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March 29, 2007
How Mothers May Infect Their Children with HCV
Studies show that up to one in ten mothers infected with the Hepatitis C virus are likely to transmit the infectious disease to their children. Learn how much the risk of transmission increases when the mother is also infected with HIV.
Derek Thaczuk, Thursday, March 29, 2007
http://www.aidsmap.com
A new meta-analysis has confirmed that the mother-to-child transmission risk for hepatitis C virus (HCV) nearly doubles for mothers who are HCV/HIV coinfected. In coinfected mothers with detectable HCV viremia, the risk is nearly tripled. The results, published in the April 15th issue of Clinical Infectious Diseases, confirm those of a 2003 meta-analysis by another researcher.
Rates of vertical (mother-to-child) transmission of HCV range from 4 to 10%; mothers coinfected with HIV are more likely to transmit HCV to their child. An earlier meta-analysis (Pappalardo, 2003) determined the odds ratios for HIV-coinfected compared to HIV-negative mothers as 2.82 (95% CI, 1.78 to 4.45, p=.00001) for HCV antibody-positive women, and 1.97 (95% CI, 1.04 to 3.74, p=.04) for women with HCV viremia (detectable HCV in the blood).
Researchers from Johns Hopkins University School of Medicine have now performed a similar meta-analysis including two large studies not published at the time of the Pappalardo review. One of these – the European Pediatric Hepatitis C Virus Network (EPHN) study – is the largest such cohort to date, including 1479 babies.
The team’s conclusions were drawn from a restricted analysis that they believed provided the most reliable estimate (details below). According to this analysis, vertical transmission was 1.9 times more likely for HIV/HCV coinfected mothers than for HCV-infected mothers without HIV (95% confidence interval, 1.36–2.67). For coinfected mothers with detectable HCV viremia, the risk was 2.82-fold greater (95% CI, 1.17 to 6.81) than for HIV-negative mothers without HCV viremia.
Much of the Johns Hopkins report details the methodology of how studies were selected for the meta-analysis. The original literature review found 243 “potentially relevant” published articles (conference abstracts were not considered). From these, the team selected only results published in English which (among other criteria) presented original data, compared coinfected with HCV-monoinfected women, and included at least 20 coinfected women. This left only ten (mostly European) studies, published between 1993 and 2005 (Lam, 1993; Zanetti, 1995; Paccagnini, 1995; Zuccotti, 1995; Tovo, 1997; Zanetti, 1998; Granovsky, 1998; Resti, 2002; Rerrero, 2003; EPHN, 2005). All but one of these were prospective cohorts, yielding a total of 4424 mother/child pairs, 19.4% of which included coinfected mothers.
However, the investigators felt that the “most reliable estimate” came from an even more restricted pool – the five studies with sample sizes of at least 50. The odds ratio for coinfected mothers, calculated from the ten originally selected studies, was 2.75 (95% CI, 1.51 to 4.99). However, analysis indicated that the estimates in this group were “heterogeneous and ideally should not be pooled”. The lack of comparability was ascribed to “a lack of standardised HCV diagnostic criteria and the inability to control for known confounders” – such as selection bias, loss to follow-up, and means of delivery (Caesarean vs. live birth). The researchers therefore analysed various subgroups of the ten studies, leading to the 1.9-fold odds ratio drawn from the five studies (Paccagnini, Tovo, Granovsky, Resti, and EPHN) which “showed low heterogeneity, and were of better overall quality.”
Despite the similarity to the 2003 findings, the report concludes that more research is still required, particularly calling for “large studies that control for potential known confounders, use clear selection criteria … and employ standardized HCV testing[.]”
References
Polis CB et al. Impact of maternal HIV coinfection on the vertical transmission of hepatitis C virus: a meta-analysis. Clin Inf Dis 44:1123-1131, 2007.
Pappalardo BL. Influence of maternal human immunodeficiency virus (HIV) co-infection on vertical transmission of hepatitis C virus (HCV): a meta-analysis. Int J Epidemiol 32:727-734, 2003.
Posted by Editors at 11:24 AM --- Printer-friendly version
How Your Immune System Can Help Defeat Hepatitis C
Eighty-five percent of HCV patients develop chronic Hepatitis C. The remaining 15 percent have acute Hepatitis C, which spontaneously resolves within weeks or months. Learn how the health of your immune system determines whether the virus progresses to advanced liver disease and what you can do to help support your immune system.
by Nicole Cutler, L.Ac.
Our defense against bacteria and viruses, the immune system is essential in maintaining health. The strength of our immune system is one factor that determines whether Hepatitis C becomes of an acute case or develops into a chronic illness.
Hepatitis C’s extraordinary ability to evade the body’s immune system has been the focus of countless medical studies. Researchers at Johns Hopkins University School of Medicine have discovered how the genetic changes resulting from Hepatitis C infection allow it to avoid destruction by the body’s immune system.
Two Ways, Two Sites
Scientists have found that HCV is programmed to change form in two different ways, at two different sites. The genetic material under attack by immune cells evolves to weaken the immune system, while genetic material at different sites reverts back to an ancestral, or original, genetic code. This dual morphing capability of the Hepatitis C virus is why it is so challenging for the immune system to destroy. The infection becomes chronic when the virus evades immune cells and establishes itself in the body. At this point, the immune system becomes weakened and ineffective against Hepatitis C. For the millions of people in this position, their best defense against progression of the disease is by supporting and strengthening their immunity.
According to Hopkins study investigator, associate professor and infectious disease specialist, Stuart Ray, MD, "We think this piecemeal exchange is helping the virus evade the body's immune system. In a newly infected person, the virus may need to adopt new mutations to escape recognition by the immune system's T cells, which fight infection, but it may need to lose the mutations that had protected it in someone else. Despite pressure to change, the virus is always restoring its shape."
Ancestral Genetic Sequence
Hepatitis C demonstrates amazing self-modification capability. When the danger dissipates, the virus returns to its original form. The Johns Hopkins investigators found that when the immune response weakened, the Hepatitis C virus naturally mutated back to its preferred state. During the acute phase of infection, the virus is under severe pressure from the body’s immune response, forcing it to mutate. However, this change appears to be reversible. Once the virus successfully evades a particular immune cell, its amino acids revert back to its original sequence.
Fast Reproduction
According to the lead author of one of the studies, assistant professor at Hopkins and infectious disease specialist, Andrea Cox, MD, PhD, “The Hepatitis C virus naturally mutates, or alters its genome, very rapidly. For example, its strains have two to three times more genetic variability than HIV, the virus that causes AIDS, and Hepatitis C reproduces over 100 billion times per day, 100 times faster than HIV. Compounding the problem, Hepatitis C infection is asymptomatic in the early stages, making it less likely that diagnosis will be made early, when it is easiest to treat.” The speed at which Hepatitis C is capable of reproducing poses an additional challenge to stopping the virus dead in its tracks.
Darwin’s Prodigy
Charles Darwin, the father of evolution comprehension, put forth the concept that the Hepatitis C virus closely follows. The well-known phrase, “survival of the fittest,” is applicable to this virus’ lifecycle. The Hepatitis C virus' genetic material changes in ways that make it more reproductively "fit" in the face of each immune system it encounters. The virus changes to evade the immune system in one host, then restores itself when the pressure is off.
Good News
The silver lining in discovering Hepatitis C’s mastery of transformation is the insight it provides researchers working to defeat the virus. In response to this research, scientists have identified Hepatitis C’s chain of amino acids, its ancestral genetic code. Having this code is a critical to genetic biologists in developing a potential vaccine.
Maintaining strong immunity means paying attention to your body and incorporating healthful lifestyle choices into your routine. In general, experts recommend the following tips for a healthy immune system:
· Get Sufficient Sleep – The immune system is replenished during the deep stages of sleep.
· Wash Your Hands – Keeping your hands clean will reduce stress on the immune system by minimizing the microbes it must constantly battle.
· Follow a Balanced, Nutritious Diet – Eating well provides your immune system with the tools it needs to be in tip-top shape. Avoid sugar and the processed foods that harm immunity by suppressing crucial immune cells. If need be, consult a nutritionist for proper guidance.
· Avoid Toxins – Items toxic to your immune system include alcohol, cigarettes, chemicals and pollution. Toxins slow down and weaken the immune response. Consider an antioxidant and natural detoxifier such as Liv.52 to neutralize the toxins you encounter every day.
· Reduce Stress – Finding ways to minimize stress reduces stress-related hormones from weakening the immune system.
· Supplement – Consider supplementing your diet with a safe, energy enhancement solution product such as Fatigue Relief Plus. In addition to naturally replenishing energy to overcome the fatigue associated with HCV, it provides vitamins, minerals and probiotics to strengthen the body’s immune system.
Keeping your immune system as strong as possible is the key to longevity. Whether you are virus-free or not, fortifying your defenses can make the difference between developing acute or chronic viral hepatitis, as well as preventing liver disease progression.
