Hepatitis C
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Articles by
Dr. Zhang
 
TCM and MCM Theory Related to Common Liver Disease Blood Test Markers

Low Dose Interferon Patient Experiment

Hepatitis A Prevention Reminder

Hepatitis: Causes of Pain in Liver Region 

The Need to Monitor Your Chronic Hepatitis

Liver Enzyme Fluctuation during Allergy Season 

What are the Serum Markers of Hepatitis B and What do They Mean?

Enterogenous Endotoxemia in Chronic Hepatitis–
Part 2

Enterogenous Endotoxemia in Chronic Hepatitis–
Part 1
 

Chronic Hepatitis and "Blood Activating and Stasis Expelling" (BASE) Therapy -
Part 2

Chronic Hepatitis and "Blood Activating and Stasis Expelling" (BASE) Therapy
Part 1

What Causes Gastrointestinal Bleeding in Cirrhotic Liver Disease

Dietary Support for Cirrhotic Liver Diseases

Ascites - A Complication of De-Compensated Liver Cirrhosis

Liver Cirrhosis - Portal Vein Hypertension Complications

Liver Cirrhosis Overview

PG-IFN and Ribavirin Treatments

Antibiotics and Chronic Liver Diseases

Why is Alcohol Harmful for People with Hepatitis?

Co-infections and Super-infections of Viral Hepatitis

Beware of Medications That Can Cause Liver Damage

Bile Retention and Its Clinical Manifestations (MCM) part 4

Modern Chinese Medicine (MCM) Part 3 
Jaundice and Chronic Viral Hepatitis

Modern Chinese Medicine (MCM) Anti-Liver-Fibrosis Treatments - Part 2

Modern Chinese Medicine (MCM) Anti-Liver-Fibrosis Treatments - Part 1

What is Liver Fibrosis and How is It Different from Cirrhosis?

How does the liver change as we get older?

How is that my LFTs are so good when my viral load is seemly so high?

Comprehensive Care for Chronic Viral Hepatitis

What can Cause Liver Inflammation?  

What Are the Major Functions that the Liver Carries?


 





How is that my LFTs are so good when my viral load is seemly so high?

Few days ago I got a fax from a patient of mine, whose blood chemical panels are all in normal ranges but his HCV viral load was 3,470,000 iu/ml, which was a bit high. So he raised a few questions that many of my patients have asked when they see their LFT’s improve but their viral load fluctuate without improvement.

What is the relationship between "viral load" and the liver damage?
How important is the viral count relative to its role in monitoring the progression of the disease?
How to interpret clinical significance of viral count?

Patients often have these questions while they read their blood tests results.

In order to answer these questions, we first should know that HCV is a cytopathic and also an immunopathic virus. Cytopathic means that the replication of the virus can directly cause liver cell damage. Immunopathic means that HCV infection triggered inadequate immune reactions that cause damage to the liver cells. Clinically, we know that most liver cell damages were caused by immunopathy. Cytopathy was not significant in chronic viral liver disease.

The relationship between the severity of the liver cell damages and the viral count is weak at best. "It seems that it is more important 'how' your body responds to the presence of the hepatitis C virus in your liver than 'how much' virus is in your liver that counts." (Howard Monsour, M.D., Viral Counts - Do We Need Them? Hepatitis, Jul/Aug 2001, p. 22)

The body's constitutional make up, which determines the immune response to the infection, has more influence than the viral load in determining how much scar formation is caused under the inflammation. Life style, such as alcohol drinking might also play a greater role in promoting fibrosis than viral count.

The technique of viral load test is very variable and the results are not reliable, depending on the specific lab that performed the test.  Different labs and different times almost always produce different results.

Viral counts can also change within one day and in a week, ranges varying several million copies per milliliter of serum is common. I have one patient who tested one day with the result of 156,000 copies/ml and the next day, 5,000,000 copies/ml. These "ups and downs" might not be caught at a single point of time. That is why up to now, the FDA has still not approved viral count as a diagnostic procedure and is only used for research purposes.

So, "Following viral counts to see what's going on in the liver is of little use." (Howard Monsour, M.D., same article as above) It might be useful while doing research but not very useful in clinical practice. There is poor correlation with ALT, AST levels and viral count. To really determine the liver damage, a biopsy is still the best method, although it is an invasive procedure. The clinical significance of viral load has only been shown while doing IFN based treatments, low viral load (less than 2 million copies/ml) may have better response rate to IFN based treatments.

So when the viral load elevated, it does not mean the liver has taken more damage. We try to enhance the body's immunity to control the viral load and at same time use herbs such as olive leaf and its extract to lower the viral load.  We have to admit that anti-viral is the weak point of our herbal protocols. Because of this weakness, some patients have started to experiment with "low dose IFN injection every day plus herbal remedies" and they have been getting very good results in normalizing their liver functions and also reducing the viral load.  Most of them reduced to undetectable level. With low dose IFN combine with the herbal protocol, they also experienced much less side effects.

 

Return Home
About HCV
Overview
Causes and Transmission

 
Diagnostic Tests
Antibody
HCV RIBA
HCV RNA 
Viral Load

Viral Genotyping

 
Major Signs
Liver Inflammation
Fibrosis
Cirrhosis

 
Peripheral Signs and Symptoms
Fatigue
Jaundice
Bile Retention
Joint Pains and Skin Rashes
Blood Sugar Instability
Portal Vein Hypertension
Ascites

 
Important Liver Function Test Markers
Overview
ALT and AST
ALP and GGT
Albumin
Bilirubin
PT (Prothrombin Time)
 
Liver Biopsy
Overview
Procedure
Inflammation Grade
Fibrosis Stage
 
Interferon Based Treatment
Overview
Ideal Candidate
Possible Side-effects
 
Liver Support with TCM
Overview
Liver Enzymes
Serum Albumin
Blood Clotting Factors
Bile metabolism
GGT
 
Dietary Considerations
Overview
Proteins
Essential Fats
Carbohydrates
Vitamins
 
 

 


 

 

Medical Information Sources:
http://www.nih.gov/
http://www.nlm.nih.gov/

http://nccam.nih.gov/
http://www.medlineplus.org/


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