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Re: [GIWorld-Hepatitis] Digest Number 1392

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  • Mick Lowenthal
    Interesting ! I don t know when I signed up for this forum. However, I have suffered from chronic hepititas for 17 years. The wonderful 80 s. I believe I may
    Message 1 of 3 , Jan 14, 2004
      Interesting ! I don't know when I signed up for this forum. However, I have suffered from chronic hepititas for 17 years. The wonderful 80's. I believe I may have got it during boot camp at MCRD in San Diego. It may have been going through the shot line up. It seems that they were not to clean with those air guns.

      I just finished my second treatment of chemo. The second being pegintron combination therapy. The first was just interfuron/combination ribaviran. The first one had seemed successful until I had been off for 6 months. Likewise I am hoping that the second combination therapy will be more successful. So far the count is neglable or they can't find the virus. I will continue to go back and get checked at the VA in Salt Lake City.

      I do however have a fatty liver condition which seems to be more prominate in type 3. The begginings of some damage. They will continue to do Liver ultrasounds every six months I am told. I have yet to get one done.

      Anyone who has some information about it I would be happy to listen.

      All the best to all of you out there.

      Mick

      GIWorld-Hepatitis@yahoogroups.com wrote:
      There are 9 messages in this issue.

      Topics in this digest:

      1. Kemin Pharma Developing Two New Molecules That Appear Promising in the Battle A
      From: "Alley"
      2. I'm kind of confused, but that's nothing new - LOL
      From: "Julie"
      3. RE: I'm kind of confused, but that's nothing new - LOL
      From: Gail Samples
      4. "TRUE" AMBER ALERT-(Virus Screened)-Child Missing-Pass it on! Marty
      From: 2byteme@...
      5. Re: I'm kind of confused, but that's nothing new - LOL
      From: "w.m.landstra"
      6. Re: Amber Alert with Photo. Sorry for the problems with the last one, it did not post. Marty
      From: 2byteme@...
      7. Treatment considerations in patients with hepatitis C and cirrhosis
      From: claudine intexas
      8. Re: I'm kind of confused, but that's nothing new - LOL
      From: claudine intexas
      9. Re: Re: Amber Alert with Photo. Sorry for the problems with the last one, it did not post. Marty
      From: "Connie Ray"


      ________________________________________________________________________
      ________________________________________________________________________

      Message: 1
      Date: Tue, 13 Jan 2004 09:45:22 -0600
      From: "Alley"
      Subject: Kemin Pharma Developing Two New Molecules That Appear Promising in the Battle A

      Kemin Pharma Developing Two New Molecules That Appear Promising in the Battle Against Hepatitis C
      Monday January 12, 4:53 pm ET


      HERENTALS, Belgium, Jan. 12 /PRNewswire/ -- Kemin Pharma has identified two different molecules that appear to have very good biological effects against the hepatitis C virus (HCV). The first of these molecules is already being tested in Phase II clinical trials. Kemin Pharma discovered molecule KPE02003002, a synthetic derivative of a phytochemical with several chiral centers, in October 2002, through a collaborative effort with the National Institutes of Health in Bethesda, Maryland, and the Rega Institute for Medical Research in Leuven, Belgium. The second molecule, KPE00001113, was discovered in 2003 as part of the same collaborative, in vitro, antiviral screening program.


      http://biz.yahoo.com/prnews/040112/dam050_1.html

      [Non-text portions of this message have been removed]



      ________________________________________________________________________
      ________________________________________________________________________

      Message: 2
      Date: Tue, 13 Jan 2004 17:33:20 -0000
      From: "Julie"
      Subject: I'm kind of confused, but that's nothing new - LOL

      Hi Everyone. I haven't used this forum before, but I must have
      signed up to be a member because I'm getting emails from this group
      now (I'm GLAD to be).

      I am hoping this note (my first here) will post, and I'll get used to
      using this support forum, too. I've got chronic Hep C, have had it
      for about 27 years, began treatment in Oct 2003 but didn't do well
      due to rapid drop in wbc's and platelets (but not low enough to start
      Neupogen). Since there was a risk of overwhelming infection due
      to "underlying peridontal disease" that flared up two weeks into Hep
      C treatment, my GI doc decided to stop treatment "temporarily", get
      my peridontal disease treated, and then attempt treatment again.

      I went under the care of a periodontist in November and had my
      periodontal disease (which was termed "silent" peridontal disease)
      treated. I have since begun feeling 100% better, and although I want
      to try the Hep C treatment again (Pegasys / Copegus combo), I'm
      still undecided if I want to go through it again.

      Anyhow.... I look forward to being a part of this group! Good luck
      and hugs to everyone.