References:
Gremion C, Cerny A, Hepatitis C Virus and the Immune System: A Concise Review, Reviews in Medical Virology, July/August 2005.
www.businessweek.com, Waging War on Hepatitis C, John Carey, McGraw Hill Companies, February, 2006.
www.hcvadvocate.org, The Role of the Immune System in Determining Viral Outcome After Hepatitis C Viral Infection, Jose Azocar, MD, DS, Hepatitis C Support Project, 2006.
www.medicinenet.com, Hepatitis C, MedicineNet, Inc., 2006.
www.medicalnewstoday.com, How Hepatitis C Virus Evades Immune System in Acute and Chronic Infections, Johns Hopkins Medical Institutions, June 2005.
www.sciencedaily.com, Study Details Hepatitis C Ability to Block Immune System Response, Scripps Research Institute, May 2006.
Posted by Editors at 09:22 AM --- Printer-friendly version | Comments (0)
March 28, 2007
New HCV Treatment Recommended for Non-Responders
A new drug called Infergen is opening new doors for people infected with the Hepatitis C virus who are not responding to standard treatment. Learn why this treatment option is recommended for non-responders, and other key information to share with your physician in determining whether Infergen may be right for you.
Help for Hep C
By Margot Kim
http://abclocal.go.com
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 yearlong 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 dose 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 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
Posted by Editors at 04:08 PM --- Printer-friendly version
March 26, 2007
Hepatitis C Remains Major Health Threat
According to the Centers for Disease Control and Prevention (CDC), vaccination programs for Hepatitis A and B have helped decrease the rate for new acute hepatitis infections. Despite this good news, the American Liver Foundation (ALF) points out that chronic Hepatitis C infection rates have not followed suit and are actually increasing. Learn what is causing the concern behind the ALF's response, and how the cost of treating Hepatitis C impacts our health care system.
http://sev.prnewswire.com
The American Liver Foundation Urges Cautious Optimism about CDC Report on Declining Acute Hepatitis Infection Rates
Focus Must Remain on the Millions Still Suffering from Chronic Hepatitis B and C
NEW YORK, March 21 /PRNewswire/ -- The Centers for Disease Control and Prevention (CDC) has reported that significant decline in the rates of new acute hepatitis infections in the United States in the last 10 years, reflecting the success of hepatitis A and B vaccination programs. The American Liver Foundation wants to highlight these positive results, but remind people that chronic hepatitis B and C are very serious diseases that affect over five million Americans and that the prevalence of chronic hepatitis C infection is actually increasing. This is in response to the article "Surveillance for Acute Viral Hepatitis -- United States, 2005," published by the CDC in their publication Morbidity and Mortality Weekly Report.
Acute, or short-term, infections are more common with hepatitis A and B and less likely to cause serious health problems than a chronic, or long-term, infection. Hepatitis A does not cause chronic infections. Only five percent of all adults infected with hepatitis B develop chronic infection, although 90 percent of infants infected with hepatitis B do develop chronic hepatitis B. On the other hand, hepatitis C becomes a chronic infection for 70-80% percent of those exposed to the virus.
"I was very pleased to read this report about the decline in acute hepatitis infections," said Dr. James Boyer, Chair of the Board of the American Liver Foundation and Director of the Liver Center at the Yale University Medical School. "But this good news must not let us forget the millions of Americans suffering with chronic hepatitis. Without diagnosis and treatment these people are in serious risk of developing cirrhosis and liver cancer. Much more work needs to be done to combat hepatitis in this country."
With nearly two percent of Americans infected with the hepatitis C virus, the costs of this disease to the health care system is severe. A study conducted in 2002 estimated total medical expenditures for people with hepatitis C at $15 billion per year. The projected direct and indirect costs of hepatitis C, if infection rates do not continue to drop significantly, will be $85 billion for the years 2010-2019 as the number of people chronically infected will continue to increase.
Facts about hepatitis
* There are five distinct types of hepatitis: A, B, C, D, and E. All
cause inflammation of the liver
* The hepatitis B virus is 100 times more infectious than HIV
* It is estimated that there are 1.4 million Americans with chronic
hepatitis B
* Hepatitis B and C can lead to liver cancer
* There are vaccines for hepatitis A and B. There is no vaccine for
hepatitis C
* Hepatitis C is the most common blood-borne infection in the United
States
* Almost 4 million Americans, or 1.8 percent of the U.S. population, are
or have been infected with hepatitis C
* Recent studies suggest that approximately 40 percent of the 2.2 million
people in America's prison system are infected with hepatitis C
About the American Liver Foundation
The American Liver Foundation is the nation's leading nonprofit organization promoting liver health and disease prevention. ALF provides research, education and advocacy for those affected by liver-related diseases including hepatitis. Please visit the American Liver Foundation's Web site at http://www.liverfoundation.org/
Website: http://www.liverfoundation.org/
Posted by Editors at 10:29 AM --- Printer-friendly version | Comments (0)
March 23, 2007
Night Sweats: Another Approach to this Common HCV Symptom
Night sweats are a common symptom of chronic Hepatitis C infection. Though Western medicine has neither a concrete explanation nor a solution, Traditional Chinese Medicine has ways of dealing with this uncomfortable symptom. Learn more about the causes of night sweats and what you can do to manage and minimize their impact.
by Nicole Cutler, L.Ac.
Chronic Hepatitis C presents many different symptoms in its patients, such as fatigue, abdominal pain, nausea, jaundice, muscle aches, and night sweats. Individuals who suffer from night sweats may awaken in the middle of the night either feeling too cold or too hot, their palms clammy and their bed sheets wet with perspiration. Night sweats can disrupt sleep, causing stress and insomnia. For an illness without a cure, the only resolution of night sweats for people with Hepatitis C is the eradication of the virus. A common symptom for people with chronic Hepatitis C and a wide range of other health disorders, Western medicine does not have a cure for night sweats. However, Traditional Chinese Medicine (TCM) recognizes night sweats as a specific dysfunction and addresses it accordingly.
Perspiration is how the body regulates its temperature. Controlled by the sympathetic nervous system, sweating can occur with any bio-thermal activity. The quantity of sweat and the speed it is expired through the body’s 200-500 million pores depends primarily on these five factors:
1. Temperature
2. Moisture
3. Wind
4. Physical health
5. Emotional status
Proposed Causes
While the physiological explanation for night sweating is widely debated, most experts believe the cause to be one of the following:
· Infectious Diseases – Hepatitis C falls under this category, as does HIV and tuberculosis. Any infectious disease bringing on a fever can cause night sweats.
· Menopause – The hormonal changes causing menopause in women is the most common cause of night sweats. However, some men also suffer from night sweats during the male menopause (andropause).
· Diabetes Insipidus – Night sweats are often a symptom of diabetes. Other metabolic conditions have also been associated with night sweating.
· Sleep Apnea – When accompanied by severe snoring and excessive daytime sleepiness, night sweats can be a sign of sleep apnea.
· Alcohol, drugs and spicy foods – Consumption of any of these can cause night sweats. Some recreational and prescription drugs can both potentially cause night sweats.
· Hot and humid environment – Sleeping in a hot room or with blankets that are too warm can cause overheating, resulting in night sweats.
Approaches
Western medicine advises approaching night sweats based on their cause. Since HCV is currently an infectious disease without a cure, this approach provides little relief. Below are some practical tips on managing night sweats:
· Avoidance – Avoid alcohol (this is a given with liver disease), cigarettes, recreational drugs, spicy foods, caffeine and sugar. All of these can raise body temperature.
· Drug check – Talk with your doctor about your medications to see if they could be contributing to night sweating.
· Cool down – Keep your bedroom cool. If weather permits, keep a window open, or try using a fan. However, avoid a draft directly on you.
· Shower – Taking a cool shower before bed may lower body temperature enough to prevent an attack of night sweats.
Traditional Chinese Medicine perceives night sweating as an indication of a person’s state of health. According to Chinese medical theory, night sweats are associated with an imbalance of yin, where body fluids and nutrients are depleted.
In TCM, the well-known yin-yang symbol is the embodiment of balance. Although they represent opposite forces, there can be no yin without yang, and vice versa. Yin is the material basis for yang. Yang is the functional manifestation of yin. The three most relevant properties of yin are as follows:
1. Cools – Due to its fluidity, yin cools the body and maintains an even body temperature.
2. Nourishes – Yin supplies nourishment to the body at all levels.
3. Provides rest – When in balance with yang, yin enables us to use our energy efficiently, recover easily from fatigue and preserve health.
In cases of chronic disease, particularly when the liver is affected, the proportion of yin to yang diminishes. Symptoms of yin deficiency include night sweats, fatigue, restlessness, insomnia, flushed cheeks, warm palms and soles, a dry mouth, red lips, and low-grade afternoon fevers. Therefore, TCM approaches night sweats by fortifying yin. Those trained in TCM utilize a variety of techniques and/or herbal prescriptions to tonify the yin. Countless case studies document night sweats disappearing under the care of a TCM practitioner. Although less potent than acupuncture or Chinese herbs, consuming the following foods can also help fortify yin:
· Grains – barley, millet
· Beans – adzuki beans, kidney beans, black beans, black soya beans, mung beans
· Protein – eggs, beef, pork, duck, oyster, clams, crab, octopus, fish
· Flavorings – sesame seeds, black sesame seeds, walnuts
· Vegetables – asparagus, artichokes, peas, regular and sweet potatoes, seaweed, yams, tomatoes
· Fruits – apples, pears, pomegranates, watermelon, bananas, avocadoes
Approximately 50 percent of people with Hepatitis C can successfully rid themselves of the virus with current western medical treatments. TCM can provide a new approach to those who continue to experience night sweats as a result of the disease. Although Traditional Chinese Medicine does not claim to rid the body of HCV, seeing a qualified practitioner or following TCM dietary advice as outlined here can put an end to this uncomfortable symptom.
