2.5.0 Cycles and Flare-ups
Hepatitis flare-ups tend to occur in cycles, where for a while you may feel pretty good, then bad (maybe days to weeks for each period), then good again. It can be frustrating to obtain some relief, but then not know whether you have recovered or if you are merely between cycles.
Some people claim that they begin to feel better in the Spring, then start to feel worse again in August/September, with a low point usually around November/December.
All persons with hepatitis C should be vaccinated against hepatitis A and B. An editorial in the New England Journal of Medicine warned that fulminant hepatitis is associated with hepatitis A virus superinfection in patients With chronic hepatitis C. What this means is that persons with hepatitis C who get hepatitis A are at significant risk for fulminant hepatitis and death. From June 1990 to July 1997, the scientists examined 163 adults with chronic hepatitis B and 432 patients with chronic hepatitis C who were seronegative for HAV antibodies; tests were conducted every four months for serum IgM and IgG antibodies to HAV.
Over the course of the study, 10 patients with HBV infections and 17 with HCV infections acquired HAV superinfection. Of these patients, fulminant hepatic failure developed in seven of the HCV-infected individuals, six of whom died. All but one of the HBV patients who developed HAV had uncomplicated courses. Since HAV infection rarely has a fulminant course and is usually non-fatal, the scientists note that "the high mortality rate among our patients with chronic hepatitis C and HAV superinfection (35 percent) is thus surprising, as is the even higher percentage of such patients with fulminant hepatitis (41 percent)."
The authors suggest, therefore, that individuals with chronic HCV infection be vaccinated against the hepatitis A virus. (Vento, Sandro, et al. New England Journal of Medicine 01/29/98 Vol. 338, No. 5, P. 286)
Patients with chronic hepatitis C who are at risk for hepatitis B should be offered vaccination during their first contact with healthcare professionals, according to a report from Great Britain’s University of Cambridge. (“Prospective Study of Hepatitis B Vaccination in Patients with Chronic Hepatitis C,” British Medical Journal, May 25, 1996;312:1336-1337).
Chronic hepatitis C (HCV) infection is estimated to occur in between 70 and 92 percent of intravenous drug users. These IV drug users are also at risk for parenterally or sexually transmitted hepatitis B. Coinfection with hepatitis B virus (HBV) may accelerate underlying liver damage due to hepatitis C.
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