Diagnosis

Potential Complications of Hepatitis C

Chronic hepatitis C infection is a long-lasting illness with potentially serious complications. About 75% to 85% of those with acute hepatitis C infection go on to develop chronic illness. Of those in the chronic illness group, more than two-thirds will develop liver disease. Up to 20% will develop cirrhosis, or scarring of the liver, within 20 to 30 years. Cirrhosis affects liver function and causes elevated blood liver enzymes. Up to 5% of people with chronic hepatitis C infection will die from liver cancer or cirrhosis. Chronic hepatitis C infection is the most common reason for liver transplantation in the U.S.

Allopathic treatment for Hepatitis C or HCV (Hep C)

When people first get hepatitis C, the infection is said to be acute. Most people with acute hepatitis C do not have symptoms so they are not recognized as being infected. However, some have low-grade fever, fatigue or other symptoms that lead to an early diagnosis. Others who become infected and have a known exposure to an infected source, such as a needlestick injury, are monitored closely.

Treatment decisions should be made on a case-by-case basis. Response to treatment is higher in acute hepatitis infection than chronic infection. However, many experts prefer to hold off treatment for 8-12 weeks to see whether the patient naturally eliminates the virus without treatment. Approaches to treatment are evolving. Patients with acute hepatitis C infection should discuss treatment options with a healthcare professional who is experienced in treating the disease. There is no established treatment regimen at this time.

Hepatitis C usually recurs after transplantation and infects the new liver. Approximately 25% of these patients with recurrent hepatitis will develop cirrhosis within five years of transplantation. Despite this, the five-year survival rate for patients with hepatitis C is similar to that of patients who are transplanted for other types of liver disease.

Allopathic treatment for HCV is very costly. Use of DAAs is the first-line treatment for hepatitis C infection. The choice of DAAs varies by specific virus genotype, and the presence or absence of cirrhosis. Treatment is recommended in all patients with chronic hepatitis C unless they have a short life expectancy that is not related to liver disease. Severe life-threatening liver disease may require liver transplantation.

Interferons, for example, Roferon-A and Infergen, and pegylated interferons such as Peg-Intron^T, Pegasys, were mainstays of treatment for years. Interferons produced sustained viral response (SVR, or cure) of up to 15%. Later, peglatedll forms produced SVR of 50%-80%. These drugs were injected, had many adverse effects, required frequent monitoring, and were often combined with oral ribavirin, which caused anemia. Treatment durations ranged up to 48 weeks.

Direct-acting antiviral agents (DAAs) are antiviral drugs that act directly on hepatitis C multiplication.

They are taken by mouth, are well tolerated, and cure over 90% of patients. Treatment time is much shorter, often 12 weeks, depending on drug and genotype.

Similar to treatments for HIV, treatment of HCV is most effective if the drugs are given in combination. The earliest options were sofosbuvir and simeprevir. These were approved by the FDA in 2013. Ledipasvir and sofosbuvir (Harvoni) followed as a once-a-day combination pill, in 2014. With this combination of DAAs, about 94%-99% of people achieve an SVR (cure) in 12 weeks with few side effects. Ombitasvir, paritaprevir and ritonavir co-packaged with dasabuvir tablets (Viekira Pak), is a combination approved in 2014. SVR with this combination is 91%-100%. The combination of elbasvir and grazoprevir was approved in 2016. SVR with this combination depends on the HCV genotype and whether individual patient factors require the addition of ribavirin. Genotype 1 has a 94%-97% SVR, and SVR is 97%-100% in genotype 4. In August 2017, FDA approved an 8-week regimen of glecaprevir and pibrentasvir (Mavryet) for all HCV genotypes. Unlike some of the earlier regimens, this combination is effective whether or not the patient has cirrhosis. It also can be given to people on kidney dialysis, whose kidney function limits treatment options. Moreover, this regimen is effective in people with genotype 1 who have failed treatment with some of the other regimens.

How effective is allopathic treatment?

If the hepatitis C RNA remains undetectable at the end of the treatment and follow-up period, this is called a sustained virologic response (SVR) and is considered a cure. Over 90% of people treated with DAAs are cured. These people have significantly reduced liver inflammation, and liver scarring may even be reversed.

About 5% of people who are treated for HCV infection are not cured by some of the older regimens. These people may still have options for cure with the newer regimens.

Who should not receive allopathic treatment for HCV?