References:
www.acupuncturetoday.com, Hepatitis C Virus: The Silent Epidemic, Part Two, Misha Cohen, OMD, L.Ac., Acupuncture Today, October 2002.
www.digitalnaturopath.com, Night Sweats, The Analyst, 2007.
www.comoxvalleyacupuncture.com, Dietary Principles According to Traditional Chinese Medicine, Comox Valley Acupuncture, 2007.
www.patients.uptodate.com, Approach to the Patient with Night Sweats, Gerald W. Smetana, MD, UptoDate, 2007.
www.sleepdisorders.about.com, How to Cope with Night Sweats, About, Inc., 2007.
www.sleepingdisorder-abc.com, Sweating Sleep: What It Means When You Have Night Sweats, Sleeping Disorder ABC, 2007.
www.thebody.com, Treating Night Sweats with Herbs, Dr. Qingcai Zhang, The Body, 2007.
Posted by Editors at 04:43 PM --- Printer-friendly version
At Risk: Veterans Test Positive for Hepatitis C
More than 60% of people who die as a result of the Hepatitis C virus (HCV) have served in our country's military. A recent study conducted by the Veterans Health Administration determined the infection rate for veterans living with HCV is five times greater than the general population. Learn why veterans are an at-risk group for carrying HCV and the value of being tested immediately.
http://moberlymonitor.com
Published: Monday, March 12, 2007
Veterans News Report
Each hour of every day, three people die from Hepatitis C or its related conditions. Two of three people have military backgrounds. A study by the Veterans Health Administration (VHA) involving 26,000 veterans showed that up to 10% of all veterans in the VHA system tested positive for hepatitis C, while the infection rate on the general population is only 1.8%.
The hepatitis C virus is a blood borne disease that attacks the liver. In 85% of the cases, the infection will last a lifetime. This puts a person at risk for developing cirrhosis of the liver, liver cancer, and even death. Many people don't know they are infected because there are no symptoms at first. However, hepatitis C can slowly progress to cirrhosis over many years.
Many ways of getting infected have been identified. Combat and even military training often bring soldiers into contact with blood. Exposures to bleeding wounds or transfusions are ways you may become infected. Tattoos, sexual contact, or injection or snorting of drugs are other possible risks.
Of the total number of persons who were hepatitis C antibody positive, and reported an era of service, 62.7% were from the Vietnam war. The second most frequent group is listed as post-Vietnam at 18.2%, followed by 4.8% Korean conflict, 4.3% post-Korean conflict, 4.2% from World War II and 2.7% Persian Gulf era veterans. It has been estimated that at least 36,000 soldiers transfused in Vietnam received infected blood.
Typical symptoms are abdominal discomfort, loss of appetite, nausea, vomiting, fatigue and weight loss, and sometimes yellowing of the skin and eyes. Symptoms can range from mild to severe. However, 75% of infected persons may have no symptoms at all.
If you have hepatitis C, there are important things you can do to help prevent spreading hepatitis C to your loved ones and other individuals. Unfortunately, most of the 4 million Americans infected have not been diagnosed, and thus do not know that they have hepatitis C. The sooner you know if you are infected, the sooner you can take steps to safeguard your health. You protected your country, now protect yourself if you have hepatitis C. If you have any questions, or want more information about hepatitis C contact your health care professional, or your VA medical center.
This information has been presented by The American Legion in conjunction with your local American Legion Post.
Posted by Editors at 03:52 PM --- Printer-friendly version
March 20, 2007
Update to Previous News Item: Politician Passes Away
Immediately upon sending the most recent Research and Treatment News Update earlier today, we learned of the unfortunate news that New York Assemblyman Kenneth Zebrowski passed away Sunday morning. Join us in sending our heartfelt condolences to the Assemblymen's family during this difficult time. In addition to learning more about Mr. Zebrowski's public service career, read on to find information regarding funeral arrangements for those who wish to pay their respects to this honored politician.
www.thejournalnews.com
Assemblyman Zebrowski dies at 61
By Suzan Clarke
Assemblyman Kenneth P. Zebrowski died yesterday morning at Nyack Hospital after a battle with hepatitis C.
The cause was a combination of liver and kidney failure, according to the family.
Zebrowski, 61, was "a force of nature," said Rockland County Legislature Chairwoman Harriet Cornell, who knew him for more than 35 years.
"I think his family was just so important to him, and he really was very, very loyal to friends and ... he really loved the art of governing," Cornell said. "It was just something he really loved, and I think he'd been very, very happy in the New York state Assembly."
Zebrowski, of New City, was first elected to the county Legislature in November 1973 at age 29 and was then the youngest member of the body. That began a 33-year career in elected office.
Representing the 5th District, which includes New City and part of the Mount Ivy area in Haverstraw, he served in the county Legislature for 21 years, including four years as chairman and two years as majority leader.
During his tenure, he was chairman of the Budget and Finance Committee and led a panel of legislators that investigated alleged misuse of authority by trustees at Rockland Community College.
In 2003, when Zebrowski was running for his fifth term on the county Legislature, he cited among his accomplishments co-sponsoring a law that banned the sale of ephedra in Rockland and helping pass laws to protect open space and waterways.
Zebrowski was first elected to the Assembly in 2004, representing the 94th District, which covers Clarkstown, Haverstraw and parts of Ramapo.
He ran unopposed after former Assemblyman Alexander Gromack left the race to take the Clarkstown town supervisor position.
While running for his second term in the Assembly, the senior Zebrowski said that the health and welfare of senior citizens were his top priority and that he was working with state Sen. Thomas Morahan, R-New City, on getting help for those affected by the Mirant tax challenge.
One bill he sponsored allows seniors to bypass automated telephone menu systems when dealing with medical insurance companies.
He served on the Assembly's Aging, Codes, Corporations, Authorities and Commissions, Governmental Employees, Judiciary, and Racing and Wagering committees.
Zebrowski twice ran unsuccessfully for state senator - once in a special election in 1999 and again in 2000. Both times were against Morahan.
In spite of their respective political affiliations, the men had a long friendship that began when both were Rockland County legislators.
"We served on two different sides of the aisle in the local Legislature, but it was always with respect for each other, and we always strove for a consensus and a compromise, so that we could get a result, and working together we got much done," Morahan said.
"When he came to Albany, we worked together on bills. ... We did a lot together. He was a pleasure to work with, and this is a very, very sad day.
"I think Rockland County lost a great spokesperson, a man who loved his job and loved being a legislator and loved writing laws. He was a wonderful man, and we'll miss him."
Morahan talked with Zebrowski a few days ago. The conversation was jocular, reflecting their need to keep their spirits up, Morahan said.
"It's hard to describe the emotion and the words that may have passed between us," he said. "They were from my side, encouragement, and from his side, he was fighting. He was fighting to get better."
Jeffrey Adams of Haverstraw called Zebrowski a mentor, colleague and friend who was always willing to help everyone.
"I'm numb, because even though I heard he was in ill health, and I spoke with him several days ago, Kenny was going to be back, and everything was going to be fine, and he was a battler, and he never quit," said Adams, an attorney.
In an interview with The Journal News in 1975, Zebrowski described having worked, while as a high school and college student, as a busboy, then waiter, then dining room manager, at Dellwood Country Club in New City.
He had complained to his father about how hard he labored and what little recognition he got.
"You get paid to do a good job, not a bad one," he recalled his father, Vincent, saying to him.
"I really am in love with the law," he said later during that interview. "I know that's about as corny as you can get, but I really think it gives you perspective on people's lives."
In 1973, he underwent surgery to remove a benign tumor from his brain lining.
A Roman Catholic who has supported funding for Planned Parenthood, Zebrowski has said his views on abortion were "his own" and that he didn't believe he had a right to legislate other people's outlook on the issue.
Zebrowski began missing Assembly votes in late February and was listed as "EOR," meaning he was excused for other reasons than legislative business.
The last session for which he was present for all votes was Feb. 14.
He underwent a procedure March 2 to treat the hepatitis and also was being treated for a blood clot in his leg.
Vince Monte, the chairman of the Rockland Democratic Committee, said he was saddened by Zebrowski's death.
"Quite frankly, I'm going to miss the discussions of politics and government," Monte said. "I'm really going to miss him, and reminiscing about our time when we came up as young Democrats."
Zebrowski was born on Nov. 12, 1945, in Brooklyn.
He is survived by his wife, Linda; children Kristen, Kevin, Kenneth P. Jr., Kristopher, Kraig and Kathryn; his mother, Jean Zebrowski; and a sister, Ronnie Horn.
His father, Vincent, died in 1989.
Calling hours will be from 2 to 4 and 7 to 9 p.m. Wednesday and Thursday at Michael J. Higgins Funeral Home, 321 S. Main St., New City.
A funeral Mass will be at 10 a.m. Friday at St. Augustine's Church, South Main Street, New City.
Zebrowski's local Assembly office will remain open today, spokesman Keith Braunfotel said.
