Digestion, health and nutrition: Dr. Anil Minocha, a gastroenterologist and nutritionist

Hepatitis C: pot of coffee or just pot?

Treatment for hepatitis C is frequently accompanied by numerous side effects and patients try various kinds of modalities to counteract them.

Researchers from University of California recently presented preliminary data on the effect of coffee and marijuana on the liver in patients with hepatitis C. This presentation was part of the annual AASLD meeting (2006).

Dr. Ishida and colleagues studied HCV infected patients and correlated their coffee, alcohol and marijuana use with liver tests.

These investigators found that while cannabis is harmful in hepatitis C (HCV) infected patients, drinking three cups of coffee a day actually protects liver. The protective effect is thought to be due to the antioxidant properties. Alcohol is also harmful, although not as much as the pot is!

Do you or someone you know has hepatitis C. What was your experience with the treatment? What did you do to combat side-effects if any?

Hepatitis A versus hepatitis C

Can one hepatitis infection heal the other?

This provocative question has frequently been debated. A recent study from Hannover Medical School in Germany certainly lends support to this hypothesis.

Dr. Deterding and colleagues report on a group of 17 patients with chronic hepatitis C who also developed an acute episode of acute hepatitis A. Their findings were published in the Journal of Hepatology (December 2006).

These investigators found that none of these chronic hepatitis C patients developed fulminant liver failure. In addition, they demonstrated that while hepatitis C could be detected in 84% of those without acute hepatitis A, it was detected only in 65% of those who developed the co-infection. This suggests that the presence of hepatitis A suppressed the hepatitis C virus.

Once the acute hepatitis A had resolved, 6 out of the nine patients showed increased hepatitis C replication, whereas two of the patients continued to test negative for hepatitis C.

These authors concluded that acute hepatitis A virus infection inhibits hepatitis C virus replication and may even lead to its eradication. In addition, they noted that fulminant hepatitis A is uncommon in patients with chronic hepatitis C infection.

Hazards of sharing toothbrush

Although patients with hepatitis C are advised to take care not to share household and personal items such as razors, nail-scissors or toothbrushes with anyone in family, the data to support these recommendations has been scarce.

Dr. Lock and colleagues from the University of Regensburg in Germany addressed this issue in their recent paper titled,"Hepatitis C - contamination of toothbrushes: myth or reality?" This paper was published in the Journal of Viral Hepatology (September 2006).

These investigators recruited thirty consecutive patients with chronic hepatitis C for the study. None of these patients was taking any antiviral medication.

They investigators collected saliva from the patients before and after brushing teeth for 2 minutes. In addition, toothbrush was rinsed after brushing and the rinsing solution was also analyzed.

The saliva before tooth brushing was positive for hepatitis C RNA in 30% of patients. Hepatitis C positive saliva was seen in 37% of patients after brushing. Interestingly, many of these patients had hepatitis C negative saliva before brushing.

Further more, HCV-RNA was seen in 40% of the toothbrush rinsing water specimens. In half of these patients, the saliva before tooth brushing had been negative for hepatitis C.

In conclusion, this study lends further support to the hypothesis that sharing of household items like toothbrushes may represent an unconventional route of hepatitis C transmission. Although some of the earlier studies had shown conflicting results, the difference in the results may be due to the analytical methods used.

Above study notwithstanding, I wonder how many people in general population (with or without hepatitis C) do share toothbrushes. I would like to know your thoughts.