Few people with hepatitis C are at risk for problems if they are treated, however there are some factors that affect treatment regimens, such as concurrent HIV medications and kidney dysfunction. Some drugs are not safe for people with cirrhosis. Individuals who are unable to comply with the treatment schedule for psychological reasons or ongoing drug or alcohol abuse may not be good candidates for treatment because the drugs are very costly and require adherence to the pill regimen and regular follow-up visits. There are some important drug interactions with some of the medications that should be considered by the health care professional.

People with past hepatitis B or who have chronic active hepatitis B should not be treated for HCV without treating for HBV as well. As highly effective treatment for HCV has emerged, reports of serious hepatitis B have come to light. Similar to HCV, hepatitis B usually does not clear from the liver after acute infection, even though it is far less likely to cause chronic active hepatitis than hepatitis C infection. It remains dormant in most people, but it can reactivate with changes in the immune system. It is not clear why eliminating the HCV can allow the HBV infection to flare up. Hepatitis B screening is an important part of the hepatitis C evaluation. Those who have laboratory evidence of active or past infection with HBV should be monitored while receiving HCV treatment.

Side effects of interferon or pegylated interferon

• The most common side effects of interferon or pegylated interferon include fever, flu, and depression. Patients must be monitored closely for depression. Risk of suicide is a reason to avoid interferons.
• Interferons also reduce white blood cell and/or red blood cell counts (leukopenia and anemia, respectively). This may cause increased susceptibility to infection. Interferons also increase the risk of certain cancers. Death rarely occurs as a result of therapy, but may occur from progression of liver failure in patients with advanced cirrhosis.

Side effects of ribavirin

• Ribavirin most commonly causes anemia due to destruction of red blood cells (hemolysis). This can be severe enough that people with heart disease may suffer a heart attack from insufficient blood flow, so people with heart disease should not receive this drug. Anemia improves with a reduction in the dose of ribavirin. Injected growth factor (erythropoietin) that stimulates the production of red blood cells often is used to improve the anemia associated with ribavirin. Ribavirin also accumulates in the testicles and ovaries and causes birth defects in animals. Although no birth defects have been reported in humans, both men and women should use contraceptive measures to avoid pregnancy during and for at least six months after ribavirin treatment.

Side effects of DAAs

Compared to interferons and ribavirin drugs, the side effects of DAAs are far fewer and more tolerable. These side effects usually do not require discontinuation of therapy and are self-limiting after completion of therapy.

• The most common and significant side effects of boceprevir (Victrelis), sofosbuvir (Sovaldi), and ledipasvir/sofosbuvir (Harvoni) include
  • fatigue (feeling tired),
  • headache, and
  • trouble sleeping (insomnia).
• The most common side effects of simeprevir (Olysio) include
  • itching,
  • skin rash, and
  • photosensitivity (tendency to get sunburns).
• Simeprevir has significant drug interactions with other medications. Certain medications can affect levels of simeprevir in the body and make simeprevir less effective or more toxic.
• The combination of ombitasvir, paritaprevir, and ritonavir tablets with dasabuvir tablets (Viekira Pak) is very well tolerated, and the most commonly reported side effects are
  • fatigue,
  • trouble sleeping, and
  • itching.
• The combination of elbasvir and grazoprevir (Zepatier) is well-tolerated. Most common side effects include
  • fatigue,
  • headache, and
  • nausea.
  • It may be used with ribavirin, which adds the side effect of anemia.
  • About 1% of people in studies may develop elevated liver enzyme blood tests last into treatment or afterward, so these tests are closely monitored.
• The combination of glecaprevir and pibrentasvir (Mavryet) is well tolerated. Most common side effects include
  • fatigue,
  • headache, and
  • nausea.

Patients with hepatitis B co-infection should be monitored for symptoms of reactivation of hepatitis, which are the same as the symptoms of acute hepatitis. The treating doctor may perform blood screening for this as well.

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Homeopathic treatment for Hepatitis C or HCV

Chelidonium Majus (Milk Thistle)

A prominent liver remedy, jaundice, pain under right scapula, Jaundice due to hepatic and gallbladder obstruction. Gall-colic. Distention. Fermentation and sluggish bowels. Constriction across, as by a string. Liver enlarged. Gallstones. Tongue yellow, with imprint of teeth; large and flabby. Taste bitter, pasty. Bad odor from mouth.

Constipation; stools hard, round balls, like sheep’s dung, bright yellow, pasty; clay-colored, stools float in water; alternation of diarrhea and constipation. Burning and itching of anus.

Urine: Profuse, foaming, yellow urine, like beer (Chenop) dark, turbid.

Pain in arms, shoulders, hands, tips of fingers. Icy coldness of tips of fingers; wrists sore, tearing in metacarpal bones. Whole flesh sore to touch. Rheumatic pain in hips and thighs; intolerable pains in heels.

