LiveWorld Transcripts

Houston Chronicle presents

Dr. Joseph S. Galati
Liver Health Issues

October 30, 2000

Dr. Joseph S. Galati discusses health issues involving liver disease, transplants, biopsies, hepatitis, and alcohol related diseases.

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Houston Chronicle: The purpose of these chats are to provide general information, and they are in no way intended to be construed as medical advice for any visitor's specific disease or condition. The intent is to increase a participant's knowledge about a general disease or condition. For treatment of your specific condition, please see your personal physician. This forum is not intended to be used in emergency situations. If you are uncertain of the urgency of your problem or condition, contact your personal physician or the nearest hospital for assistance. Welcome to Houstonchronicle.com. St. Luke's Episcopal Hospital Houston and the Talk City Network are proud to present our special guest for today, Dr. Joseph S. Galati, Medical Director of the Texas Liver Institute at St. Luke's Episcopal Hospital. Welcome Dr. Galati!

Dr Galati: Thanks for having me.

Roberta: What is hepatitis?

Dr Galati: Hepatitis is any inflammation of the liver. Most people think that hepatitis means viral hepatitis which could be contagious, but that is not necessarily true. Hepatitis can be a drug-induced hepatitis from medicine, alcoholic hepatitis, or you could even get hepatitis from heat stroke. So the key thing to remember is that it is inflammation of the liver, and there are probably 50 different causes, one of which is viral hepatitis.

Sheila: What is the difference between Hepatitis A, B & C?

Dr Galati: They are different as far as how they are contracted, and they're different in whether or not they can develop into a chronic hepatitis. The key thing is different risk factors. Hepatitis A is predominantly spread by fecal/oral contamination, and this is usually from poor sanitary conditions. Very few people die from Hepatitis A; usually the very young or the very old. Hepatitis B is spread through sexual transmission, and through intravenous drug use. 15 percent of those who contract Hepatitis B will become chronic carriers. This has to be contrasted with Hepatitis C, where 85 percent become chronic carriers. This 85 percent chronic carrier rate is the big problem with Hepatitis C. Vaccines are available for Hepatitis A and B, although none are developed yet for Hepatitis C.

GG: Is hepatitis contracted at any age, or is there a more predominant age?

Dr Galati: You're at risk for viral hepatitis at any age, depending on the risk factor. The risk factors for Hepatitis B are people who are sexually promiscuous and intravenous drug users, whereas Hepatitis A is more of a problem with travelers. This might be a good time to review risk factors for Hepatitis C, which include blood transfusions before 1992, intravenous drug use, even if done once, tattoos and body piercing, sexual promiscuity, and children born from Hepatitis C positive mothers.

Chat: Are there early signs of Hepatitis C to alert the patient?

Dr Galati: In many cases, there are no early signs, but the majority of patients will complain of fatigue. Because many people are fatigued for other reasons, this is an overlooked symptom.

Noelle: Can someone living in the same house with someone with Hepatitis C also contract hepatitis?

Dr Galati: The intra-household transmission of Hepatitis C is quite low, on the order of 2 percent. Sexual partners run a risk of approximately 4 percent. There is a large 1000 couple study that's ongoing in California, which is very carefully looking at sexual transmission for Hepatitis C. Hopefully, this will shed additional light and give us the real risk of transmission. In general, we tell all of our patients to avoid the sharing of toothbrushes and razor blades, to cover cuts, and not leave soiled Band-Aids around. There had been some data suggesting that women with Hepatitis C who were menstruating were at higher rate of sexually spreading it to their partners, so it was suggested to avoid intercourse during menstruation.

Fun E Lady: How do the treatments vary between the different types of hepatitis?

Dr Galati: Hepatitis A essentially requires no treatment, other than supportive care, hydration if necessary, and a high-protein diet. Hepatitis B, because only 15 percent become chronic carriers, usually resolves on its own. For those who need treatment, the two drugs used are Epivir and interferon in combination. With Hepatitis C, the standard of care today is interferon and Ribavirin. The latest development with this is the new Peg interferons, which are long acting. Similar to HIV treatment, three-, four- and maybe five-drug combinations will be available in the next few years.

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