      Julie



      ________________________________________________________________________
      ________________________________________________________________________

      Message: 3
      Date: Tue, 13 Jan 2004 13:24:29 -0500
      From: Gail Samples
      Subject: RE: I'm kind of confused, but that's nothing new - LOL

      Hi Julie. I understand why you're hesitant to go with treatment again if
      you feel so much better. Have you had a liver biopsy? This is really the
      landmark to go by when considering treatment. If your biopsy shows little
      damage, then you can drag your feet in regards to treatment. If it shows
      damage-moderate to severe, then you should consider treatment-even if you
      don't respond, treatment will slow progression of liver damage, even help it
      heal during the treatment. Some doctors will prescribe low dose, long term
      interferon treatment for that purpose only. Either way you go-you will be
      mostly supported here-we have all agreed to disagree now and then.

      gail


      -----Original Message-----
      From: Julie [mailto:jtwagers7@...]
      Sent: Tuesday, January 13, 2004 12:33 PM
      To: GIWorld-Hepatitis@yahoogroups.com
      Subject: [GIWorld-Hepatitis] I'm kind of confused, but that's nothing new -
      LOL



      Hi Everyone. I haven't used this forum before, but I must have
      signed up to be a member because I'm getting emails from this group
      now (I'm GLAD to be).

      I am hoping this note (my first here) will post, and I'll get used to
      using this support forum, too. I've got chronic Hep C, have had it
      for about 27 years, began treatment in Oct 2003 but didn't do well
      due to rapid drop in wbc's and platelets (but not low enough to start
      Neupogen). Since there was a risk of overwhelming infection due
      to "underlying peridontal disease" that flared up two weeks into Hep
      C treatment, my GI doc decided to stop treatment "temporarily", get
      my peridontal disease treated, and then attempt treatment again.

      I went under the care of a periodontist in November and had my
      periodontal disease (which was termed "silent" peridontal disease)
      treated. I have since begun feeling 100% better, and although I want
      to try the Hep C treatment again (Pegasys / Copegus combo), I'm
      still undecided if I want to go through it again.

      Anyhow.... I look forward to being a part of this group! Good luck
      and hugs to everyone.

      Julie



      Welcome to GIHepWorld

      Post message: GIWorld-Hepatitis@yahoogroups.com
      Subscribe: GIWorld-Hepatitis-subscribe@yahoogroups.com
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      ________________________________________________________________________
      ________________________________________________________________________

      Message: 4
      Date: Tue, 13 Jan 2004 13:37:59 -0500
      From: 2byteme@...
      Subject: "TRUE" AMBER ALERT-(Virus Screened)-Child Missing-Pass it on! Marty

      Maybe if every one passes this on someone will see this child, that is
      how the girl from Stevens Point was found by circulation of her picture
      on tv. The internet circulates even overseas South America, and Canada
      etc. Thanks



      We have a store manager (Wal-Mart) from Longs, SC who has a 9 year old
      daughter who has been missing for 2 weeks. Keep the picture moving on.
      With luck on her side she will be found.
      I am asking you all, begging you to please forward this email
      on to anyone and everyone you know, PLEASE. My 9 year old girl, Penny
      Brown, is missing. She has been missing for now two weeks..
      It is still not too late. Please help us. If anyone anywhere knows
      anything, please contact me at: zicozicozico@...

      I am including a picture of her. All prayers are appreciated!! It only
      takes 2 seconds to forward this on. If it was your child,
      you would want all the help you could get. Thank you for your kindness.


      [Non-text portions of this message have been removed]



      ________________________________________________________________________
      ________________________________________________________________________

      Message: 5
      Date: Tue, 13 Jan 2004 19:48:26 +0100
      From: "w.m.landstra"
      Subject: Re: I'm kind of confused, but that's nothing new - LOL

      HI.Welcome to the group Julie.You.ll find a lot of support and knowledge here,frome novices to old troopers,from Canada to Holland.Good Luck,Willem.
      ----- Original Message -----
      From: Julie
      To: GIWorld-Hepatitis@yahoogroups.com
      Sent: Tuesday, January 13, 2004 6:33 PM
      Subject: [GIWorld-Hepatitis] I'm kind of confused, but that's nothing new - LOL


      Hi Everyone. I haven't used this forum before, but I must have
      signed up to be a member because I'm getting emails from this group
      now (I'm GLAD to be).

      I am hoping this note (my first here) will post, and I'll get used to
      using this support forum, too. I've got chronic Hep C, have had it
      for about 27 years, began treatment in Oct 2003 but didn't do well
      due to rapid drop in wbc's and platelets (but not low enough to start
      Neupogen). Since there was a risk of overwhelming infection due
      to "underlying peridontal disease" that flared up two weeks into Hep
      C treatment, my GI doc decided to stop treatment "temporarily", get
      my peridontal disease treated, and then attempt treatment again.

