This document summarizes a study comparing the management of Hepatitis C with natural and synthetic medicines. The study compared two Unani (Eastern medicine) formulations, Hepotin tablets and Vironil syrup, to the conventional allopathic drugs interferon alfa-2b and ribavirin. Sixty patients with Hepatitis C were randomly assigned to receive either the Unani medicines or allopathic drugs for six months. Clinical signs and symptoms, biochemical markers, and viral load were measured and statistically compared between the two groups. The results showed the Unani medicines were as effective as the allopathic drugs in improving clinical symptoms, liver enzymes, and reducing viral load, with fewer side effects. The study provides evidence that Unani

1. Management of Hepatitis C with Natural and Synthetic Medicine Khan Usmanghani, Asif Iqbal Department of Basic Clinical Sciences, Faculty of Eastern Medicine HAMDARD UNIVERSITY, Karachi, Pakistan 6 th International Conference of Infection Control December 19, 2006 Liaquat National Hospital, Karachi

2. COMPARATIVE RESEARCH STUDY ON HEPATITIS C A Picrorhiza kurroa W Tamarix galica Glycyrrhiza glabra Phylanthus emblica A Rosae damascena 2.6.2 Ribavirin (Rebazole) A 2.6.1 Interferon alfa 2b (Uniferon)

3. Introduction Viral hepatitis is defined as viral infection of hepatocytes that produces necrosis and inflammation of the liver. Viral Hepatitis is a parenchymal disease of liver. This disease is caused by (a) Hepatotropic viruses A, B, C (Non-A-Non B), D,E,F,G,H (b) Other viruses like Epstein-Barr, Cytomegalovirus, and Coxsackie virus etc. Hepatitis C virus (HCV), the major causative agent of non-A and non-B hepatitis, poses a serious worldwide health problem. about 170 million people, 3% of the world's population, are infected with HCV High prevalence rates Southeast Asian countries WHO

4. Hepatitis C Prevalence and number infected by WHO Region In Pakistan: anti HCV prevalence 13.5% in chronic liver disease. Karachi: 43.06% shows seropositivity in chronic liver diseases and cirrhosis combined, with 45.7% cases of chronic liver disease and 37.7% cases in cirrhosis. 169.7 18.68 5811 Total 62.2 3.9 1600 Western Pacific 32.3 2.15 1500 South-East Asia 8.9 1.03 858 Europe 21.3 4.6 466 Eastern Mediterranean 13.1 1.7 785 America 31.9 5.3 602 Africa Rate % Millions Infected Population Hepatitis C prevalence Total Population Region of WHO

5. Hepatitis C Flaviviridae Single strand of RNA 3000 amino acids 10 encoded genes 6 genotypes (74% gt1 in USA) Many quasispecies Receptors? LDL, CD81

7. TEST AND CONTROLLED DRUG QUANTITATIVE AND COMPARATIVE STUDY:HEPATITIS C Ribavirin (Rebazole) For patients of Hepatitis C according to patient body weight: • Less than 55kg (Patient body weight) Ribavirin 400mg bid • Between 55 and 75kg Ribavirin 500mg bid • Greater than 75kg Ribavirin 600mg bid R Rosae damascena, 250 mg Glycyrrhiza glabra, 250mg Phylanthus emblica 250mg Sugar10 Water distilled 10 litre Composition of Vironil syrup Interferon alfa 2b (Uniferon) Chronic Hepatitis C: Interferon alfa 2b 3MIU injections three times a week for 6-12 months. Tamarix galica, 500mg Picrorhiza kurroa, 500mg Composition of HepotinTab Hepatitis C Control Drugs Test Drugs Formulation Test Drugs Diseases

9. INCLUSION CRITERIA Chronic Hepatitis B and C Hyper Pyrexia EXCLUSION CRITERIA All socio- economical classes No other Disease Karachi, Pakistan AGE: 20-55 Hepatic or Cardiac Impairment Liver Abcess

10. Description Characteristic of Study Sample 3MIU injections three times a week for 6-12 months Control Drug 2 tablet twice a day, 15 ml twice a day ( for 6 months) Test Drug Dosage 8 > 40 11 26 – 43 1 < 25 Age Control Drug 14 > 40 24 26 – 43 2 < 25 Age Test Drug 27 Female 33 Male Gender 20 Control Drug 40 Test Drug Total 60 Total Hepatitis C Variables

12. CLINICAL CPMPARATIVE STUDY Comparative data between Hepotin tablet, Vironil syrup and Interferon alpha-2b, Ribavirin (Anorexia) 4% 50% 50% Interferon alpha-2b and Ribavirin 0.01 0% 19% 81% Hepotin tablet and Vironil syrup p value Reverse Effect No Improved Complete Improved Level of Improvement

13. Comparative data between Hepotin tablet, Vironil syrup and Interferon alpha-2b, Ribavirin (Heart Burn) 30% 64% 36% Interferon alpha-2b and Ribavirin 0.00 0% 0% 100% Hepotin tablet and Vironil syrup p value Reverse Effect No Improved Complete Improved Level of Improvement

14. Comparative data between Hepotin tablet, Vironil syrup and Interferon alpha-2b, Ribavirin (Epigastric pain ) 30% 71% 29% Interferon alpha-2b and Ribavirin 0.00 0% 16% 84% Hepotin tablet and Vironil syrup p value Reverse Effect No Improved Complete Improved Level of Improvement

15. Comparative data between Hepotin tablet, Vironil syrup and Interferon alpha-2b, Ribavirin (Body-ache ) 75% 75% 25% Interferon alpha-2b and Ribavirin 0.00 0% 11% 89% Hepotin tablet and Vironil syrup p value Reverse Effect No Improved Complete Improved Level of Improvement

16. Comparative data between Hepotin tablet, Vironil syrup and Interferon alpha-2b, Ribavirin (Burning Micturation ) 50% 70% 30% Interferon alpha-2b and Ribavirin 0.00 0% 21% 79% Hepotin tablet and Vironil syrup p value Reverse Effect No Improved Complete Improved Level of Improvement

17. Comparative data between Hepotin tablet, Vironil syrup and Interferon alpha-2b, Ribavirin (Fever ) 85% 67% 33% Interferon alpha-2b and Ribavirin 0.00 0% 10% 90% Hepotin tablet and Vironil syrup p value Reverse Effect No Improved Complete Improved Level of Improvement

18. Comparative data between Hepotin tablet, Vironil syrup and Interferon alpha-2b, Ribavirin (Burning Palm and Sole ) 15% 33% 57% Interferon alpha-2b and Ribavirin 0.01 0% 12% 88% Hepotin tablet and Vironil syrup p value Reverse Effect No Improved Complete Improved Level of Improvement

19. BIOCHEMISTRY COMPARATIVE STUDY Comparative data between Hepotin tablet, Vironil syrup and Interferon alpha-2b, Ribavirin (ALT ) 45% 55% Interferon alpha-2b and Ribavirin 0.02 10% 90% Hepotin tablet and Vironil syrup p value No Improved Complete Improved Level of Improvement

20. SEROLOGICAL COMPARATIVE STUDY Comparative data between Hepotin tablet, Vironil syrup and Interferon alpha-2b, Ribavirin (RNA ) Frequent Adverse Reactions Peginterferon alfa-2b (12KD) 1.5  g/kg sc qw plus ribavirin 800 mg po qd 45% 55% Interferon alpha-2b and Ribavirin 0.4 35% 65% Hepotin tablet and Vironil syrup p value No Improved Complete Improved Level of Improvement

31. Thank You For Participating