Posted by Editors at 03:58 PM --- Printer-friendly version | Comments (0)
March 19, 2007
Announcing: HCV Study to Examine Fixed Dose Induction of PEGASYS
Roche will soon test a new treatment strategy in Hepatitis C patients who have a high viral load and are overweight. Individuals with hard-to-treat characteristics will be particularly interested in the result of this trial examining the effect of combining different levels of PEGASYS and ribavirin.
http://home.businesswire.com
Roche Driving PROGRESS in Treatment of Hepatitis C Patients with New PEGASYS® Trial
Large study examines fixed dose induction of PEGASYS in patients with difficult to treat characteristics
NUTLEY, N.J.--(BUSINESS WIRE)--Roche today announced the start of a large, multinational trial to examine a new treatment strategy in hepatitis C patients with difficult-to-treat characteristics. This study will evaluate the effect of PEGASYS® (peginterferon alfa-2a) and ribavirin in patients who have a high level of genotype 1 virus in their blood (high viral load) and who are heavier than average in weight. The trial, known as PROGRESS (PEGASYS and Ribavirin Optimized in Genotype 1 high virRal load patiEntS to improve SVR), will examine the potential benefits of using a fixed dose induction (360 mcg) of PEGASYS for the first 12 weeks of therapy.
“We have seen major advances in treatment success rates for hepatitis C in recent years,” said Dr. Rajender Reddy, University of Pennsylvania and one of the lead study investigators. “However, patients with high levels of genotype 1 virus in their blood and who also are overweight tend not to respond as well to current antiviral therapy regimens. PROGRESS will reveal whether induction dosing with PEGASYS in combination with either a higher dose or a standard dose of ribavirin offers these patients an improved chance of treatment success.”
About the PROGRESS Trial
More than 1,000 patients will be enrolled in PROGRESS and will be randomized to receive one of four dosing regimens of PEGASYS plus ribavirin for 48 weeks, followed by a 24-week treatment-free follow-up period. The four dosing regimens are:
* A fixed-dose induction (360 mcg) of PEGASYS given once every week for the first 12 weeks then the standard 180 mcg dose of PEGASYS for the following 36 weeks. Patients will also receive a 1,400-1,600 mg daily ribavirin dose for the full 48 week treatment period.
* A fixed-dose induction (360 mcg) of PEGASYS given once every week for the first 12 weeks then the standard 180 mcg dose of PEGASYS for the following 36 weeks. Patients will also receive the standard dose of ribavirin (1,000-1,200 mg daily) for the full 48 week treatment period.
* The standard 180 mcg dose of PEGASYS for 48 weeks plus a 1,400-1,600 mg daily ribavirin dose for the full 48 week treatment period.
* Control group who will receive the standard of care with weekly 180 mcg PEGASYS dose plus ribavirin (1,000-1,200 mg daily) for the full 48 week treatment period.
Large Multinational Clinical Trial
Fifteen countries will participate in the trial with a total of 150 trial sites. Enrollment is ongoing in the U.S., and well as Belgium, Brazil, Canada, Denmark, Finland, France, Germany, Hungary, Norway, Poland, Romania, Russia, Sweden and the United Kingdom. The trial is expected to conclude in 2008.
“Roche recognizes that there is an urgent need to improve the chances of patients with difficult-to-treat characteristics to achieve treatment success, which is why we are launching PROGRESS,” said Tom Klein, Vice President, Hepatology, Roche. “This new, landmark trial with PEGASYS underscores our long-term commitment to finding treatment solutions for as many patients as possible.”
Previous studies have suggested that induction doses of PEGASYS, together with higher doses of ribavirin, may be of value in improving outcomes in patients with heavier than average bodyweight, genotype 1 hepatitis C and a high viral load. PROGRESS also will assess the critical and evolving role of ribavirin in optimizing treatment for patients with hepatitis C.
Those interested in the trial can find more information at www.roche-trials.com.
About Hepatitis C
Hepatitis C, a blood-borne infectious disease of the liver, is transmitted through body fluids, primarily blood or blood products, and by sharing needles. Hepatitis C chronically infects an estimated 2.7 million Americans and 170 million people worldwide and is the leading cause of cirrhosis and liver cancer and the number one reason for liver transplants in the U.S.
About PEGASYS
PEGASYS, in combination with COPEGUS (ribavirin), is indicated for the treatment of adults with chronic hepatitis C who have compensated liver disease and have not previously been treated with interferon alpha. Efficacy has been demonstrated in patients with compensated liver disease and histological evidence of cirrhosis (Child-Pugh class A) and patients with HIV disease that are clinically stable (e.g., antiretroviral therapy not required or receiving stable antiretroviral therapy). In addition, PEGASYS in combination with COPEGUS is the first and only FDA-approved regimen for the treatment of chronic hepatitis C in patients coinfected with hepatitis C and HIV. PEGASYS is the only pegylated interferon indicated for the treatment of adult patients with chronic hepatitis B (HBeAg positive and HbeAg negative chronic hepatitis B who have compensated liver disease and evidence of viral replication and liver inflammation).
PEGASYS is dosed at 180mcg as a subcutaneous injection taken once a week. COPEGUS is available as a 200mg tablet, and is administered orally two times a day as a split dose. Roche has backed PEGASYS with the most extensive clinical research program ever undertaken in hepatitis C, with major studies initiated to advance treatment for hepatitis C patients with unmet needs, including patients co-infected with HIV and HCV, African Americans, patients with cirrhosis, and patients who have failed to respond to previous therapy.
Important Safety Information about PEGASYS
What is PEGASYS?
PEGASYS is a medicine used to treat some adults who have hepatitis C or hepatitis B and signs of liver damage. PEGASYS works to reduce the amount of virus in your blood, helping your body fight the virus.
PEGASYS (Peginterferon alfa-2a), like other alpha interferons, can cause fatal or make life-threatening problems worse (like mental, immune system, heart, liver, lung, intestinal and infections). Your doctor should monitor you during regular visits. If you show signs or symptoms of these conditions, your doctor may stop your medication. In most patients, these conditions get better after you stop taking PEGASYS (see medication guide for more information and warnings).
What is COPEGUS?
COPEGUS is a medicine that works by slowing down the growth of the virus. COPEGUS should be taken with PEGASYS to fight the virus. Do not take COPEGUS by itself.
COPEGUS (Ribavirin, USP) can be extremely harmful and cause birth defects in an unborn baby. Female patients and the female partners of male patients should avoid getting pregnant. Ribavirin is known to cause anemia (low red blood cells), which can make heart disease worse. Also, Ribavirin can harm your DNA and possibly cause cancer (see medication guide for more information and warnings).
Who should not take PEGASYS and COPEGUS?
Do not take PEGASYS alone or with COPEGUS if:
* You are pregnant or your partner is pregnant
* You or your partner plans to get pregnant during therapy or within 6 months after treatment ends
* You are breastfeeding
* You have hepatitis caused by your immune system (autoimmune hepatitis)
* You have unstable or severe liver disease before or during treatment
* You are allergic to alpha interferons or any of the ingredients in PEGASYS and COPEGUS
* You have abnormal red blood cells (caused by conditions like sickle-cell anemia or thalassemia major)
What if I am pregnant or thinking about having a baby?
If you are a woman who could get pregnant, you must take pregnancy tests before, during and for 6 months after treatment ends to make sure you are not pregnant.
During treatment and for 6 months after treatment, female and male patients must:
* Use two forms of birth control (one being a condom with spermicide)
* Tell your doctor right away if you or your partner becomes pregnant. You or your doctor should also call the Ribavirin Pregnancy Registry at 1-800-593-2214
What medication should I avoid when I am taking PEGASYS and COPEGUS?
You should not take didanosine with COPEGUS. Talk to your doctor about all medications that you are taking.
What are the possible side effects?
The most common side effects of PEGASYS and COPEGUS are:
* Flu-like symptoms (including fever, chills, muscle aches, joint pain, headaches)
* Tiredness
* Upset stomach (like nausea, taste changes, diarrhea)
* Blood sugar problems (may lead to diabetes)
* Skin problems (like rash, dry or itchy skin, redness and swelling at injection site)
* Hair loss (temporary)
* Trouble sleeping
The most serious side effects of PEGASYS and COPEGUS are:
* Risks to pregnancies
* Mental health problems (such as irritability, depression, anxiety, aggressiveness, trouble with drug addiction or overdose, thoughts about suicide, suicide attempts, suicide and thoughts about homicide)
* Blood problems (like a drop in blood cells leading to increased risk for infections, bleeding and/or heart or circulatory problems)
* Infections (which sometimes cause death)
* Lung problems (like trouble breathing, pneumonia)
* Eye problems (like blurred vision, loss of vision)
* Autoimmune problems (such as psoriasis, thyroid problems)
* Heart problems (including chest pain and, rarely, a heart attack)
* Liver problems (rarely, liver function worsens). Patients with both the hepatitis C virus and HIV can have an increased chance of having liver failure during PEGASYS treatment. Change in a blood test that measures liver inflammation occurs more often in patients with hepatitis B. If you have a rise in this blood test you may need to be watched more closely with additional blood tests.
Tell your doctor immediately if you think you or your partner may be pregnant or if any of these symptoms occur.