      I went under the care of a periodontist in November and had my
      periodontal disease (which was termed "silent" peridontal disease)
      treated. I have since begun feeling 100% better, and although I want
      to try the Hep C treatment again (Pegasys / Copegus combo), I'm
      still undecided if I want to go through it again.

      Anyhow.... I look forward to being a part of this group! Good luck
      and hugs to everyone.

      Julie



      Welcome to GIHepWorld

      Post message: GIWorld-Hepatitis@yahoogroups.com
      Subscribe: GIWorld-Hepatitis-subscribe@yahoogroups.com
      Unsubscribe: GIWorld-Hepatitis-unsubscribe@yahoogroups.com
      List owner: GIWorld-Hepatitis-owner@yahoogroups.com
      URL to this page: http://groups.yahoo.com/group/GIWorld-Hepatitis



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      ADVERTISEMENT





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      ________________________________________________________________________
      ________________________________________________________________________

      Message: 6
      Date: Tue, 13 Jan 2004 19:24:19 -0500
      From: 2byteme@...
      Subject: Re: Amber Alert with Photo. Sorry for the problems with the last one, it did not post. Marty

      Maybe if every one passes this on someone will see this child, that is
      how the girl from Stevens Point was found by circulation of her picture
      on tv. The internet circulates even overseas South America, and Canada
      etc. Thanks

      We have a store manager (Wal-Mart) from Longs, SC who has a 9 year old
      daughter who has been missing for 2 weeks. Keep the picture moving on.
      With luck on her side she will be found.
      I am asking you all, begging you to please forward this email
      on to anyone and everyone you know, PLEASE. My 9 year old girl, Penny
      Brown, is missing. She has been missing for now two weeks..
      It is still not too late. Please help us. If anyone anywhere knows
      anything, please contact me at: zicozicozico@...

      I am including a picture of her. All prayers are appreciated!! It only
      takes 2 seconds to forward this on. If it was your child,
      you would want all the help you could get. Thank you for your kindness.


      [Non-text portions of this message have been removed]



      ________________________________________________________________________
      ________________________________________________________________________

      Message: 7
      Date: Tue, 13 Jan 2004 17:10:23 -0800 (PST)
      From: claudine intexas
      Subject: Treatment considerations in patients with hepatitis C and cirrhosis

      NATAP - www.natap.org

      Treatment considerations in patients with hepatitis C and cirrhosis

      All NATAP reports are posted & archived at NATAP website

      J Clin Gastroenterol. 2003 Nov-Dec;37(5):395-8.
      E Jenny Heathcote
      University Health Network, Toronto Western Hospital, Toronto,
      Ontario, Canada.

      ABSTRACT
      Patients with cirrhosis due to hepatitis C have a high chance of
      dying from progressive liver disease and thus have much to gain from
      successful antiviral therapy.

      The highest sustained virologic responses in patients with cirrhosis
      have been achieved using pegylated interferon alfa plus Ribavirin;
      43% or more remain with undetectable virus 6 months after the
      cessation of 48 weeks of treatment.

      In those who achieve a sustained virologic response, the degree of
      fibrosis is less as judged on post-treatment liver biopsy; cirrhosis
      may even regress. In those individuals with cirrhosis who achieve a
      sustained virologic response, the risk of developing hepatocellular
      carcinoma is significantly reduced and it is likely that their chance
      of developing liver failure is less.

      Patients who do not achieve sustained virologic response can still
      show histologic improvement as demonstrated on liver biopsy
      post-therapy as compared to baseline.

      Patients with compensated cirrhosis can benefit from therapy while
      those who are decompensated are prone to more safety issues. Thus,
      individuals with any evidence of hepatic decompensation should
      generally not be given interferon-based antiviral therapy, but
      treatment should be encouraged for those whose status is Child Class
      A.

      BACKGROUND

      Successful antiviral therapy in patients with cirrhosis due to
      hepatitis C is potentially lifesaving, but those with cirrhosis are
      unfortunately a "difficult to treat" patient population. They are
      difficult to treat because not infrequently they have
      contraindications to current anti viral therapies, have a high side
      effect profile, and a lower rate of sustained virologic response to
      interferon (IFN)-based treatment compared with those without
      cirrhosis. Liver biopsy plays a vital role in the pre treatment
      assessment of liver disease severity. Without liver biopsy, the
      presence of underlying cirrhosis will often go unrecognized.

