B Positive – all you wanted to know about - ASHM

every attempt must be made to verify each
listed ingredient in a formulation when
hepatotoxicity occurs, to accurately identify
the causative agent so that both general
practitioners and complementary medicine
practitioners are aware of herbal medicines
with demonstrated hepatotoxicity. However,
kava should be avoided in patients with chronic
liver injury.
the australian and new Zealand expert
group reviewing the safety of black cohosh
(actea racemosa formerly named cimicifuga
racemosa) concluded that ‘there appears to be
an association between the use of black cohosh
and liver damage, but that it is very rare’. it is a
tGa requirement that this advice appear on the
label of products containing black cohosh. 36
from January to december 2004, all chronic
hepatitis b patients admitted to a Hong Kong
hospital for liver biochemistry irregularities
were prospectively screened for an intake of
tcM within six months prior to admission. the
inclusion criteria: bilirubin > 2 x upper limit of
normal (uLn), aLt or ast > 5 x uLn, aLP, GGt
> 2 x uLn. exclusion criteria: HbV exacerbation
associated with HbV dna level > 1,000,000
viral copies/mL, co-infection with hepatitis
a,c,d,e; intake of western medicine with known
hepatotoxicity, alcohol intake > 20g a day for
women and > 30g a day for men, and any other
liver disease apart from cHb. 37
of the 45 hospital admissions due to liver
dysfunction in chronic hepatitis b patients,
15.6% were attributed to tcM-induced
hepatoxicity. there were two deaths related
to tcM intake, one of whom appeared to have
pre-existing cirrhosis. in another two patients,
hepatotoxicity was based on a temporal
relationship, although specific hepatotoxic
elements were not found in the herbal
formulae. 37
Conclusion
there are emerging data suggesting
complementary medicines may have a role
in the treatment and management of chronic
hepatitis b. Phyllanthus species, compound
861, kurorinone and oxymatrine may influence
viral replication or liver inflammation in a
beneficial way. further investigations of
these agents are warranted. the poor quality
of many randomised, controlled trials of
traditional chinese medicines to date limits
the conclusions that can be drawn about
these agents. the consensus is clear that more
rigorous studies are required to provide more
definite results to guide the management of
our hepatitis b patients. 38–39
it is advisable that patients consult an
accredited practitioner of traditional chinese
medicine or western herbal medicine if they
are interested in complementary medicines.
useful contacts include the australian
acupuncture and chinese Medicine
association (aacMa) at www.acupuncture.
org.au or phone 07 3324 2599 or the national
Herbalists association of australia (nHaa) at
www.nhaa.org.au or phone 02 8765 0071.
Acknowledgment
songmei Wu, bilingual research officer,
centre for complementary Medicine research,
university of Western sydney who translated
selected research articles from china.
References
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