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Thread: For Dr. Young or SCI Nurse

  1. #1

    For Dr. Young or SCI Nurse

    I gave myself my interferon injection a few minutes ago. After having injected the med, I accidently dropped the syringe. The needle was still exposed and it pricked my other leg making it bleed. My question is if I might have re-infected myself when this happened. Dr. Young, or SCI Nurse, would you be able to tell me if this is possible?

    I would like to have an idea what to think/do about this now. Your help will be greatly appreciated.

    Raven

  2. #2

    injection question

    Raven - If I understand your post correctly, when you dropped the syringe, it pricked your other leg before it had touched any other surface. While the skin on your leg had not been cleaned, it sounds like it was only superficial, the needle had just been removed from your own body and no medication was was remaining in the syringe. Therefore, you need not be concerned.

    Does your health insurance have an 'advice line' or do you have a immediate care center in your community? In the future, when something untoward occurs that you believe needs an immediate answer, these might be good sources for you; we generally check this site at variable intervals during the day. CRF

  3. #3
    Whew! I am so relieved. Called my doctor's office and was told that I do not have to worry about it. Was told that since I already have the virus, there would be no change at all.

    Thanks CRF for your reply.

    Raven

  4. #4

    help clarify

    sorry, but can you help me understand what this is?

    (posted by raven) I gave myself my interferon injection a few minutes ago.
    thanks

  5. #5

    Hey Raven!

    How is the interferon working for you?

  6. #6

    Interferon alfa-2b

    Liz,

    I am presently taking treatment for Hepatitis C. I have to inject myself 3x wkly with interferon alfa-2b. Previously, I had begun treatment with Pegasys which was injected only 1x per week. I inject myself M W F. It has been recommended that it be done as late in the evening as possible. It has a lot of side effects but there is always the hope that it may help to at least control the virus to some point.

    Dr. Wise Young posted some information on treatment for hepatitis C and it is also used for people with MS. Dr.Young's post

    Monkeygirl, thanks for asking.

    So far, I have had several setbacks and have had to re-start treatment. Am no longer on Pegasys. My doctor had concerns with the results we kept getting on my ALT and AST tests. He wanted to do a biopsy on my liver but we ran into some problems there too. He decided not to do it because of my low platelet count. It is so complicated to go through all this but he decided that he would try the Interferon instead. I agreed. So far, I have not had any recent tests done on the viral count but do have an appointment again for June. Hopefully they will show better results.

    Have had several of the sides but am going to continue to hang on. You will notice that at times I don't check here but that is while I do feel pretty bad. For the moment, I am having a better day. Hope this stays for more time.

    Hope you all have a good and safe holiday.

    Raven

  7. #7

    needle sticks

    Raven - thanks for your update and glad that your days are going well at the moment. Once does not need added worries as you had a few days ago. It is always good to 'ask the question', whatever it may be, so that we don't unnecessarily add to our challenges of daily living. My philosophy is and always has been that "no question is inappropriate" and it is better to "err on the side of caution than foolishness". CRF

  8. #8
    thanks Raven. keep your head up. sorry to hear of your trouble

  9. #9
    Raven, I am sorry that I did not see your posting until just now... I agree with the SCI-Nurse. Don't worry about it. You cannot "re-infect" yourself with your own needle. Whether you have active hepatitis virus in your blood or not (which, by the way, I suspect you don't have) does not matter. This is not like sharing needles with anybody. You are sharing with yourself and thus it is okay. I hope that the treatment works. I found a few recent articles on the subject:


    • Hasan F, Asker H, Al-Khalid J, Al-Mekhaizeem K, Al Shamali M, Siddique I and Al Nakib B (2002). Interferon-alpha in combination with ribavirin for the treatment of chronic hepatitis C in patients with persistently normal aminotransferase levels. Digestion. 65 (2): 127-30. Summary: Background and Aims: A substantial proportion of patients with chronic hepatitis C virus infection have persistently normal serum transaminase levels. The aim of this study was to assess the efficacy and safety of interferon plus ribavirin combination therapy in this population. Methods: In this prospective open trial 152 patients with biopsy-proven chronic hepatitis C were enrolled, 32 of whom had persistently normal alanine aminotransferase levels (group A). The remaining 120 patients served as a comparison (group B). Patients were treated for 12 months with 4.5 million units of interferon-alpha(2a) thrice weekly in combination with ribavirin 1,000 or 1,200 mg daily. They were followed up for at least 6 months after therapy. Serum hepatitis C RNA was detected by polymerase chain reaction and quantified by a branched DNA assay. Results: At the end of treatment, 12 (37.5%) and 48 patients (40%) were negative for HCV-RNA in groups A and B, respectively (p = 0.33). After 24 weeks of follow-up, 9 patients (28%) from group A and 36 patients (30%) from group B were still HCV-RNA negative (p = 0.4). Treatment was well tolerated by both groups. There were no alanine transferase elevations among group A patients during therapy. Conclusion: Interferon-ribavirin combination therapy was safe and induced a sustained virologic response in a significant proportion of patients with chronic hepatitis C and repeatedly normal serum transaminase levels. <http://www.ncbi.nlm.nih.gov/htbin-po...r&uid=12021486
    http://www.online.karger.com/library...d=DIG.dig65127
    http://www.karger.com/journals/dig/dig_jh.htm> Department of Medicine, Faculty of Medicine, Kuwait University, Kuwait.

    • Herrine SK (2002). Approach to the patient with chronic hepatitis C virus infection. Ann Intern Med. 136 (10): 747-57. Summary: Chronic hepatitis C virus (HCV) infection is common and often asymptomatic. Antibodies against HCV are a highly sensitive marker of infection. Molecular testing for HCV is used to confirm a positive result on antibody testing and to provide prognostic information for treatment; however, quantitative HCV RNA does not correlate with disease severity or risk for progression. Chronic HCV infection is most frequently associated with remote or current intravenous drug use and blood transfusion before 1992, although as many as 20% of infected patients have no identifiable risk factor. In an estimated 15% to 20% of persons infected with HCV, the infection progresses to cirrhosis; alcohol intake is an important cofactor in this progression. Most specialists prefer to include an examination of liver histology in the management of patients with chronic HCV infection to aid prognostic and treatment decisions. The current standard of pharmacologic treatment of chronic HCV is weekly subcutaneous peginterferon in combination with daily oral ribavirin, which results in sustained virologic response in approximately 55% of chronically infected patients. Side effects of interferon therapy include myalgias, fever, nausea, irritability, and depression. The cost-effectiveness of interferon therapy is similar to that of many commonly accepted medical interventions. The primary care physician serves a vital role in identifying patients with chronic HCV infection, educating patients about risk factors for transmission, advising patients about the avoidance of alcohol, and aiding patients in making treatment decisions. <http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=12020143> Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA.

    • Renou C, Harafa A, Bouabdallah R, Demattei C, Cummins C, Rifflet H, Muller P, Ville E, Bertrand J, Benderitter T and Halfon P (2002). Severe neutropenia and post-hepatitis C cirrhosis treatment: is interferon dose adaptation at once necessary? Am J Gastroenterol. 97 (5): 1260-3. Summary: <http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=12014740>