      CONTRAINDICATIONS TO ANTI-VIRAL THERAPY IN CIRRHOSIS CAUSED BY
      HEPATITIS C

      Peripheral Blood Count

      Cirrhosis gives rise to portal hypertension that is frequently
      complicated by features of hypersplenism, specifically
      thrombocytopenia with or without leukopenia. Although
      thrombocytopenia may on occasion be immune-mediated in individuals
      with hepatitis C, it is most often a manifestation of hypersplenism.
      It is, however, extremely unusual for the platelet count to fall
      (with or without antiviral therapy) to such an extent that it
      promotes a bleeding disorder, although easy bruising and gum bleeding
      (often promoted by periodontal gum disease) complications may occur.
      Spontaneous episodes of septicemia are well-recognized in patients
      with cirrhosis. Such events are thought most often to be secondary to
      intra- and extrahepatic shunting of bacteria delivered to the liver
      via the portal vein. Although the precise role of leucopenia in
      promoting episodes of spontaneous sepsis in patients with cirrhosis
      remains undefined, IFN has a known bone marrow-suppressive effect and
      could produce a severe enough neutropenia to put the patient in
      danger. It is for these reasons that guidelines with regards to
      minimal acceptable numbers of circulating absolute neutrophils and
      platelets have been proposed. Most industry-initiated studies have
      prohibited the start of anti viral therapy in patients with cirrhosis
      with a platelet count of less than 70 x 106/mL or an absolute
      neutrophil count of less than 1.5 x 106/mL. In addition, guidelines
      recommending dose reduction and possible treatment discontinuation if
      the platelet count falls below 50 x 106/mL or the absolute neutrophil
      count falls to less than 0.5 x 106/mL. These guidelines have not been
      formally validated.

      Hepatic Decompensation

      Although the data are scant, there is good evidence that IFN-based
      therapy is inadvisable in individuals with decompensated cirrhosis
      due to hepatitis C.1 Early complications, mostly due to sepsis have
      been described and such individuals generally tolerate the treatment
      poorly. In addition, treatment may promote hepatic decompensation.

      Tolerance of Antiviral Therapy in Patients With Cirrhosis

      Intolerance, particularly due to neuropsychiatric side effect of IFN
      therapy, has been best described in individuals with cirrhosis due to
      hepatitis B.2 All forms of IFN therapy may be associated with a wide
      array of neuropsychiatric side effects. Although never formally
      examined, it is possible that anti viral therapy in cirrhotics could
      accentuate subclinical hepatic encephalopathy. The latter, depending
      on the method of assessment has been reported to be common in
      otherwise asymptomatic individuals with cirrhosis.3 Recent
      information suggests that individuals infected with hepatitis C virus
      (HCV), even in the absence of underlying cirrhosis, have significant
      neuropsychiatric deficiencies, particularly in the field of
      cognition.4, 5 It possible that this may in part explain the poor
      tolerance of IFN by individuals with hepatitis C.

      Efficacy of Anti Viral Efficacy in Cirrhosis caused by Hepatitis C

      Sustained Virologic Response

      The early studies using standard IFN monotherapy showed disappointing
      results in patients with cirrhosis.6 When the data from 6 European
      trials were pooled, the likelihood of a sustained virologic response
      (undetectable HCV RNA 6 months after completing therapy) was
      negligible in treatment-naive individuals with cirrhosis infected
      with HCV genotype 1. The response rates were somewhat improved once
      the combination of IFN alfa 2b plus ribavirin was introduced.
      Sustained virologic responses were reported in as many as 20% of
      patients with cirrhosis infected with HCV genotype 2 or 3.7

      Early studies with peginterferon alfa-2a (40KD) (PEGASYS) indicated
      that this long-acting form of IFN, even when given as monotherapy,
      markedly enhanced the sustained virologic response in individuals
      with cirrhosis or bridging fibrosis. In one study that recruited only
      patients with cirrhosis or bridging fibrosis, the overall sustained
      virologic response was 30% when peginterferon alfa-2a 180 [million
      units]g was given once weekly for 48 weeks. This represented a marked
      improvement over the 8% rate achieved with unpegylated IFN alfa-2a.8
      Efficacy was poorest in those infected with HCV genotype 1 (sustained
      virologic response of 12%), whereas in those with HCV genotype non-1
      infections, the sustained virologic response was 51%.

      In a large, randomized study, Pegylated IFN alfa-2b 1.5 [million

      === message truncated ===

      ---------------------------------
      Do you Yahoo!?
      Yahoo! Hotjobs: Enter the "Signing Bonus" Sweepstakes

      [Non-text portions of this message have been removed]
    • Gail Samples
      Hello ALL newcomers! I don t know much about fatty liver, except that lecithin is a very good dietary supplement to take for that. It is an emulsifier and
      Message 2 of 3 , Jan 14, 2004
        Hello ALL newcomers!