About Roche
Hoffmann-La Roche Inc. (Roche), based in Nutley, N.J., is the U.S. pharmaceuticals headquarters of the Roche Group, one of the world’s leading research-oriented healthcare groups with core businesses in pharmaceuticals and diagnostics. For more than 100 years, the Roche Group has been committed to developing innovative products and services that address prevention, diagnosis and treatment of diseases, thus enhancing people's health and quality of life. An employer of choice, in 2006, Roche was named one of the Top 20 Employers (Science magazine), ranked the No. 1 Company to Sell For (Selling Power), and one of AARP’s Top Companies for Older Workers, and in 2005, Roche was named one of Fortune magazine’s Best Companies to Work For in America. For additional information about the U.S. pharmaceuticals business, visit our websites: http://www.rocheusa.com or www.roche.us.
Contacts
Roche
Mike Nelson, 973-562-2409
mike.nelson@roche.com
or
MS&L
Joseph St. Martin, 212-468-3731
joe.stmartin@mslpr.com
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A Pending Healthcare Crisis: HCV in U.S. Prisons
The rampant spread of Hepatitis C in this country's penal system will not remain confined to those imprisoned. Ninety percent of the nation's incarcerated will be released back into the community, representing a healthcare crisis that cannot be ignored. This article highlights the importance of prevention and control efforts of at-risk populations, regardless of whether they are behind bars or right next door.
By Martha Mendoza
Associated Press
March 14, 2007
Unchecked in prison, hepatitis C threatens the world outside
VACAVILLE – The most dangerous thing coming out of prison these days may be something most convicts don't even know they have: hepatitis C.
Nobody knows how many inmates have the disease; by some estimates, around 40 percent of the 2.2 million in jail and prison are infected, compared with just 2 percent of the general population.
Eventually, when they are released, medical experts predict they will be a crushing burden on the health care system, perhaps killing as many people as AIDS in years to come. At the same time, they will be carriers, spreading the disease.
Hepatitis C can be treated, but many prisons do not test for it. Among the reasons: Budgets are tight, and treatment is expensive. So prison officials close their eyes to the gathering emergency and pass it along to the outside world.
“Right now there's a golden opportunity to bring solutions to this problem before it hits,” said Dr. John Ward, director of viral hepatitis at the National Center for HIV/AIDS at the Centers for Disease Control and Prevention in Atlanta.
Hepatitis C is already the most common disease of its sort in the United States – a chronic, life-threatening, blood-borne infection. It is most commonly linked to infected needles used for drugs, though prison tattoos and body piercing with non-sterile equipment are also risky.
What makes this virus particularly insidious is that as many as half of the people who have hepatitis C don't even know they have it. The “silent killer,” already considered epidemic by the World Health Organization, often remains dormant for decades.
Some of the infected are lucky: One in five people who get hepatitis C will clear it out of their system naturally. But without treatment, one in four will suffer liver failure or develop liver cancer. Last year liver cancer was the only one of the top 10 fatal cancers in this country to increase, in large part because of hepatitis C.
More than $1 billion is already spent each year on this country on hepatitis C, and those costs are expected to soar unless prevention and treatment are expanded.
Without those changes, researchers project that liver-related deaths will triple from around 13,000 in 2000 to 39,000 by 2030. It's also estimated that 375,000 Americans with hepatitis C will develop cirrhosis by the year 2015.
Anita Taylor, 48, is already there, in end-stage liver disease. Taylor speaks very slowly and moves with care. She often finds that she can't say the words she wants to – they just won't come out. Her body hurts most of the time. Her nose bleeds a lot.
A mother of two and former heroin addict, Taylor said she learned she had hepatitis C when she was jailed in Nevada in 1991 for being under the influence of drugs.
“They tested me and told me I had hepatitis C. They didn't tell me there was a treatment and a cure,” she said. “And I didn't know to ask.”
Taylor's experience is not unusual.
“The doctor gave me a death sentence, recalls Leslie Czirr, a 36-year-old parolee. “He told me, 'There's no cure for this and you will die from it unless you are hit by a truck first,'”
Czirr learned she had hepatitis C during a prenatal examination in 1996, at a time when she wasn't in prison. Czirr has been arrested 10 times for drug possession and served almost eight years in prison on various drug possession and dealing charges.
She has started to suffer exhaustion, brain fog and aches. She recently enrolled in a county program to be treated – treatment, she said, she was denied at California's Norco State Prison.
“I asked and asked, but they barely want to give you a Motrin,” she said. “I really want to get well, not just for myself, but so I'm not putting anyone else at risk.”
Limited studies indicate that fewer than 10 percent of prisoners who have contracted hepatitis C are treated. The reason vary. Medical staff have other priorities, and not all are well-informed about the disease. Prisoners with short sentences are often excluded because they won't be able to complete treatment, and drug addicts who are inclined to return to risky behavior are often turned away because it is assumed they will simply reinfect themselves.
Usually, though, it comes down to money. Prison officials say that even if they wanted to provide the treatment, it is extremely expensive – about $9,500 per patient per year – and no federal funds have been earmarked to pay for it.
“It's a hard sell to convince taxpayers why additional resources should be spent on the health care of the incarcerated when there are a lot of people who aren't incarcerated who don't have adequate health care,” said Dr. Joseph Bick, chief medical officer at the California Medical Facility at Vacaville.
Many of the inmates in Vacaville's hospice unit – reserved for those given six months or less to live – are dying from hepatitis C-related ailments. Bick said half of the prison's 3,200 inmates have a history of having been infected with hepatitis C, and at any given time about 40 of those men are receiving the intensive drug treatment to cure it.
“I'm pretty sure this is how I got it,” said Anthony Harris, an inmate at Vacaville. He rubbed his forearm hard, as if trying to remove the prison tattoo bearing his children's names.
Harris, 51, is a former barber serving a life sentence for second-degree murder. In 2003, a doctor at another prison told him he had Hepatitis C; he researched the disease in the prison library and has sought treatment ever since.
“They gave me shots for Hep A and B, got rid of them. I'd like to get rid of the C too,” he said. “I'm entitled to that. But some docs will give you the treatment and others won't. I keep making appointments. I keep asking.”
The course of treatment can take a year, and involves taking pills twice a day and weekly injections. Side effects are like those associated with chemotherapy – nausea, exhaustion, depression, debilitating aches and pains – and the cure only works about half the time.
But Bick said the high cost of treating prisoners for hepatitis C is a bargain compared to the bill that would come due if these cases are left untreated. “It's a tremendous opportunity for us to have an impact on the larger health of the community,” he said.
Dr. Lynn Taylor, an assistant professor of medicine at Brown University's medical school, agrees that prison is “perhaps one of the best setting for treatment of high-risk individuals.”
“Prison can be a window of opportunity to reduce the reservoir of infection,” she said.
But there are no federal rules about testing and treating hepatitis C. Federal guidelines, issued by the CDC in 2003, said correctional facilities should “become part of prevention and control efforts in the broader community.” But they don't recommend screening for all inmates.
Instead, the CDC urged medical staff to ask new inmates about their risk factors, and only those prisoners who seem likely to be exposed should undergo screening, which costs $5 to $10.
The CDC guidelines fell short, said Dr. Josiah Rich, a professor at Brown who directs the university's Center for Prisoner and Human Rights. Rich's studies confirm that convicted criminals are almost always willing to be tested for hepatitis C, but will often lie to prison authorities about their past drug use.
“We already know that more than one in three people coming through corrections has Hep C, so by definition everyone coming in is high risk. It's absurd that they're not testing everyone,” he said.
Rich concedes that testing every inmate will “jack up costs” for prisons.
“An individual is going to say, 'Hey, you tested me, you said I was positive, and now I want to be treated, and I'm going to sue you if I don't get treated,'” he said.
Lawsuits are, indeed, on the rise.
The first significant case came in 1999, when officials at the Luther Luckett Correctional Complex in La Grange, Ky., refused to allow inmate Michael Paulley access to free hepatitis C treatment. Paulley, who was serving a 25-year sentence for rape and burglary, sued and won.
But the treatment came late and he died in 2004, the year he would have been eligible for parole. The litigation prompted broader testing and treatment in Kentucky, but Paulley's physician, Dr. Bennet Cecil, a Louisville, Ky.-based hepatitis C specialist, said prisoners still die “all the time” for untreated hepatitis C.
“I think it's immoral if a country, a state a society is going to incarcerate somebody and then deny them necessary medical care. I think that's an outrage,” he said.
Prisons in at least a dozen states – Alabama, California, Delaware, Florida, Georgia, Idaho, Michigan, Mississippi, Nebraska, New York, Oklahoma and Virginia – are being sued over failure to treat hepatitis C.
But it's tough going, said Oregon civil rights attorney Michelle Burroughs. Although she's won a settlement that mandated testing for at risk inmates and treatment for those who are eligible, five of the 10 inmates she's representing in a class-action lawsuit have died while the litigation proceeds.
“It's appalling, horrendous, horrifying. Prisoners wait five years just to be evaluated,” she said.
Rep. Barbara Lee, D-Calif., recently reintroduced legislation that would mandate prison testing and treatment of hepatitis C. Earlier similar proposals in recent years have failed.
“The plain fact is that prisoners do not stay in prison. With more than 90 percent of incarcerated persons returning to their communities, it is clear that when a prisoner is infected, we are all affected,” Lee said.
