Talk:Hepatitis C

NEJM

Most, if not almost all, of these articles are based upon old information that a blood test can distinguish correctly between patients with liver damage continuing and patients with no further liver damage. All of the articles that advance the idea of a "cure" or "cure rates" based upon blood-tests are inaccurate and as such, all of these should be removed or denoted as not measuring rate of change in liver organ scarring and/or death via a reliable test instrument.

I previously began this process but an editor erased all of my statements with the New England Journal of Medicene's Dec 2008 source that showed liver damage con't even when the blood work showed a reduced and/or undetectable levels of virus in the blood. In post-treatment patients, it is now acceptable to state that blood work does not equal a liver biopsy's results for determing the rate of change of growth or deterioration of the liver. Even when the blood work would allow for the idea of a "cure", liver biopsies showed liver damage continued. Thus, the blood work cannot and should not be allowed to be advertised as a successful "cure", i.e. all of those articles need to be repaired. As it stands, this article's information is misleading, misguiding, and wrong. —Preceding unsigned comment added by Slm1202000@yahoo.com (talk • contribs) 21:50, 3 September 2010 (UTC)

You are referring to doi:10.1056/NEJMoa0707615 (PMID 19052125). This study was done in a group of patients whose liver had already been extensively damaged by hepatitis. The "damage" you refer to is fibrosis, the deposition of connective tissue. The study showed that once fibrosis is extensive, eradicating the virus makes some changes on blood tests and even the appearance of the liver biopsy (histologic necroinflammatory scores), but that this did not translate into better outcomes. It is well known that chronic liver disease is a progressive disease - once a certain degree of damage has been done, it gets worse by itself even if you remove the cause. The same is encountered in alcoholics who have stopped drinking alcohol many years earlier, yet develop cirrhosis.

It may be appropriate to make it clearer in the article that treating hepatitis C does not necessarily undo any damage that has already been done. For this, we should ideally cite a secondary source that places the findings from this study in the necessary context. JFW | T@lk 21:09, 4 September 2010 (UTC)

JFW is 100% correct on this point; treatment of hepatitis C virus infections can eradicate the virus — at least below detectable levels by PCR— but does not always result in a full reversion of the damage to the liver. I agree, a secondary source is essential. Graham Colm (talk) 21:20, 4 September 2010 (UTC)

Agree cure of the virus just not cure of the fibrosis is possible. This article is about "chronic hepatitis C who do not have a response to antiviral treatment" not general people with Hep C.Doc James (talk · contribs · email) 23:06, 4 September 2010 (UTC)

Most trials following SVR patients indicate SVR is highly correlated with improved outcomes, even in those with advanced fibrosis. SVR does not guarentee complete histological reversal of damage, but does correlate with greatly improved outcomes. SVR attained prior to sever liver damage occuring typically results in progression of disease ceasing, and liver regeneration and recovery slowly occuring. The clinical picture of recovery is complicated by high levels of substance abuse of hepatotoxic drugs in study populations.Inteluck (talk) 03:46, 9 January 2012 (UTC)

Insufflation

On the face of it, it is not at all clear how transmission can occur through sharing drugs via insufflation. My understanding is that the use of very hot devices for vaporisation of, especially, crack cocaine or heroin (e.g. a soda can heated with a flame) can lead to burns around the nose and hence the possibility of blood transmission via shared equipment. However I am not expert in this area and perhaps someone with more specialised knowledge could comment and add to the article. —Preceding unsigned comment added by Pharmagiles (talk • contribs) 14:50, 9 November 2010 (UTC)

Five virus types known?

This article says that five subtypes of hepatitis are known (A, B, C, D, E) but the article Hepatitis D says that there are seven (F and G added). Please check references for these claims to avoid ambiguity. --Vitomontreal (talk) 23:59, 19 December 2010 (UTC)

I have restored Hepatitis D (removing reference to Hepatitis F virus and Hepatitis G virus as hepatitis viruses) because they are not hepatitis viruses at all, as those linked articles explain. -- Scray (talk) 04:23, 20 December 2010 (UTC)

HIV coinfection

This article should be linked to Hepatitis C and HIV co-infection 2.124.21.183 (talk) 08:51, 27 February 2011 (UTC)

Yes. HCV is rapidly getting out of control among the gay population, particularly in NYC. There should be much more discussion of transmission among the MSM population.Arlesd (talk) 20:09, 25 July 2011 (UTC)

"SRV" is preferable to word "cure."