        I don't know much about fatty liver, except that lecithin is a very good
        dietary supplement to take for that. It is an emulsifier and helps the
        liver digest fats. Lecithin contains phosphatidylcholine, which the body
        breaks down into the B vitamin choline, another nutrient that helps the
        liver process fats. Again, this helps prevent fat build-up in the liver.
        Possible sides: High doses of lecithin/choline can cause sweating, nausea,
        bloating, and diarrhea (I can vouch for that side!) Doses of 10grams a day
        of choline can cause heart rhythm problems and make you smell like a fish
        (!?); high levels of acetylcholine can worsen the depressive stage of
        bipolar disorder- these are from Reader's Digest Guide to Drugs and
        Supplements. This is a good, cheap book on supplements, giving proper
        dosages, sides, drug interactions, etc.

        Anyway-I hope you stay negative and attain the coveted status of SR!

        gail





        Original Message-----
        From: Mick Lowenthal [mailto:micklowenthal@...]
        Sent: Wednesday, January 14, 2004 8:04 AM
        To: GIWorld-Hepatitis@yahoogroups.com
        Subject: Re: [GIWorld-Hepatitis] Digest Number 1392



        Interesting ! I don't know when I signed up for this forum. However, I have
        suffered from chronic hepititas for 17 years. The wonderful 80's. I believe
        I may have got it during boot camp at MCRD in San Diego. It may have been
        going through the shot line up. It seems that they were not to clean with
        those air guns.

        I just finished my second treatment of chemo. The second being pegintron
        combination therapy. The first was just interfuron/combination ribaviran.
        The first one had seemed successful until I had been off for 6 months.
        Likewise I am hoping that the second combination therapy will be more
        successful. So far the count is neglable or they can't find the virus. I
        will continue to go back and get checked at the VA in Salt Lake City.

        I do however have a fatty liver condition which seems to be more prominate
        in type 3. The begginings of some damage. They will continue to do Liver
        ultrasounds every six months I am told. I have yet to get one done.

        Anyone who has some information about it I would be happy to listen.

        All the best to all of you out there.

        Mick

        GIWorld-Hepatitis@yahoogroups.com wrote:
        There are 9 messages in this issue.

        Topics in this digest:

        1. Kemin Pharma Developing Two New Molecules That Appear Promising in the
        Battle A
        From: "Alley"
        2. I'm kind of confused, but that's nothing new - LOL
        From: "Julie"
        3. RE: I'm kind of confused, but that's nothing new - LOL
        From: Gail Samples
        4. "TRUE" AMBER ALERT-(Virus Screened)-Child Missing-Pass it on! Marty
        From: 2byteme@...
        5. Re: I'm kind of confused, but that's nothing new - LOL
        From: "w.m.landstra"
        6. Re: Amber Alert with Photo. Sorry for the problems with the last one, it
        did not post. Marty
        From: 2byteme@...
        7. Treatment considerations in patients with hepatitis C and cirrhosis
        From: claudine intexas
        8. Re: I'm kind of confused, but that's nothing new - LOL
        From: claudine intexas
        9. Re: Re: Amber Alert with Photo. Sorry for the problems with the last one,
        it did not post. Marty
        From: "Connie Ray"


        ________________________________________________________________________
        ________________________________________________________________________

        Message: 1
        Date: Tue, 13 Jan 2004 09:45:22 -0600
        From: "Alley"
        Subject: Kemin Pharma Developing Two New Molecules That Appear Promising in
        the Battle A

        Kemin Pharma Developing Two New Molecules That Appear Promising in the
        Battle Against Hepatitis C
        Monday January 12, 4:53 pm ET


        HERENTALS, Belgium, Jan. 12 /PRNewswire/ -- Kemin Pharma has identified two
        different molecules that appear to have very good biological effects against
        the hepatitis C virus (HCV). The first of these molecules is already being
        tested in Phase II clinical trials. Kemin Pharma discovered molecule
        KPE02003002, a synthetic derivative of a phytochemical with several chiral
        centers, in October 2002, through a collaborative effort with the National
        Institutes of Health in Bethesda, Maryland, and the Rega Institute for
        Medical Research in Leuven, Belgium. The second molecule, KPE00001113, was
        discovered in 2003 as part of the same collaborative, in vitro, antiviral
        screening program.


        http://biz.yahoo.com/prnews/040112/dam050_1.html
        <http://biz.yahoo.com/prnews/040112/dam050_1.html>

        [Non-text portions of this message have been removed]



        ________________________________________________________________________
        ________________________________________________________________________

        Message: 2
        Date: Tue, 13 Jan 2004 17:33:20 -0000
        From: "Julie"
        Subject: I'm kind of confused, but that's nothing new - LOL

        Hi Everyone. I haven't used this forum before, but I must have
        signed up to be a member because I'm getting emails from this group
        now (I'm GLAD to be).

