Hep A & B

[CT Dick]

The posting about hepatitis in Pittsburgh led me to post this.

 

Last year I got inoculated against both forms of hepatitis. My doctor is savvy enough to suggest that I have an antibody test to see if they took.

 

They didn't.

 

I'm warning those of you out there who think that you got inoculated against these diseases that your shots may not have taken. Check with your MD about an antibody test.

 

Dick

[FrancoDiSantisxxx]

Many sexually active individuals have the antibodies to Hep B and, often to Hep B, without being aware or otherwise gotten ill. However, it is an excellent idea to be tested for both and to receive the shots if the antibody test are negative, as well as following up on the shots with testing.

 

Finally, everyone should be aware that while new treatments are being researched, at present their is no way to be immunized for Hep C; another reason to engage in safer sex practice.

[Guest]

The vaccination series against Hep A involves two shots, and against Hep B involves three shots. It wasn't clear from your original posting as to whether you got the entire series or just one shot each. I haven't heard of anybody not developing antibodies against Hepatits A after the series. Make sure you doctor is testing for IgG antibodies, not IgM. If it didn't take after two shots, I would try a third. It's somewhat inconceivable to me that someone could not produce antibodies to Hepatitis A, because that would imply an either fatal or chronic case of Hepatitis A. There's never been a case of chronic Hepatitis A described to my knowledge. Also, those few people who die of Hepatitis A always have some underlying liver disease or other serious illness (i.e. chronic Hepatitis C being common). I've never heard of a healthy young adult dying of Hep A.

As for Hepatitis B, there certainly are people who can't make antibodies to the surface antigen, which is what the Hep B vaccine is. These are the people who get chronic Hep B, because they can only make antibodies to the core antigen. I think that the current recommendation is to give up to five shots of the Hep B vaccine before giving up. You may want to call your county Public Health Dept. for advice (don't count on your doctor knowing). If you really can't make antibodies to the Hep B surface antigen, watch out--you're susceptible to trouble if you do get infected with Hepatitis B.

[Guest Mikel]

Unicorn,

 

You are very knowledgeable. I'm glad you are a member of this board.

 

Mikel

[Guest Mikel]

Unicorn,

 

You seem to know a lot about the liver...so I have another question. When drug commercials say "This may not be appropriate for people with liver problems. Your Doctor may want to conduct simple blood tests for liver problems." are they referring to Hep A, Hep B, Hep C, other liver problems??? Do you know? And is it because the liver can't metabolize the drug?

[FrancoDiSantisxxx]

Exactly

 

>And is it because the liver can't metabolize

>the drug?

 

 

Some medications interact with other medications which impacts the bodies ability to metabolize and therefore use the medication, and this often happens in the liver. This is one of the reasons HIV+ men taking the antiretroviral drug Ritonavir were advised not to take the recreational drug "X" (ecstasty), as the HIV medication increased the bodies ability to absorb through the liver.

 

Other medications, as they get processed through the liver, place a strain on this organ. Testosterone and anbolic steroids are examples of these, which is why body builders and other men who take abusive or excessive amounts of these substances places themselves at risk for both liver and kidney failure (as the kidney is also an organ in the body used to excrete some drug by-products).

 

There are several very good, laymen language books and web sites about drug interactions, but if you have specific concerns, you really should raise them with both your medical provider and your pharmacist.

[buckguy]

I just went through this for Hep B with a medical workover for some overseas work travel. It's very common for people who are in the 30s or 40s, or older not to show titers for Hep B. I was vaccinnated in 1995, but did not show titers in '98 (my last review of this stuff) or now. The provider, an infectious disease clinic that does this kind of screening all the time, told me not to worry, because I had documentation of having no antibodies and then taking the 3-dose schedule. they also showed me the clinical CDC recommendations (which your health dept and most infectious disease docs are likely to) which backed this up.

[Guest Merlin]

I believe it is now routine to test for the antibodies during the course of the vaccination shots, and to continue until the tests show antibodies. I had the A and B shots two years ago and the test was negative so they gave me another shot and another test, positive the second time. I don't know whether the test was for the A or the B. I understand that Hepatitis C is usually obtained from blood transfusions. I am no sure that it can be obtained from sexual activity.