Skin: Dry heat of skin; itches, yellow. Painful red pimples and pustules. Old, spreading, offensive ulcers. Wilted skin. Sallow, cold, clammy.

Hepar Sulph

Stitching in region of liver when walking, coughing, breathing, or touching it. Hepatitis, hepatic abscess; abdomen distended, tense; chronic abdominal affections. Frequent eructation, without taste or smell. Distention of stomach, compelling one to loosen the clothing. Burning in stomach. Heaviness and pressure in stomach after a slight meal. Yellowish complexion. Middle of lower lip cracked

Stool: Clay-colored and soft. Sour, white, undigested, fetid. Loss of power to expel even a soft stool.

Urine: Voided slowly, without force-drops vertically, bladder weak. Seems as if some always remained. Greasy pellicle on urine. Bladder difficulties of old men.

Skin: Abscesses; suppurating glands are very sensitive. Papules prone to suppurate and extend. Acne in youth. Suppurate with prickly pain. Easily bleed. Angioneurotic edema. Unhealthy skin; every little injury suppurates. Chapped skin, with deep cracks on hands and feet. Ulcers, with bloody suppuration, smelling like old cheese. Ulcers very sensitive to contact, burning, stinging, easily bleeding. Sweats day and night without relief. “Cold-sores” very sensitive. Cannot bear to be uncovered; wants to be wrapped up warmly. Sticking or pricking in afflicted parts. Putrid ulcers, surrounded by little pimples. Great sensitiveness to slightest touch. Chronic and reoccurring urticaria. Smallpox. Herpes circinate. Constant offensive exhalation from the body.

Fever: Chilly in open air or from slightest draught. Dry heat at night. Profuse sweat; sour, sticky, offensive.

Lachesis Mutus

Liver region sensitive, cannot bear anything around waist. Especially suitable to drunkards. Abdomen tympanitic, sensitive, painful. Any food causes distress. Pit of stomach painful to touch. Hungry, cannot wait for food. Gnawing pressure made better by eating, but returning in a few hours. Perceptible trembling movement in the epigastric region. Empty swallowing more painful than swallowing solids.

Constipated, offensive stool. Anus feels tight, as if nothing could go through it. Pain darting up the rectum every time be sneezes or coughs. Hemorrhage from bowels like charred straw, black particles. Hemorrhoids protrude, become constricted, purplish. Stitches in them on sneezing or coughing. Constant urging in rectum, not for stool.

Chilly in back; feet icy cold; hot flushes and hot perspiration. Paroxysm returns after acids. Intermittent fever every spring.

Skin: Hot perspiration, bluish, purplish appearance. Boils, carbuncles, ulcers, with bluish, purple surroundings. Dark blisters. Bed-sores, with black edges. Blue-black swellings. Pyemia; dissecting wounds. Purpura, with intense prostration. Senile erysipelas. Wens. Cellulitis. Varicose ulcers.

Mercurius Solubilis

Stabbing pain, with chilliness. Boring pain in right groin. Flatulent distention, with pain. Liver enlarged; sore to touch, indurated. Jaundice. Bile secreted deficiently. Putrid eructation. Intense thirst for cold drinks. Weak digestion, with continuous hunger. Stomach sensitive to touch. Hiccough and regurgitation. Weakness of limbs. Bone-pains and in limbs; worse, night. Patient very sensitive to cold. Oily perspiration. Dropsical swelling of feet and legs.

Stool: Greenish, bloody and slimy, worse at night, with pain and tenesmus. Never-get-done feeling. Discharge accompanied by chilliness, sick stomach, cutting colic, and tenesmus. Whitish-gray stools.

Urine: Frequent urging. Greenish discharge from urethra; burning in urethra on beginning to urinate. Urine dark, scanty, bloody, albuminoids.

Skin: Almost constantly moist,  Excessive odorous viscid perspiration, Ulcers, irregular in shape, edges undefined. Pimples around the main eruption. Itching, worse from warmth of bed. Crusta lactea; yellowish-brown crusts, considerable suppuration.

Fever: Generally gastric or bilious, with profuse nightly perspiration; debility, slow and lingering. Heat and shuddering alternately. Yellow perspiration. Profuse perspiration without relief. Creeping chilliness, worse in the evening and into night. Alternate flashes of heat in single parts.