In North Dakota, it didn't take legislation, court orders or new regulations to prompt medical services director Kathleen Bachmeier to begin screening every inmate for hepatitis C after a methamphetamine epidemic tripled her state's prison population in about a decade. As the intravenous drug addicts arrived, so did the hepatitis C.
“It became obvious to me that these people are going to cost the state a lot of money if we don't do something about it,” she said.
North Dakota now treats anyone who meets certain medical criteria, whose sentence is long enough to complete the course of treatment and who is willing to try to quit using drugs.
“We look at this as a huge public health initiative,” she said.
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New York Politician Hospitalized with Hepatitis C
Reminding us that Hepatitis C can affect anyone, a New York assemblyman has announced he is being treated for Hepatitis C. Read how his diagnosis has apparently affected his life and his career in public service.
By Sarah Netter
The Journal News
www.thejournalnews.com
Rockland assemblyman hospitalized
Assemblyman Kenneth P. Zebrowski has been hospitalized and is being treated for hepatitis C, causing him to miss part of the legislative session, a spokesman confirmed yesterday.
Media coordinator Keith Braunfotel said Zebrowski, a New City Democrat, underwent a procedure March 2 to treat the hepatitis and was being treated for a blood clot in his leg.
Braunfotel said Zebrowski's office remained fully staffed and that the assemblyman was working while recuperating.
"We do wish he was feeling better," Braunfotel said, "but he's as sharp as a tack."
State Sen. Thomas Morahan, R-New City, is a close colleague and friend of Zebrowski's and has visited him often.
"He's laid up for a while and his legislative agenda is being attended to," Morahan said.
Little has been said about Zebrowski's illness or treatment.
"The family's kind of keeping it close to the vest, so to speak," Rockland Democratic Chairman Vincent Monte said yesterday.
Peter Wozniak of Valley Cottage said yesterday that he had heard a while ago that Zebrowski was ill, but he had listened to him on radio station WRCR just last week.
Wozniak said he thought Zebrowki's office was keeping up with the assemblyman's work for now.
"If it's only temporary, I'm sure it will be no problem," he said.
Morahan said his office had been in constant contact with Zebrowski's. If a public appearance is necessary, Morahan said, he will go and report back to Zebrowski on any feedback from residents or other politicians. "We hope to see him back up here soon," Morahan said.
Zebrowski, 61, began missing Assembly votes in late February and was listed as "EOR." That means he's excused for other reasons, specifically for something other than legislative business.
The last session for which he was present for all votes was Feb. 14. He was absent for votes Feb. 26 and March 5, 6 and 7, as well as for Monday's and yesterday's joint session between the Senate and the Assembly to elect four members of the state Board of Regents.
Zebrowski was ill last year, spending time in the hospital, and was noticeably thinner and had lost his hair, but told supporters and The Journal News during election season that he was feeling much better.
The Web site for the national Centers for Disease Control and Prevention says the hepatitis C virus affects the liver and is transferred by blood.
Zebrowski was first elected to the Assembly in 2004 after replacing now-Clarkstown Supervisor Alexander Gromack on the ballot. In November, he easily defeated Right to Life Party candidate Peter Partridge and had no Republican opposition. He served on the county Legislature for 21 years, including four years as chairman and two years as majority leader.
In the Assembly, Zebrowski serves on the Aging, Codes, Corporations, Authorities and Commissions, Governmental Employees, Judiciary, and Racing and Wagering committees.
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March 15, 2007
How Hepatitis C Can Affect a Patient's Sex Life
While some chronic Hepatitis C patients maintain normal sexual function and a healthy interest in sex, many experience reduced libido, erectile dysfunction and diminished sexual satisfaction. Learn how Hepatitis C impacts the sex lives of both men and women and how opening up about these issues can help improve patients' quality of life.
by Nicole Cutler, L.Ac.
Hepatitis C is commonly accompanied by fatigue and depression, followed by a decreased interest in sex. Additionally, antiviral medications typically used to battle Hepatitis C may cause sexual dysfunction and decreased libido. Sexual dysfunction is the most frequently encountered side effect of many antidepressant medications used to treat the depression and anxiety associated with Hepatitis C combination treatment. When discontinued, the medication-induced sexual dysfunction typically vanishes. Due to its prevalence in chronic Hepatitis C patients, openly discussing sexual problems with a physician can help identify if the source is the disease, prescribed medications or some other condition.
Studies
Although no large-scale clinical trials have been conducted proving that the Hepatitis C virus (HCV) directly causes sexual dysfunction, many patients report an association between the two. The following two studies demonstrate a relationship between sexual dysfunction and Hepatitis C:
1. A study published in the June 2006 issue of American Journal of Gastroenterology investigated the prevalence of sexual dysfunction among men with chronic HCV infection and evaluated its impact on health-related quality of life. After evaluating 350 participants, researchers concluded “…Our study demonstrates a strong association between chronic HCV infection and sexual dysfunction among men in the United States. Men with chronic HCV infection had markedly reduced sexual function in all the five domains evaluated (sex drive, erectile function, ejaculation, sexual problem assessment and overall sexual satisfaction) compared to HCV-uninfected controls…”
2. A study published in the February 2005 edition of Journal of Endocrinology evaluated sexual dysfunction in men with chronic HCV on antiviral therapy. Researchers found that testosterone levels decreased significantly during antiviral therapy, closely correlating with decreased libido and sexual function. Additionally, depression increased during interferon therapy, a condition also associated with sexual dysfunction.
Hormone Changes
Hepatitis C infection also contributes to advanced liver disease which can alter levels of hormones. Approximately two percent of middle-aged men experience decreased sexual interest and erectile dysfunction. This percentage remains consistent both in men without liver disease and those in the early stages of liver disease. However, men with advanced liver disease are more likely to experience the following conditions related to changes in hormone levels:
· Testicular dysfunction
· Loss of body hair
· Gynecomastia (enlarged breasts)
· Redistribution of body fat
· A female configuration of pubic hair
· Decreased muscle mass
· Decreased sexual desire
· Erectile dysfunction
The male sex hormone (testosterone) is typically lowered with advanced liver disease, while the female sex hormone (estrogen) typically increases. Because alcohol abuse further lowers testosterone levels, alcoholic men with Hepatitis C who have progressed to advanced liver disease are particularly vulnerable to sexual dysfunction issues.
Women
Women with chronic Hepatitis C commonly complain of vaginal dryness, which typically results in decreased sexual interest. The majority of women with Hepatitis C who experience pain during intercourse, vaginal irritation, vaginal burning and itching are on interferon and ribavirin therapy. Discomfort may be severe when combined with atrophic vaginitis, a condition common when estrogen levels decline, such as in postmenopausal women. While a topical estrogen and progesterone cream can improve or alleviate the dryness, oral estrogen supplements should only be taken under a physician’s close supervision. Whether in the form of natural soy estrogen or oral estrogen supplements, estrogen supplementation carries the following risks to women with liver disease:
· Worsening jaundice
· Cholestasis
· Hepatitis
Regardless of your gender or whether or not you are undergoing combination therapy, living with Hepatitis C can spawn sexual dysfunction. Even though it is a subject that most of us prefer to avoid, speaking up on impaired sexual function or interest can prompt your physician to re-evaluate your liver management plan. Since a healthy sex life is one expression of physical, spiritual and emotional health, supporting this component can dramatically increase someone’s quality of life. By discussing this sensitive topic, people with Hepatitis C can get the help needed to reclaim this most basic part of being human.
References:
Jensen SB, Gluud C, Sexual dysfunction in men with alcoholic liver cirrhosis, Liver, April 1985.
M R Krauss, et al., Sexual dysfunction in males with chronic hepatitis C and antiviral
therapy: interferon-induced functional androgen deficiency or depression?, Journal of Endocrinology, February 2005.
www.liverdisease.com, Sex and Liver Disease, Melissa Palmer, MD, 2007.
www.natap.org, Sexual Dysfunction is Highly Prevalent Among Men with Chronic Hepatitis C Virus Infection and Negatively Impacts Health-Related Quality of Life, The American Journal of Gastroenterology, Ann Danoff, MD, et al, June 2006.
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Hepatitis C's Other Symptoms
Although most people with chronic Hepatitis C do not exhibit symptoms of the "silent" epidemic, a significant number will experience its impact in organs other than their liver. Learn how to recognize these lesser-known conditions to help in the early detection and treatment of Hepatitis C.
by Nicole Cutler, L.Ac.
Many people infected with the Hepatitis C virus have no symptoms. Even if the person has been infected with Hepatitis C for a long time, no symptoms of the disease may present themselves until cirrhosis has developed. When symptoms are present, they can range from mild to severe. The most common symptom of chronic Hepatitis C is fatigue. Additional common symptoms of Hepatitis C include:
· Intermittent abdominal pain
· Reduced appetite and weight loss
· Nausea or vomiting
· Depression
· Jaundice – yellowing of the skin or whites of the eyes
· Low-grade fever
· Muscle aches
· Pale or grey colored stool
· Dark urine
· Generalized itching
· Ascites
· Bleeding varices – dilated veins in the esophagus
Extrahepatic Manifestations
People with Hepatitis C may exhibit symptoms and signs of infection that manifest in organs other than the liver. Known as extrahepatic manifestations, or immune-complex mediated diseases, these symptoms arise from the immune system’s effort to fight off the infection. Chronic Hepatitis C infection leaves people vulnerable to the development of diseases involving the kidneys, the skin, eyes, joints, immune system and the nervous system. The occurrence of an extrahepatic manifestation does not correlate with the severity of the underlying liver disease. The following associated conditions are the most commonly seen as a result of liver disease:
1. Cryoglobulinemia – This condition is due to the presence of abnormal antibodies (called cryoglobulins) that come from Hepatitis C virus stimulation of lymphocytes (white blood cells). These antibodies can deposit in small blood vessels, thereby causing inflammation of the vessels (vasculitis) in tissues throughout the body. The skin, joints and kidneys (glomerulonephritis) are often targets of the vasculitis.