    • Fargion S, Fracanzani AL, Rossini A, Borzio M, Riggio O, Belloni G, Bissoli F, Ceriani R, Ballare M, Massari M, Trischitta C, Fiore P, Orlandi A, Morini L, Mattioli M, Oldani S, Cesana B and Fiorelli G (2002). Iron reduction and sustained response to interferon-alpha therapy in patients with chronic hepatitis C: results of an Italian multicenter randomized study. Am J Gastroenterol. 97 (5): 1204-10. Summary: OBJECTIVES: It has been suggested that iron depletion improves the response to interferon in patients with chronic hepatitis C. We aimed to evaluate whether iron reduction by phlebotomy before interferon improves the rate of virological sustained response in previously untreated noncirrhotic patients. METHODS: One hundred fourteen hepatitis C virus (HCV) RNA positive patients with hepatic iron concentrations of > or =700 microg/g dry wt (men) and > or =500 microg/g dry wt (women), stratified according to HCV genotype and gamma- glutamyltransferase values, were randomly allocated to interferon alone (6 MU three times a week) (group A) or to phlebotomy until iron depletion followed by interferon (6 MU three times a week) (group B). After 4 months dosage was reduced to 3 MU three times a week for another 8 months. RESULTS: Virological sustained response was observed in 25 patients (22%), nine (15.8%, 95% CI = 7.5-27.9) of group A and 16 (28.1%, 95% CI = 17.0-41.6) of group B. At univariate analysis the variables associated with the response were HCV genotypes 2-3, normal gamma-glutamyltransferase, higher levels of baseline ALT, normal ALT values, and negativity for HCV-RNA at the 3rd month of therapy. At multivariate analysis, genotype and ALT levels at enrollment maintained their association with the response. A trend toward a better response to interferon was observed in patients who received phlebotomy (odds ratio = 2.32, 95% CI = 0.96-6.24, p = 0.082). Patients with hepatic iron concentration of < or = 1100 microg/g dry wt had a trend toward a higher rate of virological sustained response [p = 0.059) when submitted to treatment B. CONCLUSION: Iron removal by phlebotomy is able to improve the rate of response to interferon, especially in patients with lower hepatic iron deposits; it could be useful as adjuvant therapy to new therapeutic modalities. <http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=12014729> Dipartimento Medicina Interna, Ospedale Maggiore IRCCS, Universita di Milano, Italy.

    • Zilly M, Lingenauber C, Desch S, Vath T, Klinker H and Langmann P (2002). Triple Antiviral Re-Therapy for Chronic Hepatitis C with Interferon- alpha, Ribavirin and Amantadine in Nonresponders to Interferon-alpha and Ribavirin. Eur J Med Res. 7 (4): 149-54. Summary: Background: Therapy options for patients with chronic hepatitis C who failed prior treatment are needed. In recent studies triple antiviral therapy with Interferon-alpha, ribavirin, and amantadine seemed to increase sustained virological response rates in this group. - Method: To evaluate efficacy, side effects and safety of a triple re-therapy in an open labeled prospective study, we compared 23 nonresponders to interferon monotherapy (9 nonresponders, 3 relapsers, 11 with breakthrough) with 23 nonresponders to standard combination therapy (interferon plus ribavirin) (16 nonresponders, 7 breakthroughs). All outpatients enrolled for re-therapy received Interferon-alpha 2a (6 mega units [MU] three times in week), ribavirin (1000-1200 mg daily in divided doses) and amantadine (200 mg daily) for six months. In case of virological re-therapy response (negative qualitative HCV RNA) study medication was continued with interferon monotherapy for another six months. - Results: Sustained virological response was achieved in 16 (35%) out of 46 prior therapy nonresponders. Response rates were dependent on pretreatment outcome. In the standard combination therapy group only 1 (6%) primary nonresponder achieved sustained response, but none of the 9 monotherapy nonresponders did. After primary breakthrough sustained response was seen in 8 of 11 (73%) patients in the interferon monotherapy and in 5 of 7 (71%) in the combination therapy group. Of 3 monotherapy relapsers 2 (66%) did also clear the virus sustained. Safety profile under triple therapy was similar to the previous therapy. Compliance was higher and side effects lower in those patients already experienced in combination therapy. - Conclusion: In patients with a breakthrough or relapse after interferon monotherapy or standard combination therapy with interferon and ribavirin a re-therapy with a triple combination of interferon, ribavirin, and amantadine results in a high rate of sustained virological response. <http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=12010649> Division of Infectiology and Hepatology, Department of Internal Medicine, University of Wuerzburg, Josef-Schneider-Str. 2, D-97080 Wuerzburg, Germany. m.zilly@medizin.uni-wuerzburg.de