        I am hoping this note (my first here) will post, and I'll get used to
        using this support forum, too. I've got chronic Hep C, have had it
        for about 27 years, began treatment in Oct 2003 but didn't do well
        due to rapid drop in wbc's and platelets (but not low enough to start
        Neupogen). Since there was a risk of overwhelming infection due
        to "underlying peridontal disease" that flared up two weeks into Hep
        C treatment, my GI doc decided to stop treatment "temporarily", get
        my peridontal disease treated, and then attempt treatment again.

        I went under the care of a periodontist in November and had my
        periodontal disease (which was termed "silent" peridontal disease)
        treated. I have since begun feeling 100% better, and although I want
        to try the Hep C treatment again (Pegasys / Copegus combo), I'm
        still undecided if I want to go through it again.

        Anyhow.... I look forward to being a part of this group! Good luck
        and hugs to everyone.

        Julie



        ________________________________________________________________________
        ________________________________________________________________________

        Message: 3
        Date: Tue, 13 Jan 2004 13:24:29 -0500
        From: Gail Samples
        Subject: RE: I'm kind of confused, but that's nothing new - LOL

        Hi Julie. I understand why you're hesitant to go with treatment again if
        you feel so much better. Have you had a liver biopsy? This is really the
        landmark to go by when considering treatment. If your biopsy shows little
        damage, then you can drag your feet in regards to treatment. If it shows
        damage-moderate to severe, then you should consider treatment-even if you
        don't respond, treatment will slow progression of liver damage, even help it
        heal during the treatment. Some doctors will prescribe low dose, long term
        interferon treatment for that purpose only. Either way you go-you will be
        mostly supported here-we have all agreed to disagree now and then.

        gail


        -----Original Message-----
        From: Julie [mailto:jtwagers7@...]
        Sent: Tuesday, January 13, 2004 12:33 PM
        To: GIWorld-Hepatitis@yahoogroups.com
        Subject: [GIWorld-Hepatitis] I'm kind of confused, but that's nothing new -
        LOL



        Hi Everyone. I haven't used this forum before, but I must have
        signed up to be a member because I'm getting emails from this group
        now (I'm GLAD to be).

        I am hoping this note (my first here) will post, and I'll get used to
        using this support forum, too. I've got chronic Hep C, have had it
        for about 27 years, began treatment in Oct 2003 but didn't do well
        due to rapid drop in wbc's and platelets (but not low enough to start
        Neupogen). Since there was a risk of overwhelming infection due
        to "underlying peridontal disease" that flared up two weeks into Hep
        C treatment, my GI doc decided to stop treatment "temporarily", get
        my peridontal disease treated, and then attempt treatment again.

        I went under the care of a periodontist in November and had my
        periodontal disease (which was termed "silent" peridontal disease)
        treated. I have since begun feeling 100% better, and although I want
        to try the Hep C treatment again (Pegasys / Copegus combo), I'm
        still undecided if I want to go through it again.

        Anyhow.... I look forward to being a part of this group! Good luck
        and hugs to everyone.

        Julie



        Welcome to GIHepWorld

        Post message: GIWorld-Hepatitis@yahoogroups.com
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        ________________________________________________________________________
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        Message: 4
        Date: Tue, 13 Jan 2004 13:37:59 -0500
        From: 2byteme@...
        Subject: "TRUE" AMBER ALERT-(Virus Screened)-Child Missing-Pass it on! Marty

        Maybe if every one passes this on someone will see this child, that is
        how the girl from Stevens Point was found by circulation of her picture
        on tv. The internet circulates even overseas South America, and Canada
        etc. Thanks



        We have a store manager (Wal-Mart) from Longs, SC who has a 9 year old
        daughter who has been missing for 2 weeks. Keep the picture moving on.
        With luck on her side she will be found.
        I am asking you all, begging you to please forward this email
        on to anyone and everyone you know, PLEASE. My 9 year old girl, Penny
        Brown, is missing. She has been missing for now two weeks..
        It is still not too late. Please help us. If anyone anywhere knows
        anything, please contact me at: zicozicozico@...

        I am including a picture of her. All prayers are appreciated!! It only
        takes 2 seconds to forward this on. If it was your child,
        you would want all the help you could get. Thank you for your kindness.


        [Non-text portions of this message have been removed]



        ________________________________________________________________________
        ________________________________________________________________________

        Message: 5
        Date: Tue, 13 Jan 2004 19:48:26 +0100
        From: "w.m.landstra"
        Subject: Re: I'm kind of confused, but that's nothing new - LOL

        HI.Welcome to the group Julie.You.ll find a lot of support and knowledge
        here,frome novices to old troopers,from Canada to Holland.Good Luck,Willem.
        ----- Original Message -----
        From: Julie
        To: GIWorld-Hepatitis@yahoogroups.com
        Sent: Tuesday, January 13, 2004 6:33 PM
        Subject: [GIWorld-Hepatitis] I'm kind of confused, but that's nothing new -
        LOL


        Hi Everyone. I haven't used this forum before, but I must have
        signed up to be a member because I'm getting emails from this group
        now (I'm GLAD to be).

