May 2003
May 21 -- Dr. Ed Wakil, Hepatologist with California Pacific Medical Center

SCC Classrooms 3 & 4
As a principal investigator in trial therapies studied by Sutter Health and as a praticing hepatologist, Dr. Wakil has managed the treatment of thousands of hepatitis C patients and recipients of liver transplants.

Upcoming Agendas:
Meeting Agenda:
6:30 p.m. (sharp) - Theme Song: I Will Survive
6:35 - 6:45 Announcements
6:45 - 8:15 Dr. Ed Wakil
8:15 - 8:45 (or earlier) questions/answers 'til we adjourn

June 18 -- Rm 220 -- Susan Smith, owner of Dry Creek Herb Farm
Liver Walk sponsored by American Liver Foundation

June 1, 2003 - William Land Park. $15/person registration fee to: American Liver Foundation, Northern California Chapter, 870 Market Street, Suite 1046, San Francisco, CA 94102 Or fax to: 415/248-1066
More News
Our Meetings: 3rd Wednesdays of every month; at SCC (Sutter Cancer Center, aka: Buhler Bldg) classroom 3&4 or Room 220; 2800 L St (@ 28th & L: kitty corner across from the 2-story parking & across L St. from Sutter Hospital)
Contact Us: Phone number: (916) 444-6996
Our Web Site> www.sacmall.net/transplant/hepc.html
Email: dck@innercite.com (include "I Will Survive" in subject line or your message might be delected before being read).
*New readers of this newsletter, see the following.
If you want to be included on our mailing/emailing list and you can afford to include a donation, make it to "I Will Survive, The Effort", P.O. Bx 2180, Loomis, CA 95650 for:
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$ 0 if, right now, you can't afford to pay dues. In which case "I Will Survive" will mail monthly Newsletters to you. Please contribute to the "Donations" Box at the meetings as you are able.

From May 2003 HCV Advocate:
...HCV RNA is now being measured in International Units (IUs) rather
than copies/ml. The conversion from copies/ml to IU/mL varies from each quantitative test as shown in the following table:
Assay
Conversion Factor
Amplicor HCV Monitor v2.0
 -- 1 IU/mL = 0.9 copies/ml
Cobas Amplicor HCV Monitor v2.0
 -- 1 IU/mL = 2.7 copies/ml
Versant HCV RNA 3.0 Quant. Assay
 -- 1 IU/mL = 5.2 copies/ml
LCx HCV RNA Quant. Assay
 -- l1 IU/mL = 3.8 copies/ml
SuperQuant
-- 1 IU/mL = 3.4 copies/m
...The liver is completely covered by a fibrous sheath called Glisson's capsule which covers thousands of liver lobules. A lobule is hexagonal (six-sided) and consists of many liver cells. In the center of the hexagon is a central vein which carries blood away from the liver. At each corner of the hexagon is a portal triad, also called a portal tract. The portal triad consists of an artery, a vein, and a bile duct (which carries bile away from the lobule).
HCV is able to reproduce itself in liver cells, blood cells, and bone marrow. Hepatitis C causes liver damage in stages. It first causes inflammation. Liver inflammation refers to the presence of special cells called inflammatory cells in the liver. Inflammation leads to changes in liver structure, slowed blood circulation, and the death of liver cells (necrosis). Chronic inflammation eventually causes scar tissue to form, a condition known as fibrosis. If the disease goes untreated, fibrosis (scarring) will occur around the portal triad and is called periportal fibrosis. As the fibrosis extends, it typically extends like spokes from the center of a wheel. The spokes are called fibrous septae. Bridging fibrosis occurs when the fibrous spokes from one wheel meet with the fibrous spokes from another wheel. Cirrhosis is severe scarring surrounding the lobules which disturbs the architecture of the liver. This may interfere with normal functioning of the liver.
It is important to realize that the quality of each tissue sample can vary. Liver disease does not always affect the liver in a uniform pattern; so one sample may not reflect the overall disease activity. All liver biopsies are subject to variability in interpretation by different observers.
The Metavir score for interpreting liver biopsies was specifically designed for patients with hepatitis C. The score consists of a grade and a stage. The grade gives an indication of the activity (amount of inflammation) and the stage indicates the amount of fibrosis (scarring). The grade, or activity score, is assigned a number based on the intensity of inflammatory lesions which cause cell injury leading to cell degeneration or cell death. On a scale of 0-3 or 4 (depending on the pathologist), 0 is no activity and 3 or 4 is severe activity. This is important because inflammatory changes are precursors to fibrosis. If the activity score is high, there is a significant amount of inflammation occurring in the liver which progresses to scarring.
The fibrosis score is also assigned a number from 0-4. 0=no scarring, 1=portal fibrosis without septa (scarring around the portal triad), 2=few septa (few spokes coming out from the wheel of the portal triad), 3=numerous septa with cirrhosis, 4=cirrhosis (severe scarring surrounding the lobule). Scarring of the liver leads to distortion of the architecture of the liver. As this progresses to cirrhosis, the liver may be unable to perform its needed functions.
The Knodell score is also known as the histologic activity index (HAI). It is composed of 4 individually assigned numbers making up one single score. The first component is scored 0-10 and the remaining are scored 0-4 with total Knodell scores ranging from 0-22. The first three scores (periportal and/or bridging necrosis, intralobular degeneration and focal necrosis, and portal inflammation) compose the inflammatory portion of the score and are indications of how much inflammation is occurring in the liver. The inflammatory score can range from 0-18. A score of 0 indicates no inflammation, 1-4 indicates minimal inflammation, 5-8 shows mild inflammation, 9-12 reveals moderate amounts of inflammation, and 13-18 indicates marked amounts of inflammation in the liver. The fourth component (fibrosis) indicates the amount of scarring in the liver and is scored from 0 (no scarring) to 4 (cirrhosis).

If you have no money or insurance call:
Sacramento Clinical Trials
Schering's Commitment to Care 1-800-521-7157
Infergen's Safety Net Program 1-888-508-8088
Roche's Patient Assistance 1-800-443-6676
Dr. Gish, et al, call: Pacific Hepatology, (916) 443-0503
Dr. Pimstone UCD Med Center, (916) 734-1557
Dr. Rossaro UCD Med Cntr, call: Katherine Suggett (916) 734-8696



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