    • Castro FJ, Esteban JI, Juarez A, Sauleda S, Viladomiu L, Martell M, Moreno F, Allende H, Esteban R and Guardia J (2002). Early detection of nonresponse to interferon plus ribavirin combination treatment of chronic hepatitis C. J Viral Hepat. 9 (3): 202-207. Summary: We have investigated the value of early hepatitis C virus (HCV) RNA decline (DeltaHCV RNA) to predict response to combination therapy in 66 chronic hepatitis C patients treated with IFN-alpha2b (3 MU thrice weekly) and ribavirin (800 mg daily) for 12 months [25 sustained responders (SR) and 41 nonresponders or relapsers (NR)]. Serum HCV RNA was retrospectively measured in samples obtained at baseline and 4, 8 and 12 weeks after treatment onset, using a commercially available quantitative RT-PCR assay. At 4 weeks, serum HCV RNA had decreased a mean of 2.6 +/- 0.8 logs among SR as compared with only 0.5 +/- 0.8 logs in NR (P < 0.001), and was already undetectable [< 600 IU/mL) in 12 [48%) of the SR but in none of the NR. At 8 weeks, HCV RNA was undetectable in 21 SR and in 2 NR and mean DeltaHCV RNA were 4.2 +/- 1.3 and 0.8 +/- 1.0 logs, respectively [P < 0.001). At week 12 all SR had undetectable HCV RNA as compared with only five NR [P < 0.001). Stepwise logistic regression analysis identified DeltaHCV RNA at 12 weeks as the strongest predictor of sustained response. Receiver operating characteristic [ROC) curves of DeltaHCV RNA for sustained response prediction identified sensitivity peaks with 100% negative predictive value corresponding to DeltaHCV RNA > 1 log at 4 weeks, > 2 logs at 8 weeks and > 3 logs at 12 weeks. Our results show that early changes in the HCV RNA level may reliably identify patients having no chance of a sustained virological response during the first 3 months of combination therapy, thus providing an excellent tool for optimizing antiviral treatment of chronic hepatitis C. <http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=12010508> Liver Unit, Department of Medicine, Hospital Universitari Vall d'Hebron, Barcelona, Spain, Centre de Transfusio I Banc de Teixits, Barcelona, Spain, Roche Molecular Systems, Barcelona, Spain, Department of Pathology, Hospital Universitari Vall d'Hebron, Barcelona, Spain.

    • Leung NW (2002). Management of viral hepatitis C. J Gastroenterol Hepatol. 17 Suppl 1: 146-154. Summary: The hepatitis C virus was first identified in 1989. It causes chronic hepatitis, cirrhosis and hepatocellular carcinoma. Global anti-HCV prevalence is 1-3%. Contaminated blood product, dirty needles and instruments, and injection drug use are the main parenteral routes of transmission. Cultural practices, such as acupuncture, tattoo, body piercing and scarring, also play a role. Universal precaution is the mainstay for prevention before vaccine is developed. Therapy for chronic hepatitis C (CHC) with interferon (IFN) is not satisfactory. Non-response and early relapse reduce sustained response (SR). In 1997, National Institute of Health consensus recommended IFN therapy only for selected patients with compensated CHC, raised ALT and moderate to severe histologic disease activity; 15-20% SR is expected. Major advances in CHC therapy is combination therapy. Ribavirin in combination with IFN significantly increases SR to 30-40%. Even patients with high viral load, genotype 1, significant fibrosis or cirrhosis respond better. EASL and APASL Consensus in 1999 recommended IFN-ribavirin combination as the first line therapy. Recent data on pegylated IFN showed very encouraging results. Combined with ribavirin, 60% SR was achieved. It benefits patients with severe bridging necrosis and also cirrhosis. However, 23-27% of patients receiving combination therapy with either IFN type, experienced adverse events and required therapy discontinuation. Many important issues remained unsolved. Therapy for children, the elderly, patients with comorbidity and extra- hepatic syndromes need to be addressed. Therapy is too expensive and not affordable to the majority of patients in developing countries. <http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=12000600> Prince of Wales Hospital and Chinese University of Hong Kong, Hong Kong.