Phosphorus for HCV

Feels cold (Caps). Sharp, cutting pains. A very weak, empty, gone sensation felt in whole abdominal cavity. Liver congested. Acute hepatitis. Fatty degeneration (Carbon tetrachloride; Ars. Chlorof). Jaundice. Pancreatic disease. Large, yellow spots on abdomen. Hunger soon after eating. Sour taste and sour eructation after every meal. Belching large quantities of wind, after eating. Throws up ingests by the mouthfuls. Vomiting; water is thrown up as soon as it gets warm in the stomach. Tibia inflamed and becomes necroes. Arms and hands become numb. Can lie only on right side. Post-diphtheritic paralysis, with formication of hands and feet. Joints suddenly give way.

Stool: Very fetid stools and flatus. Long, narrow, hard, like a dog’s. Difficult to expel. Desire for stool on lying on, left side. Painless, copious debilitating diarrhea. Green mucus with grains like sago. Involuntary; seems as if anus remained open. Great weakness after stool. Discharge of blood from rectum, during stool. White, hard stools. Bleeding hemorrhoids.

Urine: Hematuria, especially in acute Bright’s disease. Turbid, brown, with red sediment.

Fever: Chilly every evening. Cold knees at night. Adynamic with lack of thirst, but unnatural hunger. Hectic, with small, quick pulse; viscid night-sweats. Stupid delirium. Profuse perspiration.

Skin: Wounds bleed very much, even if small; they heal and break out again. Jaundice. Little ulcer outside of large ones. Petechiae. Ecchymosis. Purpura hemorrhagica. Scurvy. Fungus haematodes and excrescences.

Nux vomica

Bruised soreness of abdominal walls (Apis; Sulph). Flatulent distension, with spasmodic colic. Colic from uncovering. Liver engorged, with stitches and soreness. Colic, with upward pressure, causing short breath, and desire for stool. Sour taste, and nausea in the morning, after eating. Weight and pain in stomach; worse, eating, Sour, bitter eructation. Nausea and vomiting.

Constipation, with frequent ineffectual urging, incomplete and unsatisfactory; feeling as if part remained un expelled. Alternate constipation and diarrhea – after abuse of purgatives. Urging to stool felt throughout abdomen. Itching, blind hemorrhoids, with ineffectual urging to stool; very painful; after drastic drugs. Diarrhea after a debauch; worse, morning. Frequent small evacuations. Scanty stool, with much urging. Dysentery; stools relieve pains for a time. Constant uneasiness in rectum. Diarrhea, with jaundice.

Skin: Body burning hot, especially face; yet cannot move or uncover without feeling chilly. Urticaria, with gastric derangement. Acne; skin red and blotchy.

Fever: Cold stage predominates. Paroxysms anticipate in morning. Excessive rigor, with blueness of finger-nails. Aching in limbs and back, and gastric symptoms. Chilly; must be covered in every stage of fever. Perspiration sour; only one side of body. Chilliness on being uncovered, yet he does not allow being covered. Dry heat of the body.

Digitalis Purpura

Severe abdominal pains, pulsation in abdominal aorta, and epigastric constriction. Enlarged, sore, painful liver. Sweet mouth taste with constant ptyalism. Excessive nausea, not relieved by vomiting. Faintness, great weakness in stomach. Discomfort, even after a small quantity of food, or from mere sight or smell. Tenderness of epigastrium. Copious salivation.

Stool: White, chalk-like, ashy, pasty stools. Diarrhoea during jaundice.

Urine: Continued urging, in drops, dark, hot, burning, with sharp cutting or throbbing pain at neck of bladder, as if a straw was being thrust back and forth; worse at night. Suppressed. Ammoniacal, and turbid. Urethritis, phimosis, strangury. Full feeling after urination. Constriction and burning, as if urethra was too small. Brick-dust sediment.

Swelling of the feet. Fingers go to sleep easily. Coldness of hands and feet. Rheumatic pain in joints. Shining, white swelling of joints. Muscular debility. Nocturnal swelling of fingers.

Skin: Erythema, deep red, worse on back, like measles. Blue distended veins on lids, ears, lips and tongue. Dropsical. Itching and jaundiced.

Lycopodium Clavatum

Abdomen: Immediately after a light meal, abdomen is bloated, full. Constant sense of fermentation in abdomen, like yeast working.

Liver sensitive. Brown spots on abdomen. Dropsy, due to hepatic disease. Hepatitis, atrophic from of nutmeg liver. Pain shooting across lower abdomen from right to left.

Stool: Diarrhoea. Inactive intestinal canal. Ineffectual urging. Stool hard, difficult, small, incomplete. Haemorrhoids; very painful to touch, aching.

Urine: Pain in back before urinating; ceases after flow; slow in coming, must strain. Retention. Polyuria during the night. Heavy red sediment. Child cries before urinating.

