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hepatitis c

Discussion in 'Diving Medicine' started by gehadoski, Apr 7, 2005.

  1. gehadoski

    gehadoski Liveaboard

    # of Dives: 500 - 999
    Location: Cairo, Egypt, Egypt
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    I have a friend of mine how has inactive hepatitis c and he wants to dive. I don't know if he can dive or not? I went to a doctor specialized in the diving medicine, the doctor told me that he can't dive?
    As a matter of fact I don't trust just one opinion. So if you have any information about this please let me know
     
  2. Kim

    Kim Here for my friends..... ScubaBoard Supporter

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    I'm not sure that there is such a thing as 'inactive' hepatitis c. This is actually a very serious disease that normally has no apparent symptoms - until it destroys your liver. It is often fatal over time. The standard treatment involves Interferon or PolyInterferon used with Ribavirin for the best effect. How effective the treatment is depends on the type that you have - there are several. Someone undergoing treatment on these drugs would not be able to dive as they are very strong with considerable side effects.
     
  3. TwoBitTxn

    TwoBitTxn Instructor, Scuba

    # of Dives: 500 - 999
    Location: North Texas
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    Any reason why you don't trust the dive doc?

    Can you call DAN?

    TwoBit
     
  4. BillP

    BillP Senior Member

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  5. GoBlue!

    GoBlue! Manta Ray

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    He should go to a doctor who specializes in dive medicine. Individual cases vary, and I can assure you that you do not know enough details of his particular medical condition to provide enough info to the doc to make an informed judgement.

    Jim
     
  6. GoBlue!

    GoBlue! Manta Ray

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    Kim,

    Your response is approximately half true.

    I agree that Hepatitis C is a serious disease that is underdiagnosed, likely due to its lack of symptoms.

    Let's not nitpick over the semantics of "inactive hepatitis C;" suffice it to say that there are plenty of patients with detectable prior exposure to hepatitis C (hep C antibodies present) but no active replication of virus (e.g., HCV RNA undetectable). These are a lucky bunch, and the potential diver in question may, in fact, be among them.

    "It is often fatal over time" is a strong statement. The majority of patients with HepC do not die of cirrhosis/end stage liver disease.

    Jim
     
  7. Kim

    Kim Here for my friends..... ScubaBoard Supporter

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    Jim.
    Untreated HCV is often a time bomb waiting to go off. The testing for the virus is not a completely reliable test. It can exist at non detectable levels but that does not mean that it is not present and that it will not at some stage begin to replicate much faster and cause damage. Many people who have treatment seem to successfully respond and the virus falls below the detection threshold - unfortunately in the majority of these cases it comes back again after the treatment is finished. This is particularly true of Type 1. It is estimated that 85% of the people who contract HCV will not get rid of it.
    Maybe "It is often fatal over time" was worded a little too strongly - although I'd agree that the majority do not die from the disease, maybe you would accept that a significant number do.

    As related to diving my point was that you cannot/shouldn't dive while on a treatment regime of Interferon/Ribavirin. As related to 'inactive' - I believe this to be very misleading and inaccurate. Non-detectable is not the same as not present - and denial with this disease is not a good idea.
     
  8. GoBlue!

    GoBlue! Manta Ray

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    Kim,

    I don't want to imply that Hep C is not a cause for great concern, and that it's often underdiagnosed & undertreated. Yes, from the global perspective, it should be considered a "time bomb." Estimates range from approximately 55-85% that those who contract become chronically infected, but 30% of those people will never develop liver disease. Of course, that leaves the majority of the chronically infected that will develop some chronic liver disease, which is obviously a very serious matter, but despite this only 1-5% of all who contract Hep C actually die from chronic liver disease according to the National Center for Infectious Diseases/CDC. So, your comment that "it is often fatal over time" just stood out as being far too strong & sensational.

    With regard to the diving issue, yes, I agree that those treated with IFN/ribavirin would not be the best diving candidates.

    But, the diver in question is not being treated with IFN/ribavirin, so that wasn't the issue. He very well could be in the 15-45% (admitted, likely closer to 15-20%) of HepC patients that do NOT develop chronic infection, or he could have chronic infection but does not need IFN/ribavirin at this time. You refer to this as "standard therapy," which it has become, but you need to qualify that generally therapy is only considered in patients with persistently elevated liver enzymes, detectable HCV RNA, or liver biopsy evidence of progressive disease (according to the NIH Consensus panel).

    My point is, if the guy has Hep C but is not currently undergoing treatment (which may be a perfectly appropriate course), I would not jump to declaring a contraindication to diving.

    Jim
     
  9. gehadoski

    gehadoski Liveaboard

    # of Dives: 500 - 999
    Location: Cairo, Egypt, Egypt
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    I do trust the doctor, but hearing more than one opinion gives you more information and help you to take the right descion
     
  10. wedivebc

    wedivebc CCR Instructor ScubaBoard Supporter

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    Getting medical opinions from laymen about a serious medical condition can be a costly mistake. I would ignore any advice from someone who doesn't have a MD after their name (including mine ;) )
     

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