I've been reading the literature and don't find any journal articles claiming a "cure" for HCV. Instead, the desirable outcome is "sustained virologic response" or "SRV," meaning that virus is undetectable in the patient's blood six months after treatment. Of those who achieve SRV, 1-2% of them will relapse.

I have barely any WP editing experience, so for now will limit my contributions to the talk page.Cyclopiano (talk) 01:24, 3 March 2011 (UTC)

The pharmaceutical companies have now admitted that Hep C treatments of Interferon and Rebetol do NOT work. They are attempting another variation on this theme with a third drug added to the mix, which their white pages suggests may result in a 40% SRV rate. All of the 1-2% relapse rates are inaccurate. Anything reporting an 80% success rate is inaccurate. The New England Journal of Medicine reported that 0% were cured using these 2 drugs in Dec 2008 when patients were tested with true three core biopsies. The patients had to submit to more than one biopsy to begin with in order to be in the study, but the major requirement for them to begin the study was that a biopsy discovered that they had actually a form of Hep C. This is not really skewing the results, as I would not want patients with rheumatiod arthritis given radiation treatments for Hep C to ensure that a perfect control group exists. Any of the patients could have been cured. Now, even the pharmaceutical company admits the drugs do not work. It is erroneous to say there is a cure, but this article has in the past specifically spelled out that there WAS a cure. I am glad that the talk has shifted to SRV, but even here, there must be an update to allow that drug trials to find a continued SRV response are on-going. When it is suggested that only 1-2% might relapse, that in no way is taking into account all of the research that suggests otherwise that liver damage continued to exist in the liver even to the point of death.slm1202000 (talk) 13:45, 3 March 2011 (UTC)

SVR is currently most commonly correlated with triple therapy (PEG/RIB/TELEPRAVIR). SVR attained prior to severe liver damage occuring typically halts disease progression. If the virus remains undetectable for 12 months or more, the chance of spontaneous recurrence is extremely small, as is the prospect of liver damage. It is far more typical for those attaining SVR to reverse existing lver damage, and risks associated with HCV gradually diminish. For this to be considered a cure, all that is required is for more people to attain SVR. Present trials suggest it will soon be possible to attain SVR in 24 weeks or less in 80% of patients or more. I believe this could be considered a cure.Inteluck (talk) 03:57, 9 January 2012 (UTC)

Kissing?

The article states: "HCV is not spread through casual contact, such as hugging, kissing, or sharing eating or cooking utensils." but the provided source (http://www.cdc.gov/hepatitis/HCV/HCVfaq.htm#b1) never says anything about kissing "HCV is not spread by sneezing, hugging, holding hands, coughing, sharing eating utensils or drinking glasses, or through food or water."

Maybe I was not able to find the correct paragraph? — Preceding unsigned comment added by 91.113.6.100 (talk) 14:40, 28 August 2011 (UTC)

Public pools and hep c

If hep c cannot be contacted casually then why are public pools closed when there is an outbreak of hep c? — Preceding unsigned comment added by 64.130.132.43 (talk) 14:34, 23 September 2011 (UTC)

You are confusing hepatitis C with hepatitis A. Graham Colm (talk) 14:39, 23 September 2011 (UTC)

GA Review

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dashboard disambig links external links See WP:DEADREF for dead URLs

This review is transcluded from Talk:Hepatitis C/GA1. The edit link for this section can be used to add comments to the review.

Reviewer: Muboshgu (talk · contribs) 15:44, 3 January 2012 (UTC) I'll be on vacation until the 8th (just checking in on the Wiki in a spare moment), so I won't be able to conduct the review for a few days. – Muboshgu (talk) 15:44, 3 January 2012 (UTC)

Thanks. --Doc James (talk · contribs · email) 07:31, 6 January 2012 (UTC)

GA review (see here for what the criteria are, and here for what they are not)

1. It is reasonably well written.

   a (prose): b (MoS for lead, layout, word choice, fiction, and lists):