        I am hoping this note (my first here) will post, and I'll get used to
        using this support forum, too. I've got chronic Hep C, have had it
        for about 27 years, began treatment in Oct 2003 but didn't do well
        due to rapid drop in wbc's and platelets (but not low enough to start
        Neupogen). Since there was a risk of overwhelming infection due
        to "underlying peridontal disease" that flared up two weeks into Hep
        C treatment, my GI doc decided to stop treatment "temporarily", get
        my peridontal disease treated, and then attempt treatment again.

        I went under the care of a periodontist in November and had my
        periodontal disease (which was termed "silent" peridontal disease)
        treated. I have since begun feeling 100% better, and although I want
        to try the Hep C treatment again (Pegasys / Copegus combo), I'm
        still undecided if I want to go through it again.

        Anyhow.... I look forward to being a part of this group! Good luck
        and hugs to everyone.

        Julie



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        ________________________________________________________________________
        ________________________________________________________________________

        Message: 6
        Date: Tue, 13 Jan 2004 19:24:19 -0500
        From: 2byteme@...
        Subject: Re: Amber Alert with Photo. Sorry for the problems with the last
        one, it did not post. Marty

        Maybe if every one passes this on someone will see this child, that is
        how the girl from Stevens Point was found by circulation of her picture
        on tv. The internet circulates even overseas South America, and Canada
        etc. Thanks

        We have a store manager (Wal-Mart) from Longs, SC who has a 9 year old
        daughter who has been missing for 2 weeks. Keep the picture moving on.
        With luck on her side she will be found.
        I am asking you all, begging you to please forward this email
        on to anyone and everyone you know, PLEASE. My 9 year old girl, Penny
        Brown, is missing. She has been missing for now two weeks..
        It is still not too late. Please help us. If anyone anywhere knows
        anything, please contact me at: zicozicozico@...

        I am including a picture of her. All prayers are appreciated!! It only
        takes 2 seconds to forward this on. If it was your child,
        you would want all the help you could get. Thank you for your kindness.


        [Non-text portions of this message have been removed]



        ________________________________________________________________________
        ________________________________________________________________________

        Message: 7
        Date: Tue, 13 Jan 2004 17:10:23 -0800 (PST)
        From: claudine intexas
        Subject: Treatment considerations in patients with hepatitis C and cirrhosis

        NATAP - www.natap.org

        Treatment considerations in patients with hepatitis C and cirrhosis

        All NATAP reports are posted & archived at NATAP website

        J Clin Gastroenterol. 2003 Nov-Dec;37(5):395-8.
        E Jenny Heathcote
        University Health Network, Toronto Western Hospital, Toronto,
        Ontario, Canada.

        ABSTRACT
        Patients with cirrhosis due to hepatitis C have a high chance of
        dying from progressive liver disease and thus have much to gain from
        successful antiviral therapy.

        The highest sustained virologic responses in patients with cirrhosis
        have been achieved using pegylated interferon alfa plus Ribavirin;
        43% or more remain with undetectable virus 6 months after the
        cessation of 48 weeks of treatment.

        In those who achieve a sustained virologic response, the degree of
        fibrosis is less as judged on post-treatment liver biopsy; cirrhosis
        may even regress. In those individuals with cirrhosis who achieve a
        sustained virologic response, the risk of developing hepatocellular
        carcinoma is significantly reduced and it is likely that their chance
        of developing liver failure is less.

        Patients who do not achieve sustained virologic response can still
        show histologic improvement as demonstrated on liver biopsy
        post-therapy as compared to baseline.

        Patients with compensated cirrhosis can benefit from therapy while
        those who are decompensated are prone to more safety issues. Thus,
        individuals with any evidence of hepatic decompensation should
        generally not be given interferon-based antiviral therapy, but
        treatment should be encouraged for those whose status is Child Class
        A.

        BACKGROUND

        Successful antiviral therapy in patients with cirrhosis due to
        hepatitis C is potentially lifesaving, but those with cirrhosis are
        unfortunately a "difficult to treat" patient population. They are
        difficult to treat because not infrequently they have
        contraindications to current anti viral therapies, have a high side
        effect profile, and a lower rate of sustained virologic response to
        interferon (IFN)-based treatment compared with those without
        cirrhosis. Liver biopsy plays a vital role in the pre treatment
        assessment of liver disease severity. Without liver biopsy, the
        presence of underlying cirrhosis will often go unrecognized.