Skin: Ulcerates. Abscesses beneath skin; worse warm applications. Hives; worse, warmth. Violent itching; fissured eruptions. Acne. Chronic eczema associated with urinary, gastric and hepatic disorders; bleeds easily. Skin becomes thick and indurated. Varicose veins, naevi, erectile tumors. Brown spots, freckles worse on left side of face and nose. Dry, shrunken, especially palms; hair becomes prematurely gray. Dropsies. Offensive secretions; viscid and offensive perspiration, especially of feet and axilla. Psoriasis.

Cardus Marianus for HCV

Pain in region of liver. Left lobe very sensitive. Fullness and soreness, with moist skin. Constipation; stools hard, difficult, knotty; alternates with diarrhoea. Stools bright yellow. Swelling of gallbladder with painful tenderness. Hyperaemia of liver, with jaundice. Cirrhosis, with dropsy. Mouth taste bitter. Aversion to salt meat. Appetite small; tongue furred; nausea; retching; vomiting of green, acid fluid. Stitches in left side of stomach, near spleen (Ceanoth). Gallstone disease with enlarged liver.

Haemorrhagic piles, prolapse or rectum, burning pain in anus and rectum, hard and knotting, clayey stools. Profuse diarrhoea due to rectal cancer. 10 drops doses (Wapler).

Urine: Cloudy; golden-colored.

Ceanothus Americanus for HCV

Enormous enlargement of the spleen. Splenitis; pain all up the left side. Deep-seated pain in left hypochondrium, hypertrophy of spleen. Leukemia. Violent dyspnoea. Menses profuse, and yellow weakening leucorrhoea. Unable to lie on left side. Pain in liver and back.

Rectum: bearing down in abdomen and rectum, Diarrhoea, Dysentery. Stool light brown, with loud flatus. Continual bearing-down in rectum with constricting sensation

Urine: Constant urging to urinate. Green; frothy; contains bile, sugar.

Fever. Shivering; loss of appetite, and nervous excitement. Rigors at frequent intervals. Intermittents with splenic enlargements. Cheeks and ears hot, with cold fingers, with constant chilliness up and down back; after chill very hot; fever; pulse 120.

Chionanthus Virginica for HCV

Complete loss of appetite, jaundice and constipation. Clay-colored stool, also soft, yellow and pasty. Tongue heavily coated. No appetite. Bilious colic. Hepatic region tender. Pancreatic disease and other glandular disorders, offensive flatus during the day, Uneasy sensations in region of spleen and liver, Hypertrophy of liver. Obstruction of liver in malarious districts. Enormous liver, constipation, stools clay-coloured, skin very yellow, urine very dark, almost black. Soreness in region of liver, quick, weak pulse, stools undigested and showing entire absence of bile, Chronic cases of jaundice.-Jaundice recurring every summer. Bilious colic. Gallstone colic.

Constipation, stools clay-coloured.-Stools undigested and showing an absence of bile. Diarrhoea. First part of stool watery, but last more solid in appearance, stool copious, watery, dark brown. Stools terribly offensive, like carrion. Stool copious, watery, dark brown, with pieces of undigested food in it. Stool thin, watery, blackish-brown and very offensive. Stool flakey, thin, watery; flakey portion dark yellow; fluid portion dark green, with light green foam or froth on top, streaked with a white mucous-looking substance. Emission of flatus during stool. Hot, scalding sensation in anus during stool, which continued fifteen or twenty minutes after stool.

Urine: Large amount of high specific gravity; frequent urination; bile and sugar in urine. Urine very dark – almost black.

Skin: Yellow; marked moisture of skin. Sallow, greenish, itching. Yellow all over body. Jaundice of years’ standing recurring annually.

Natrum Sulphuricum

Duodenal catarrh; hepatitis; icterus and vomiting of bile; liver sore to touch, with sharp, stitching pains; cannot bear tight clothing around waist, worse, lying on left side. Flatulency; wind colic in ascending colon; worse, before breakfast. Burning in abdomen and anus. Bruised pain and urging to stool. Diarrhoea yellow, watery stools. Loose morning stools, worse, after spell of wet weather. Stools involuntary, when passing flatus. Great size of the fecal mass. Vomits sour. Brown, bitter coating on tongue. Yellow complexion. Thirst for something cold. Bilious vomiting, acid dyspepsia, with heartburn and flatulence.

Urine: Loaded with bile. Brisk-dust sediment. Excessive secretion. Diabetes.

Skin: Itching while undressing. Jaundiced, watery blisters. Sycotic excrescences; wart-like red lumps all over body.