   1a: Prose can be tightened in a few places. "For those that do manifest symptoms, they are in general mild and vague, including a decreased appetite, fatigue, nausea, muscle or joint pains, and weight loss" - here, the "they" is vague (are we talking about the infected individuals or the symptoms?). "The infection resolves spontaneously in 10-50% of cases being more likely in those who are young and females" is clumsy. "About 80% of those exposed to the virus develop a chronic infection,[6] with most experiencing minimal or no symptoms during the initial few decades of the infection[7] although chronic hepatitis C can be associated with fatigue.[8]" is a bit of a run-on sentence and should be broken in two. There are a few other places to improve prose, in addition to those. I'm not going to list them all, but a thorough review of the prose would be beneficial. Also, I just found a disambiguation link (now tagged in the article). I don't know where it's supposed to go, but it needs to be corrected.
   1b: Solid lead overall, which summarizes the entire article. No words to watch, fiction not applicable (though it would be nice if this was a fiction article), nor is lists. Regarding layout, however, some work needs to be done. One-sentence paragraphs are frowned upon, and this article has one-sentence sections. Those should either be expanded or merged as appropriate.

2. It is factually accurate and verifiable.

   a (references): b (citations to reliable sources): c (OR):

   This is my first review involving WP:SCG. The article cites many sources, in many places where appropriate. Many of these sources come from high quality journals, and most of them were published in the last few years. There doesn't seem to be any original research here. However, the reference titled "Hepatitis Drug-Maker Complaints Reviewed" is a dead link and that needs to be replaced.

3. It is broad in its coverage.

   a (major aspects): b (focused):

   Most major aspects are covered. Regarding focus, I think the article's focus suffers due to some of the one-sentence sections I mentioned earlier. It would help to cover the major aspect of HCV in society/culture if that section were expanded.

4. It follows the neutral point of view policy.

   Fair representation without bias:

   No bias here.

5. It is stable.

   No edit wars, etc.:

   No edit warring here.

6. It is illustrated by images, where possible and appropriate.

   a (images are tagged and non-free images have fair use rationales): b (appropriate use with suitable captions):

   All images are appropriate and have captions.

7. Overall:

   Pass/Fail:

   This is a well-written article that can meet GA standards with a little bit of work, as I outlined above. I'll put the article on hold for a week to allow for improvement (longer if work is in progress).

Reply

First of all many thanks for taking on this GAN.

• With respect to the disambig link. Pegylated interferon alpha is not really a disambig. I have thus removed the disambig tag from it as it is really a stub for a class of meds.
• I have added to the two section in question.
• I will see if I can get someone who knows prose to improve this. Doc James (talk · contribs · email) 23:38, 10 January 2012 (UTC)

• Well, pegylated interferon alpha may be the proper medical term, but on Wikipedia, Pegylated interferon alpha is a disambiguation page, and GA's can't link to a disambiguation page, so something has to give there. – Muboshgu (talk) 21:34, 12 January 2012 (UTC)

Yes it is no longer a disambig as the term does not mean multiple things.Doc James (talk · contribs · email) 21:58, 12 January 2012 (UTC)

Okay. That article could use some improvement, though that has nothing to do with this GA review. I'll take a look at it and see if I can do some of the copy editing and let you know where we stand. – Muboshgu (talk) 22:02, 12 January 2012 (UTC)

Source #48, "Chapter 4 — Hepatitis, Viral, Type C — Yellow Book, CDC Health Information for International Travel 2008" comes up as not found. – Muboshgu (talk) 22:10, 12 January 2012 (UTC)

thanks and fixed.Doc James (talk · contribs · email) 22:42, 12 January 2012 (UTC)

Great. I'm done with the copy editing, so I'll pass this on criterias 1 and 2 (except for 2b). I feel you've done enough to expand the article to meet 3a, which also took care of 3b. Where 2b comes in is that I added a citation needed tag in the Epidemiology section for a statement I feel needs to be sourced. If you add that, I'll pass this article. – Muboshgu (talk) 22:54, 12 January 2012 (UTC)

Sure that does not a ref. Do not understand how I missed it... Doc James (talk · contribs · email) 23:18, 12 January 2012 (UTC)

It happens to the best of us. Congratulations on your good work. I'm passing this as a Good Article. – Muboshgu (talk) 00:49, 13 January 2012 (UTC)