Disclaimer

My husband has been diagnosed with hepatitis C. He started smoking marijuana on a daily basis. Is that dangerous to his condition?

Although marijuana may not have a direct effect on the liver, it can negatively affect his physical and psychological health.

I was tested and do not have hepatitis C or B, but my liver enzymes are still high at 90. Why?

A number of other liver conditions should be considered. These common liver diseases are fatty liver, iron overload condition, and autoimmune liver diseases. At this point, it is advisable to seek the opinion of a gastroenterology specialist to make sure other causes of liver disease have been excluded.

I went to the hospital with a Bartholin's gland cyst. Blood tests for alanine aminotransferase (ALT) was 64 and for alkaline phosphatase (Alk Phos) was 136. This showed up in two different tests. Approximately 2½ weeks later, my ALT was back to normal. Alk Phos is down to 125. Should I still be concerned and seek medical attention for Alk Phos? What should I be looking for--liver damage? What could be causing this, and what tests would you recommend? I'm not a drinker and am 46 years old. Is hepatitis C a concern?

An isolated elevation of Alk Phos is usually not of concern. However, if the liver tests are repeated and the abnormality remains, all causes of chronic liver disease need to be considered. Although HCV usually causes elevation of ALT and aspartate aminotransferase (other liver enzymes), it can occasionally be associated with higher Alk Phos. If the elevation persists, diseases of the bile ducts need to be considered.

My husband found out that he has hepatitis C on a Monday. By Friday, he was in "liver crisis." How long would he have had hepatitis C for his liver to be in this condition? Also, his blood levels are continuing to get worse. Is there anything that can stop this crisis?

Although HCV infection is usually not associated with symptoms, occasionally acute hepatitis C can be very symptomatic. In this case, it is important to make sure that a second liver disease is not playing a role here. For example, patients with chronic HCV infection who are infected with another liver virus (acute hepatitis A) seem to have an exaggerated course of their HCV liver disease. In the setting of severe liver failure, the only option for treatment may be a liver transplantation.

What is fatty liver disease?

This is a common liver disease associated with infiltration of fat in the liver. Although a number of conditions can cause fatty liver, the most common causes are alcohol use, obesity, and diabetes. A type of fatty liver called steatohepatitis can progress to cirrhosis in approximately 20% of patients.

I have hepatitis C. Is there harm in drinking alcohol once in a while?

There is little doubt that excessive alcohol use (>5 drinks per day) will hasten HCV liver disease, but there is little consensus on the "safer" amounts of alcohol consumption in patients with hepatitis C. If a patient has mild disease on a liver biopsy, occasional alcohol use may be fine. However, those with advanced liver disease should be advised against alcohol consumption.

What combination therapy is the best for genotype 1a HCV infection--interferon and ribavirin, or Pegasus and copegasus?

Weekly injection of pegylated interferon alpha and daily doses of ribavirin is the most effective treatment. Although there are two approved products on the market, currently there is no solid evidence to support using one product over the other.

A biopsy in 1995 showed 4 on the Knoll scale; HCV had been eating at the liver for 20 years. I went through all three treatments and have not responded to treatment since June 2003. What state do you think my liver is in now? I have no insurance or cash and need help.

It seems that the liver disease in 1995 was quite mild. The chance of progression over the last 10 years is small. Nevertheless, it may be reasonable to consider another liver biopsy to see what degree of progression has occurred over the past 10 years. Given that the three courses of treatment did not work, the likelihood of response with another course of treatment with current HCV medications is negligible. If there is no insurance, a call to the local chapter of the American Liver Foundation may be helpful. They may be aware of programs or research protocols that can provide the liver biopsy or blood tests free of charge.