        CONTRAINDICATIONS TO ANTI-VIRAL THERAPY IN CIRRHOSIS CAUSED BY
        HEPATITIS C

        Peripheral Blood Count

        Cirrhosis gives rise to portal hypertension that is frequently
        complicated by features of hypersplenism, specifically
        thrombocytopenia with or without leukopenia. Although
        thrombocytopenia may on occasion be immune-mediated in individuals
        with hepatitis C, it is most often a manifestation of hypersplenism.
        It is, however, extremely unusual for the platelet count to fall
        (with or without antiviral therapy) to such an extent that it
        promotes a bleeding disorder, although easy bruising and gum bleeding
        (often promoted by periodontal gum disease) complications may occur.
        Spontaneous episodes of septicemia are well-recognized in patients
        with cirrhosis. Such events are thought most often to be secondary to
        intra- and extrahepatic shunting of bacteria delivered to the liver
        via the portal vein. Although the precise role of leucopenia in
        promoting episodes of spontaneous sepsis in patients with cirrhosis
        remains undefined, IFN has a known bone marrow-suppressive effect and
        could produce a severe enough neutropenia to put the patient in
        danger. It is for these reasons that guidelines with regards to
        minimal acceptable numbers of circulating absolute neutrophils and
        platelets have been proposed. Most industry-initiated studies have
        prohibited the start of anti viral therapy in patients with cirrhosis
        with a platelet count of less than 70 x 106/mL or an absolute
        neutrophil count of less than 1.5 x 106/mL. In addition, guidelines
        recommending dose reduction and possible treatment discontinuation if
        the platelet count falls below 50 x 106/mL or the absolute neutrophil
        count falls to less than 0.5 x 106/mL. These guidelines have not been
        formally validated.

        Hepatic Decompensation

        Although the data are scant, there is good evidence that IFN-based
        therapy is inadvisable in individuals with decompensated cirrhosis
        due to hepatitis C.1 Early complications, mostly due to sepsis have
        been described and such individuals generally tolerate the treatment
        poorly. In addition, treatment may promote hepatic decompensation.

        Tolerance of Antiviral Therapy in Patients With Cirrhosis

        Intolerance, particularly due to neuropsychiatric side effect of IFN
        therapy, has been best described in individuals with cirrhosis due to
        hepatitis B.2 All forms of IFN therapy may be associated with a wide
        array of neuropsychiatric side effects. Although never formally
        examined, it is possible that anti viral therapy in cirrhotics could
        accentuate subclinical hepatic encephalopathy. The latter, depending
        on the method of assessment has been reported to be common in
        otherwise asymptomatic individuals with cirrhosis.3 Recent
        information suggests that individuals infected with hepatitis C virus
        (HCV), even in the absence of underlying cirrhosis, have significant
        neuropsychiatric deficiencies, particularly in the field of
        cognition.4, 5 It possible that this may in part explain the poor
        tolerance of IFN by individuals with hepatitis C.

        Efficacy of Anti Viral Efficacy in Cirrhosis caused by Hepatitis C

        Sustained Virologic Response

        The early studies using standard IFN monotherapy showed disappointing
        results in patients with cirrhosis.6 When the data from 6 European
        trials were pooled, the likelihood of a sustained virologic response
        (undetectable HCV RNA 6 months after completing therapy) was
        negligible in treatment-naive individuals with cirrhosis infected
        with HCV genotype 1. The response rates were somewhat improved once
        the combination of IFN alfa 2b plus ribavirin was introduced.
        Sustained virologic responses were reported in as many as 20% of
        patients with cirrhosis infected with HCV genotype 2 or 3.7

        Early studies with peginterferon alfa-2a (40KD) (PEGASYS) indicated
        that this long-acting form of IFN, even when given as monotherapy,
        markedly enhanced the sustained virologic response in individuals
        with cirrhosis or bridging fibrosis. In one study that recruited only
        patients with cirrhosis or bridging fibrosis, the overall sustained
        virologic response was 30% when peginterferon alfa-2a 180 [million
        units]g was given once weekly for 48 weeks. This represented a marked
        improvement over the 8% rate achieved with unpegylated IFN alfa-2a.8
        Efficacy was poorest in those infected with HCV genotype 1 (sustained
        virologic response of 12%), whereas in those with HCV genotype non-1
        infections, the sustained virologic response was 51%.

        In a large, randomized study, Pegylated IFN alfa-2b 1.5 [million

        === message truncated ===

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      • Alley
        Howdy Mick! Welcome to the list :) I went undetecteded while on treatment too, but relapsed at the 6 mo post pcr. I m genotype 1b. Good luck on this round!
        Message 3 of 3 , Jan 15, 2004
          Howdy Mick! Welcome to the list :) I went undetecteded while on
          treatment too, but relapsed at the 6 mo post pcr. I'm genotype 1b.
          Good luck on this round!

          Alley
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