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July 14, 2005
Confused patients
Q I had Hepatitis C and endured treatment for one year. After six months of treatment, I tested negative for the virus. What is the likelihood of the virus returning? Will I always test positive for the antibody? Will I ever be able to donate blood or organs?
A The combination of interferon and ribavirin has greatly improved the prospects for successful treatment of Hepatitis C, one of the world’s most prevalent liver infections.
The combination can achieve a “sustained virologic response.” That phrase indicates that virus cannot be detected in the blood at the completion of treatment and again six months later. The majority of patients who achieve a sustained virologic response appear to be cured. “Cure” is used with caution, since enough time in monitoring patients has not elapsed to make such a sweeping declaration. Not finding virus in your blood after six months of treatment is a favourable sign that you will obtain a sustained response.
The actual percentage of treated patients who have a sustained response depends on which hepatitis virus strain infects them. When strain 1 is the infecting virus, the sustained response is about 45 per cent. When strain 2 or 3 is the infecting virus, the response approaches 80 per cent.
Your antibody question is hard to answer. Antibodies are gamma globulins, large proteins that the immune system produces to eliminate germs. They are good guys. Antibodies also serve as lab markers of prior infection. Treatment does decrease antibodies, because the number of viruses dwindles with treatment. Why did you ask the antibody question? It has little to do with success of treatment.
Most organ-donor organizations and blood banks are reluctant to accept donations from someone who has had Hepatitis C. They need 100 per cent assurance that blood and organs are completely free of virus.
Q I am a 76-year-old man married to a 69-year-old lady. After one year of marriage she told me that she has Hepatitis C. Recently my semen has turned brownish. Would the Hepatitis C cause this?
A What you have is, in all probability, hematospermia — blood in the semen. Hepatitis C does not cause it. It comes from the breaking of tiny blood vessels in the passageways that sperm take to reach the outside world, or from broken blood vessels in the prostate gland. Sometimes it results from a genital tract infection, sometimes from small stones in the prostate gland, but most of the time it’s something that just happens.
It worries every man it happens to. He thinks of cancer, but cancer rarely is the cause. All you have to do is tell your doctor about it. With a few simple tests and an examination, the doctor can give you assurance that nothing terrible is happening.
Q What would cause a person’s bones to reject calcium? I exercise, eat a low-fat diet, take calcium and vitamin D and eat calcium-rich foods, but my bone density is very low. Is this a sign of bone cancer? Actonel, Fosamax and Evista play havoc with me.
A It’s not a sign of bone cancer. It’s a sign of osteoporosis. You are doing everything in your power to combat osteoporosis — calcium, vitamin D and exercise — but you’re not winning the war against it. You need the help of medicine.
Actonel and Fosamax are effective osteoporosis fighters, and it’s too bad you can’t tolerate them. They now come in a once-weekly pill. Have you tried that? Evista is an oestrogen-like product without the estrogen risk for breast cancer. It has to be taken daily. Forteo is a newer osteoporosis medicine. It’s a carbon copy of parathyroid hormone, the hormone that pushes calcium into bone. It comes as an easily self-administered injection. It might solve your dilemma.
Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write to him or request an order form of available health newsletters at PO Box 536475, Orlando, FL 32853-6475
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