[Guest]

There are quite a few medications which cause serious liver problems, occasionally fatal, but only in people with underlying liver disease. In other people, these drugs may simply cause minor, reversible liver inflamation which will go away soon after the drug is withdrawn. Common drugs which do this are the more popular cholesterol medications, TB meds, and rheumatoid arthritis drugs.

Before starting a patient on these drugs, a physician would be wise to start with baseline measures of liver inflamation (at least an ALT, probably an AST, and possibly a GGT) before starting the drug and periodically thereafter. If the baseline values are abnormal, then the physican can investigate why they're abnormal (infection, alcohol, or other problems). These drug reactions are called "idiosyncratic" because there's no way to predict who's going to be the one to develop liver inflamation (which, again, is usually only dangerous in someone who already has liver problems to begin with, or in whom it is allowed to continue for a long time--weeks to months).

This is a separate issue from common drug interactions. When a patient receives two drugs which are metabolized by the same liver enzymes, the drugs' doses often have to be adjusted in a somewhat predictable manner. The list of drugs in this category is huge--from HIV meds to antibiotics to seizure meds, alcohol, and many others. This is the main reason why one should always get all of one's drugs at one pharmacy (i.e. so the pharmacy computer will alert the pharmacist and doctor of these interactions).

[Guest]

Opinions vary about who should be tested to see if the vaccine "took" and what to do about it if it didn't. Here's the CDC's official recommendations:

Post-vaccination Testing

 

* After routine vaccination of infants, children, adolescents, or adults post-vaccination testing for adequate antibody response is not necessary.

* Post-vaccination testing IS recommended for persons whose medical management will depend on knowledge of their immune status.

 

This includes persons who:

 

* are immunocompromised (e.g., hemodialysis patients)

* received the vaccine in the buttock

* are infants born to HBsAg (hepatitis B surface antigen)-positive mothers

* are healthcare workers who have contact with blood

* are sex partners of persons with chronic hepatitis B virus infection

 

* Post-vaccination testing should be completed 1-2 months after the third vaccine dose for results to be meaningful. A protective antibody response is 10 or more milliinternational units (>=10mIU/mL).

[Guest Love Bubble Butt]

>Finally, everyone should be aware that while new treatments

>are being researched, at present their is no way to be

>immunized for Hep C; another reason to engage in safer sex

>practice.

 

Sexual activity is not considered to be a major method of transmission for Hep C. Matter of fact, current research is leaning towards it requiring blood to blood contact which is why drug addicts sharing needles and blood transfusions (and in some cases, child birth) seem to be the predominant modes of transmission.

[Guest Mikel]

Unicorn,

 

Back to my original question,

 

Is Hep A or Hep B one of the "liver problems" that would preclude someone from taking meds like the anticholesterol drugs?

 

Also, it was just mentioned that Hep C cannot be contracted through sexual activity...is this accurate? Can it be contracted through semen or rimming?

 

Thanks for all your info.

[Will]

Unicorn, you are one of the reasons why this site is such a class act.

[Guest]

>Unicorn,

>

>Back to my original question,

>

>Is Hep A or Hep B one of the "liver problems" that would

>preclude someone from taking meds like the anticholesterol

>drugs?

>

Hep A is never a contraindication to anything since it's never chronic. If someone is taking a medication which can cause liver problems, and that person has never either been exposed or vaccinated to Hep A, it may be a good idea to vaccinate that person just in case. 90% of those with Hep B recover fully, but of those 10% who get chronic infection, one would have to be very careful with cholesterol drugs. There's chronic active and chronic persistent Hep B. One might try cholesterol drugs in the latter case, but in the former case, the person with chronic active Hep B has bigger things to worry about than his cholesterol.

 

>Also, it was just mentioned that Hep C cannot be contracted

>through sexual activity...is this accurate? Can it be

>contracted through semen or rimming?

>

Sexual transmission of Hep C is suspected but not proven. Strangely, in the case of non-drug using married couples, the other spouse is most often not infected! Presumeably, Hep C is found in blood but not in semen. Nevertheless, it's hard to imagine that Hep C can't be transmitted sexually. It's super-contagious blood-wise: about ten times more than Hep B and 100 times more than HIV. Just sharing a cocaine straw will do it.

 

>Thanks for all your info.

>

You're very welcome.