blood tests in 3 – 6 months. During the treatment periods, every 3 – 6 months blood tests are recommended for re-evaluation. For better results, patients need to continue taking Proteliv(oxymatrine) until the symptoms completely disappear and blood tests return to normal. But the dosage of Proteliv(oxymatrine) can be decreased along with the symptoms and blood tests returning to normal.
Recommended dosage of Proteliv (oxymatrine)
• 600 mg daily for therapy (2 capsules, three times per day with or after meals)
• 400 mg daily for maintenance (2 capsules, two times per day with or after meals)
• 200 mg daily to prevent relapse (2 capsules, once a day with or after meals)
This information has been reviewed by doctors and is for general educational purposes only. It is not a substitute for medical advice. For your particular concerns, please consult your family doctor with questions about your individual conditions.