    • Pramoolsinsup C (2002). Management of viral hepatitis B. J Gastroenterol Hepatol. 17 Suppl 1: 125-145. Summary: Hepatitis B virus (HBV) infection is a major global health concern and is the most common cause of chronic liver disease worldwide. The natural history and clinical outcomes of chronic HBV infection are determined by the viral replication cycle and the host immune responses. Treatment of chronic hepatitis B is directed at interrupting the natural history by suppressing HBV replication before development of any significant irreversible liver cell damage. Effective antiviral therapies should be followed by sustained suppression of HBV-DNA, normalization of transaminases levels and a stable stage of HBeAg seroconversion with persistence of circulating anti-HBeAg antibodies. Two major classes of antiviral therapeutic agents that have been approved for treatment of chronic hepatitis B are immunomodulating agents (i.e. interferon) and the nucleoside analogs (i.e. lamivudine). A 4-6 month course of interferon-alpha has resulted in improvement of survival in 20%-30% of patients with chronic hepatitis B who had elevated serum ALT levels without hepatic decompensation. Interferon- alpha therapy is associated with HBeAg seroconversion; normalization of ALT levels, reduced hepatic inflammation, and possibly reduced disease progression to cirrhosis and hepatocellular carcinoma. Interferon can also be used with caution in patients with early compensated cirrhosis. A 12-month course of lamivudine has been shown to be well tolerated and effective. Lamivudine can be used in decompensated cirrhosis and immunosuppressed patients and for prevention of recurrent HBV infection after liver transplantation. The response rates after 3 years of lamivudine therapy account for 40-65%. A major problem of antiviral treatment is the emergence of drug resistance conferred by mutations in the YMDD motif of HBV reverse transcriptase. The prevalence of YMDD mutations increases with longer durations of antiviral therapies and this has been detected in 20% of immunocompetent patients receiving lamivudine per year. Contentious issues remain when to stop the treatment if HBeAg seroconversion does not occur. Many new immunomodulatory therapies and antiviral agents are in various stages of clinical development and have shown some promise. Among newer HBV antivirals, adefovir dipivoxil, entecavir, emtricitabine, DAPD and clevudine appear to be at least as potent as lamivudine in suppressing HBV replication. In vitro studies have shown that YMDD mutations confer cross-resistance between lamivudine and emtricitabine. However, adefovir, dipivoxil, lobucavir, DAPD and possibly clevudine suppress replications of both YMDD mutants and wild types of HBV. Immunomodulatory approaches for treatment of chronic hepatitis B are conceptually attractive, but newer agents used to date (thymosin-alpha, interleukin-12, therapeutic vaccines) have not demonstrated sufficient efficacy for widespread use. Combinations of an immunomodulatory agent and nucleoside analog may improve the therapeutic efficacy and reduce the emergence of drug resistance. Nevertheless, combinations of interferon and lamivudine therapies do not confer such additional benefits. The next challenge for HBV treatment is to use antivirals in combination and/or in cyclical therapy to minimize the emergence of drug resistance and increase efficacy, particularly to achieve sustainable post-treatment suppression of HBV. Randomized prospective control trials of combined antiviral therapies given simultaneously or sequentially are needed to establish safe and effective combined regimens that can be recommended for future treatment strategies. <http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=12000599> Division of Gastroenterology and Tropical Medicine, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.

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