Tyler's Lucky to be Alive!

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Tyler's " Lucky to be Alive! "

By: Michele R. Berman, MD | May 03, 2011

Tyler seems to be making a major comeback. The Aerosmith frontman has

gotten favorable reviews in his new role as American Idol judge, showing a

sympathetic, humorous side that few knew was there. He's on the cover of People

magazine this week, had an interview with Today show host Matt Lauer, and will

be releasing his memoir Does the Noise in My Head Bother You? on May 3rd. But

Tyler says it's amazing that he has made it this far. As he told People:

" Left up to my own devices, I probably would have been dead several times

over. "

It's well known that Tyler has had drug problems and been in rehab eight times,

but he has also had a slew of other health issues. He had a torn ACL ligament in

his knee, a broken blood vessel in his throat and, in 2005, was diagnosed with

Hepatitis C. Post-surgery pain medications got him addicted to prescription pain

medications, and in August 2009 he took a bad tumble off a stage, lacerating his

scalp, breaking his left shoulder. This, combined with his kids concerns about

his health, prompted his last visit to the Betty Ford Center, which has finally

kept him clean.

The hepatitis C virus (HCV) is one of the most important causes of chronic liver

disease in the United States. It accounts for about 15% of acute viral

hepatitis, 60% to 70% of chronic hepatitis, and up to 50% of cirrhosis,

end-stage liver disease, and liver cancer. Of the U.S. population, 1.6%, or an

estimated 4.1 million Americans, have antibody to HCV (anti-HCV), indicating

ongoing or previous infection with the virus. Hepatitis C causes an estimated

10,000 to 12,000 deaths annually in the United States.

A distinct and major characteristic of hepatitis C is its tendency to cause

chronic liver disease in which the liver injury persists for a prolonged period

if not for life. About 75% of patients with acute hepatitis C ultimately develop

chronic infection.

Chronic hepatitis C varies greatly in its course and outcome. At one end of the

spectrum are infected persons who have no signs or symptoms of liver disease and

have completely normal levels of serum enzymes, the usual blood test results

that indicate liver disease. Liver biopsy usually shows some degree of injury to

the liver, but the extent is usually mild, and the overall prognosis may be

good. At the other end of the spectrum are patients with severe hepatitis C who

have symptoms, high levels of the virus (HCV RNA) in serum, and elevated serum

enzymes, and who ultimately develop cirrhosis and end-stage liver disease. In

the middle of the spectrum are many patients who have few or no symptoms, mild

to moderate elevations in liver enzymes, and an uncertain prognosis.

Chronic hepatitis C can cause cirrhosis, liver failure, and liver cancer.

Researchers estimate that at least 20% of patients with chronic hepatitis C

develop cirrhosis, a process that takes at least 10 to 20 years. Liver failure

from chronic hepatitis C is one of the most common reasons for liver transplants

in the United States. After 20 to 40 years, a small percentage of patients

develop liver cancer. Hepatitis C is the cause of about half of cases of primary

liver cancer in the developed world. Men, alcoholics, patients with cirrhosis,

people over age 40, and those infected for 20 to 40 years are at higher risk of

developing HCV-related liver cancer.

HCV is transmitted through parenteral exposures to contaminated blood, usually

through use of injection drugs (sharing of needles or works) and to a lesser

extent through exposures in health-care settings as a consequence of inadequate

infection-control practices. Transmission rarely follows receipt of blood,

tissues, and organs from HCV-infected donors who were not identified during

routine screening activities, which have been mandated in the United States

since 1992. Occupational and perinatal exposures, although less efficient, also

can result in transmission of HCV. Sexual transmission of HCV had been

considered to occur rarely. However, recent data indicate that sexual

transmission of HCV can occur, especially among HIV-infected persons.

The most common risk factors for acquiring hepatitis C are:

• injecting drugs, including having used injection drugs only once many years

ago

•having a blood transfusion before June 1992, when sensitive tests for anti-HCV

were introduced for blood screening

•receiving clotting factor concentrates (such as anti-hemophilic factor) before

1987, when effective means to inactivate HCV were introduced

•hemodialysis for kidney failure

•birth to an HCV-infected mother

•suffering a needle-stick accident from a person with hepatitis C

Other risk factors that have a slightly increased risk for hepatitis C are

• having sex with someone with hepatitis C or having multiple sex partners

•intranasal use of cocaine using shared equipment or paraphernalia

The treatment of Hepatitis C

The therapy for chronic hepatitis C has evolved steadily since alpha interferon

was first approved for use in this disease more than 15 years ago. At the

present time, the optimal regimen appears to be a 24- or 48-week course of the

combination of pegylated alpha interferon and ribavirin.

Alpha interferon is a host protein that is made in response to viral infections

and has natural antiviral activity. Recombinant forms of alpha interferon have

been produced, and several formulations (alfa-2a, alfa-2b, consensus interferon)

are available as therapy for hepatitis C. These standard forms of interferon,

however, are now being replaced by pegylated interferon (peginterferon).

Peginterferon is alpha interferon that has been modified chemically by the

addition of a large inert molecule of polyethylene glycol. Pegylation changes

the uptake, distribution, and excretion of interferon, prolonging its half-life.

Peginterferon can be given once weekly and provides a more constant level of

interferon in the blood, whereas standard interferon must be given several times

weekly and provides intermittent and fluctuating levels. In addition,

peginterferon is more active than standard interferon in inhibiting HCV and

yields higher sustained response rates with similar side effects. Because of its

ease of administration and better efficacy, peginterferon has replaced standard

interferon both as monotherapy and as combination therapy for hepatitis C.

Ribavirin is an oral antiviral agent that has activity against a broad range of

viruses. By itself, ribavirin has little effect on HCV, but adding it to

interferon increases the sustained response rate by 2- to 3-fold. For these

reasons, combination therapy is now recommended for hepatitis C, and interferon

monotherapy is applied only when there are specific reasons not to use

ribavirin.

Last week an FDA advisory panel recommended approval of two new medications,

boceprevir and telaprevir, for the treatment of Hepatitis C, genotype 1. If the

FDA approves these drugs (which it is expected to do), the drugs would be added

to the above regimen. According to MedPage Today, clinical trials " showed that

in the difficult-to-treat genotype 1 patients, boceprevir yielded sustained

virological response rates as high as 67% " , while telaprevir trials " indicated

that adding the protease inhibitor could boost the sustained response rate above

70%, to as much as 90%, in patients who had never been treated for HCV. "

Sources: CDC and NIDDIC