People with cryoglobulinemia can present a variety of symptoms, including weakness, joint pain or swelling (arthralgia or arthritis), and a raised, purple skin rash (palpable purpura) usually in the lower portion of the legs. As well, people may experience swelling of the legs and feet due to loss of protein in the urine from the kidney involvement and nerve pain (neuropathy). What is more, this vascular condition can spawn Raynaud’s phenomenon, in which the fingers and toes turn color (white, then purple, then red) and become painful in cold temperatures.
2. B-cell non-Hodgkin's lymphoma – This cancer of the lymph tissue is associated with the chronic Hepatitis C virus. Its cause is believed to be excessive stimulation by the Hepatitis C virus of B-lymphocytes, resulting in the abnormal reproduction of the lymphocytes. Most individuals with Hepatitis C virus-associated non-Hodgkin’s lymphoma will require standard anti-cancer therapies.
3. Porphyria cutanea tarda (PCT) – PCT is a skin condition characterized by the overproduction of enzymes involved in the manufacturing of blood. People with PCT often have blisters and vesicles form on the back of the hands, forearms and neck, as well as the face. Lesions develop in areas exposed to the sun or have sustained minor trauma. Increased facial hair and pigmentation changes are also common. Major risk factors for the development of PCT include excessive iron exposure, heavy alcohol use, and the use of estrogens.
4. Lichen planus – A skin condition, Lichen planus appears as shiny, flat-topped bumps that often have an angular shape. This rash can occur anywhere on the skin, but often favors the inside of the wrists and ankles, the lower legs, back and neck. The mouth, genital region, hair and nails are affected in some individuals. Thick patches may occur, especially on the shins. About 20 percent of those affected with lichen planus of the skin experience minimal symptoms and need no treatment. However, in many cases the itching can be constant and intense.
5. Diabetes mellitus – An increasingly common metabolic disorder, diabetes mellitus is characterized by resistance to insulin, the hormone that regulates the amount of sugar in your blood. The accompaniment of Hepatitis C with diabetes is strongly associated with advanced liver fibrosis or cirrhosis. People with cirrhosis are believed to have decreased hepatic uptake of glucose, along with reduced hepatic clearance of insulin, leading to high levels of insulin and, therefore, insulin resistance syndrome.
Other conditions noted to be associated with Hepatitis C infection, include:
· Thyroid disease
· Kidney disease, especially Membranoproliferative Glomerulonephritis (MPGN)
· Vitiligo
· Arthritis
· Sjogren’s syndrome
· Mooren’s ulcer
· Neuropathy
While Hepatitis C is perceived as a virus attacking only the liver, clinical practice proves that its ramifications extend beyond solitary hepatic involvement. Perhaps due to the liver’s involvement in nearly every aspect of health, Hepatitis C is a systemic problem. The wide range of possible manifestations of this virus should signal increased public education for earlier diagnosis and treatment of Hepatitis C. Additionally, understanding the commonality between conditions associated with Hepatitis C can help a person suffering with multiple ailments recognize the likely origin of their extrahepatic manifestations.
References:
www.aocd.org, Lichen Planus, American Osteopathic College of Dermatology, 2006.
www.ccjm.org, Hepatitis C Infection: A Systemic Disease with extrahepatic manifestations, Aman Ali, MD, Nizar N Zein MD, Cleveland Clinic Journal of Medicine, November 2005.
www.hcvadvocate.org, Extrahepatic Manifestations of Chronic Hepatitis C, Roderick Remoroza, MD, Herbert Bonkovsky, MD, Hepatitis C Support Project, 2003.
www.idph.state.il.us, Health Beat: Hepatitis C, Illinois Department of Public Health, 2006.
www.medicinenet.com, What Conditions Outside the Liver are Associated with Hepatitis C?, Tse-Ling Fong, MD, MedicineNet, Inc, 2006.
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New Drug Being Tested to Prevent HCV Recurrence
The percentage of liver transplant patients who experience Hepatitis C recurrence is extremely high. The Mayo Clinic Transplant Center is currently conducting research on Civacir, a potential drug therapy that could inhibit the return of HCV.
www.allamericanpatriots.com
Mayo Clinic Tests New Drug to Prevent Hepatitis C Recurrence after Liver Transplant
March 08, 2007 -- ROCHESTER, Minn. -- The Mayo Clinic Transplant Center is studying whether Hepatitis C Immune Globulin (Human), an investigational drug candidate known as Civacir, prevents the recurrence of hepatitis C-related liver disease in liver transplant patients.
Mayo Clinic sites in Arizona, Florida and Minnesota are looking for adults to participate in this study. Eligible participants must have hepatitis C and need a liver transplant. Individuals who have liver cancer may participate.
Hepatitis C is a liver infection caused by the hepatitis C virus (HCV). Each year approximately 6,000 liver transplants are performed in the United States, and more than 2,000 of those are due to HCV. There are no approved or effective treatments for HCV-positive liver transplant patients or patients who receive HCV-positive livers.
"The clinical need for hepatitis C prevention in liver transplant patients is great," says Michael Charlton, M.D., medical director of the liver transplant program at Mayo Clinic's campus in Rochester, Minn. "HCV recurrence for liver transplant patients is nearly 100 percent. Five years after transplantation, one-third of re-infected patients either pass away, get re-transplanted or experience cirrhosis from HCV."
Civacir is a human-pooled antibody product created from blood and serum donated by individuals who have HCV antibodies. The idea for this potential therapy for hepatitis C came from an unexpected result of a similar human antibody drug for hepatitis B, known as HBIG.
"Prior to the discovery of hepatitis C in 1988, HBIG unknowingly included hepatitis C antibodies," says Dr. Charlton. "A retrospective study of approximately 200 patients who received HBIG found that in addition to preventing hepatitis B, it also prevented hepatitis C in about half of the cases."
The Mayo Clinic study will test whether Civacir can prevent HCV recurrence after liver transplant.
More than 400 patients receive liver transplants at Mayo Clinic's three sites each year. Mayo Clinic is the most experienced liver transplant center in the nation, with some of the highest survival rates in the world.
For more information on eligibility requirements and the screening process for this study, contact Kristin Eggebraaten, Mayo Clinic liver transplant referral coordinator at 1-507-538-5908.
Civacir is a product of NABI Biopharmaceuticals and Kedrion S.p.A.
Source: Mayo Clinic
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March 12, 2007
New Dosing Study for HCV Genotype 1
Preliminary results assessing Pharmasset's R7128 treatment for Hepatitis C genotype 1 are encouraging. This well-tolerated polymerase inhibitor will now be evaluated on an ascending dose schedule. Due to current therapies for genotype 1 having a low HCV eradication rate, R7128's development is worthy of attention.
Pharmasset Initiates Multiple Ascending Dose Study of R7128 in Patients Chronically Infected With HCV Genotype 1
PR Newswire Europe (inc. UK Disclose) - Feb. 28, 2007
PRINCETON, New Jersey, February 28 /PRNewswire/ --
http://www.therapeuticsdaily.com
Pharmasset initiated the multiple ascending dose portion of an on-going Phase 1 clinical trial evaluating R7128 in up to 40 patients chronically infected with hepatitis C virus (HCV) genotype 1. The primary objective of this part of the study, being conducted in collaboration with Roche, is to assess the safety, tolerability and pharmacokinetics of multiple doses of R7128 after once-daily or twice-daily dosing for 14 days. The secondary objective is to assess antiviral efficacy of R7128 by measuring the decrease in HCV viral load. As a result of the initiation of the multiple ascending dose portion of this study, Pharmasset triggered a US$5.0 million milestone payment from Roche.
Pharmasset and Roche recently completed part 1 of this Phase 1 study in 38 healthy volunteers who received single ascending doses of R7128. The effect of food on R7128 was also assessed. Preliminary data from the single ascending dose portion of the study indicate:
- All doses of R7128 studied were generally well-tolerated.
- All patients completed the study, and none experienced gastrointestinal adverse events or serious adverse events during the study.
- No hematological or laboratory abnormalities of clinical significance were noted.
The preliminary safety and pharmacokinetic data from part 1 of the study supported progression of R7128 into part 2 of the study in patients chronically infected with HCV genotype 1.
About R7128
R7128 is a polymerase inhibitor being developed for the treatment of chronic hepatitis C. R7128 is a prodrug of PSI-6130, which demonstrated excellent potency in preclinical studies. PSI-6130 is a pyrimidine nucleoside analog inhibitor of HCV RNA polymerase, an enzyme that is necessary for hepatitis C viral replication. Results from an oral single ascending dose study in 24 healthy male volunteers showed that PSI-6130 was generally well tolerated with no serious adverse events in doses up to 3000 mg.
R7128 Phase 1 Study Overview
The Phase I clinical trial is a multiple center, observer-blinded, randomized and placebo-controlled study to investigate the pharmacokinetics, pharmacodynamics, safety, tolerability and food effect of R7128 in healthy volunteers and in patients chronically infected with HCV genotype 1. This study is comprised of two parts:
- Part 1 is a single ascending dose study being conducted in up to 38
healthy volunteers. The primary objective of Part 1 is to assess the
safety, tolerability and pharmacokinetics of R7128 following single
ascending doses under fasting conditions. The secondary objective of
Part 1 is to explore the effect of food on the pharmacokinetics of
R7128.
- Part 2 is a multiple ascending dose study being conducted in up to 40 patients chronically infected with HCV genotype 1. The primary
objective of Part 2 is to assess the safety, tolerability and
pharmacokinetics of R7128 after once-daily or twice-daily dosing for 14 days. The secondary objective is to assess antiviral efficacy by
measuring the decrease in HCV viral load.
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March 09, 2007
HIV Pathology Helps Identify Hepatitis C Protein
Rockefeller University scientists researching the HIV virus recently discovered how a protein commonly found in the liver is necessary for Hepatitis C infection. By targeting this specific protein, scientists may develop more effective treatment strategies for Hepatitis C.
http://newswire.rockefeller.edu
February 26, 2007
Key protein for hepatitis C virus entry identified
For as many as 200 million people worldwide infected with hepatitis C, a leading cause of chronic liver disease, treatment options are only partially effective. But new research by Rockefeller University scientists points to a potential new target for better drugs: a key protein that resides in human liver cells that hepatitis C requires for entry.
Scientists have known that for HCV to infect human cells, at least two molecules — CD81 and SR-B1 — must be present on the surface of the cell. However, they suspected that at least one other molecule also has to be present, because in some cells that contained the known molecules HCV was still unable to gain entry.
Co-first authors Matthew Evans and Thomas von Hahn, postdoctoral associates in Rockefeller’s Laboratory of Virology and Infectious Disease led by Charlie Rice, set out to find the missing receptor. HCV is notorious for being too difficult to replicate in cell culture, so Evans and von Hahn used HCV “pseudoparticles,” HIV particles in which the HIV envelope proteins are replaced with those from HCV. This replacement tricks the host cell into allowing the engineered particle to enter in a manner identical to that of authentic HCV. Once inside the cell, however, the HIV replication machinery takes over.
In order to identify potential entry receptors, Evans and von Hahn teamed up with co-authors Theodora Hatziioannou and Paul Bieniasz, HIV researchers at Rockefeller and the Aaron Diamond AIDS Research Center who had developed a special multiple-round screening technique. The screen pointed them to claudin-1, a protein involved in the maintenance of cell structures called tight junctions that is found in several epithelial tissues in the body, and is most prevalent in the liver.
A series of experiments on various human cell lines confirmed that claudin-1 is a requirement for HCV entry, says von Hahn. The research showed that the HCV pseudoparticle was able to enter cells that contain claudin-1, as well as claudin-1-deficient cells that were made to artificially express the protein, but not other cells. “We did not see HCV enter any cell that did not have claudin-1,” says von Hahn.
Further experiments showed that claudin-1 only appears to come into play after the virus has bound to the cell, perhaps as a means for the virion to actually be taken up by the cell or facilitate fusion between the virus and cell membranes. The scientists reported their findings this week in an advance online publication in the journal Nature.
The researchers believe that there may be additional receptors – yet to be identified – that are necessary for HCV to infect cells, as some human cell lines contain all three receptors but still do not become infected. HCV also does not enter some human cells that express all three factors, nor can it infect mouse cells that have been engineered to express the three human receptors.
The identification of claudin-1, and the possible discovery of additional host cell receptors, offers the promise of new avenues for anti-HCV therapeutics, according to the authors.
“Anti-HCV drugs currently under development are directed against viral enzymes required for viral replication, to which the virus can readily evolve resistance,” says Evans. “HCV may be less able to develop resistance to drugs targeting receptors on the host cell.”
“We also foresee the potential for combination therapies, which would attack different stages of HCV infection, much like the HIV cocktail that has been so effective,” says Rice, who is the Maurice R. and Corinne P. Greenberg Professor and scientific director of the Center for the Study of Hepatitis C, a cooperative endeavor of Rockefeller, Weill Medical College of Cornell University and NewYork-Presbyterian Hospital.
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March 08, 2007
Can Saliva Transmit Hepatitis C?
With over 5 million Americans infected, the Hepatitis C virus is the most common cause of liver disease today. Although it is believed to be primarily transmitted through blood to blood contact, there are indications that other means of contracting Hepatitis C are possible. Of primary interest to those concerned with the number one cause of liver disease is the possibility of transmitting Hepatitis C via saliva.
by Nicole Cutler, L.Ac.
As the most common chronic blood borne infection in the United States, the concentration of Hepatitis C virus in a drop of infected blood is exponentially higher than the concentration of HIV in a drop of infected blood. This explains why it is important to avoid anything that could possibly be tainted with any amount of blood. While not normally found in urine, semen, vaginal/cervical fluids, feces or saliva, injury or illness may cause some of these substances to be contaminated with blood.
In nearly half the cases of Hepatitis C, the infected individuals cannot identify the source for their infection. While it is believed most cases are due to risk factors involving contaminated blood, there remain unidentified modes of Hepatitis C transmission. Salivary transmission is one potential explanation for many unexplained viral causes.
Tiny and Infectious
Measuring only about 50 nanometers in diameter, Hepatitis C is an extremely small virus. A nanometer is one billionth of a meter; 200,000 Hepatitis C viruses placed end to end would only measure a single centimeter. Smaller than the wavelength of visible light, viral particles have no color. In those who are infected, Hepatitis C may produce approximately one trillion new viral particles every day.
Unlike many other viruses (like HIV), any potential source of blood to blood contact seems capable of carrying the Hepatitis C virus. This is true, even if the source is indirect, such as a used razor, making HCV far more transmissible than most other blood borne viruses. As documented by occupational exposure statistics, Hepatitis C is approximately seven times more infectious than HIV.
Saliva
People with chronic Hepatitis C are advised not to share toothbrushes, razors, nail clippers or other personal articles that may have potentially been in contact with their blood. While there is very little emphasis on saliva as a vehicle of Hepatitis C transmission, under the right circumstances there is some evidence to the contrary:
1. As published in the September 2006 issue of Journal of Viral Hepatitis, German researchers investigated the transmission of Hepatitis C via a toothbrush. A team from the University of Regensburg examined 30 patients with Hepatitis C to see whether they had contaminated their toothbrushes with the virus. They collected saliva samples from infected patients both before and after tooth brushing. Figures showed that 30 percent of infected patients tested positive for traces of the virus in their saliva before brushing their teeth, while 38 percent tested positive in their saliva after brushing. Additionally, about 40 percent of the water used to rinse the infected toothbrushes tested positive for the virus. This information confirms the caution against toothbrush sharing, and also sounds a possible Hepatitis C transitory alarm.
2. In September of 2003, evidence that saliva contains the Hepatitis C virus was disclosed at the Interscience Conference on Antimicrobial Agents and Chemotherapy. Scientists from the University of Washington in Seattle concluded that while saliva may be infectious, the strongest predictor of viral presence in the saliva is serum viral load. Researchers found that Hepatitis C was not found in saliva if the person’s viral load was under one million. Additionally, any risk of acquiring infection through salivary contact existed only in the presence of gum disease. Investigators attribute this risk to microscopic amounts of blood in the saliva and visually undetectable open mouth wounds present in gum disease.
All possibilities must be considered in trying to determine how unknown sources of Hepatitis C infection took place. Although Hepatitis C has been detected in saliva, the necessary conditions render it unlikey—but not impossible—to be transmitted by kissing or through the sharing of a toothbrush. Before anybody panics about these potential risks, remember that there are conditions accompanying these possible modes of transmission:
· The person with the virus must have a viral load over one million.
· Both parties involved have gum disease.
While experts view the risk of transmitting this disease through saliva as extremely low, it is recommended to maintain good oral hygiene, and toothbrushes be used solely by their owners.
References:
Jancin, Bruce, Hepatitis C virus may be spread through saliva: avoid toothbrush sharing, OB/GYN News, November 2003.
Hepatitis C – contamination of toothbrushes: myth or reality?, Journal of Viral Hepatitis, September 2006.
www.cdc.gov, Hepatitis C FAQ, US Department of Health and Human Services, 2006.
www.epidemic.org, The Hepatitis C Virus, Trustees of Dartmouth College, 2006.
www.hcvadvocate.org, HCV: Important Study on Dried Blood Stability, Hepatitis C Support Project, January 2004.
www.hcvets.com, Saliva may have infectious amounts of HCV in presence of high HCV viral load and gum disease, Michael Carter, HCVets.com, September 2003.
www.hepnet.com, Stopping the Spread of the Virus, Molly Colin, Schering Canada Inc., 2006.
www.medicalnewstoday, Kissing Could Spread Hepatitis C, MediLexicon International, Ltd., September 2003.
www.pafp.com, Hepatitis C Virus can Live in Dried Blood, Pennsylvania Academy of Family Physicians, 2003.
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