1)  Can you have a normal liver enzyme (e.g., ALT) level and still have chronic hepatitis C?
Yes. It is common for persons with chronic hepatitis C to have a liver enzyme level that goes up and down, with periodic returns to normal or near normal. Some persons have a liver enzyme level that is normal for over a year but they still have chronic liver disease. If the liver enzyme level is normal, persons should have their enzyme level re-checked several times over a 6 to 12 month period. If the liver enzyme level remains normal, your doctor may check it less frequently, such as once a year.

2)  What is the risk that HCV infected women will spread HCV to their newborn infants?
About 5 out of every 100 infants born to HCV infected women become infected. This occurs at the time of birth, and there is no treatment that can prevent this from happening. Most infants infected with HCV at the time of birth have no symptoms and do well during childhood. More studies are needed to find out if these children will have problems from the infection as they grow older. There are no licensed treatments or guidelines for the treatment of infants or children infected with HCV. Children with elevated ALT (liver enzyme) levels should be referred for evaluation to a specialist familiar with the management of children with HCV-related disease.

3)  Can Mosquitos Transmit HCV?
Researchers have determined that the hepatitis C virus is not transmitted by mosquitos. There is a lack of epidemiological or physical evidence that it is mosquito-borne and experiments to see any HCV replication in mosquito cells have failed. There are two ways that mosquitos can transmit illness to humans. These are "mechanical transmission" in which a small amount of blood may be present on the mosquito's feeding spike. This type of transmission does not occur with serious human diseases such as HCV, HBV, or HIV. The second way mosquitoes transmit disease is called "biological" transmission. Studies show that mosquitoes can swallow viruses into their middle gut, but once there the virus dies and is digested in the same way we digest food - by breaking it down using acid.

4)  What are the chances of persons with HCV infection developing long term  infection, chronic liver disease, cirrhosis, liver cancer, or dying as a result of hepatitis C?
Of every 100 persons infected with HCV about:

• 85 persons may develop long-term infection,
• 70 persons may develop chronic liver disease,
• 15 persons may develop cirrhosis over a period of 20 to 30 years, and
•   5 persons may die from the consequences of long term infection (liver cancer or cirrhosis).

• HCV is not spread by sneezing, hugging, coughing, food or water, sharing eating utensils or drinking glasses, or casual contact.
• Persons should not be excluded from work, school, play, child-care or othersettings on the basis of their HCV infection status.
• Involvement with a support group may help patients cope with hepatitis C.

7)  Is it necessary to do genotyping when managing a person with chronic hepatitis C?
No. Although persons with genotype 1 respond less often to treatment, genotype should not be a deciding factor on whether or not to treat. With newer therapies, however, treatment regimens might differ on the basis of genotypes.

8)  Why do most persons remain infected?
Persons infected with HCV mount an antibody response to parts of the virus, but changes in the virus during infection result in changes that are not recognized by preexisting antibodies. This appears to be how the virus establishes and maintains  long-lasting infection.

9)  Can persons become infected with different genotypes?
Yes. Because of the ineffective immune response described above, prior infection does not protect against reinfection with the same or different genotypes of the  virus. For the same reason, there is no effective pre- or postexposure prophylaxis (i.e, immune globulin) available.

10)  How Do I Clean Up Blood Spills?
A 10% bleach (soak for 30 minutes) should be used on all contaminated surfaces. There is no proof that this KILLS everything, but you can't autoclave the world. There are also chemical disinfectants containing phenols and other very expensive ingredients, but for home use bleach is the best we have. Bleach can be VERY VERY corrosive on some surfaces..so be careful what you slop it on.

11)  Is HCV the Same Thing as HIV?
Yes and No. HIV and HCV are both RNA viruses. That is both use RNA to carry their genetic code until they find a yummy host! However, these viruses belong to two entirely different families. Sort of like whales and humans are both mammals, but boy what a difference. They have completely different strategies for replication and for survival. HIV is a retrovirus, and once the virus is in a human cell it copies itself to DNA and migrates into the cell nucleus andintegrates into the host genome and is then copied everytime the cell copies it's own DNA. Retro meaning it reverts to a DNA virus once it is in the cell. Other retro viruses are HTLV viruses like some types of leukemia. HCV is a flavivirus. It is related to yellow fever and dengue fever viruses. It replicates by making positive and negative RNA strands and does not make DNA or integrate into the host genome. There are lots of other structural and envelope differences between these two, but the main point is that HIV and HCV are NOT very similar at all--except they both completely screw up the immune system and there is no known cure.

12)  How Do We Know If The Interferon Is Working?
Your doctor and nurse will use several methods to measure how well your treatments are working. You will have frequent physical exams and blood tests. Don't hesitate to ask the doctor about the test results and what they show about your progress. While tests and exams can tell a lot about how the interferon is working, side effects tell very little. Sometimes people think that if they don't have side effects, the drugs aren't working or that if they do have side effects, the drugs are working well. Side effects vary so much from person to person, that having them or not having them usually isn't a sign of whether the treatment is effective. If you do have side effects, there is much you can do to help relieve them. It is especially important that you rest when you feel you need to as well as drinking as much, if not more, water than you can stand. If you are reading this section before you begin taking interferon, you may feel overwhelmed by the wide range of side effects it describes. But remember: Every person doesn't get every side effect, and some people get few, if any. In addition, the severity of side effects varies greatly from person to person. Whether you have a particular side effect, and how severe it will be, depends on your own particular doseage and injection schedule, and how your body reacts. Be sure to talk to your doctor and nurse about which side effects are most likely to occur for you, how long they might last, how serious they might be, and when you should seek medical attention for them.

13)  What About High Iron Levels?
A new study published in the fall issue of American Journal of Gastroenterology, Vol 89, No. 7, suggests that using "Iron Reduction Therapy" along with interferon can result in an effective cure rate in the area of 75-80% and that adding cytokines and antivirals such as ribavirin can improve effectiveness even further. The theory behind this is that viruses need iron to replicate, and by reducing the hepatic iron in the liver you prevent them from replicating. It should be notedthat this new procedure is not yet FDA approved and is still in the early trial stages. Iron is an element required for replication of virtually all virulent microorganisms. Reducing the amount of iron helps to limit the replication of the hepatitis C virus. Increases in levels of serum ferritin, iron, and transferrin saturation also have been noted with high frequencies in patients with chronic hepatitis C,2 and the higher levels have, in general, been associated with lesser likelihood of response to interferon therapy.

14)  What Else Should I Know About HCV?
Medical research and acceptance of the illness will develop only if our national support organizations which promote them are strong. Be sure to support your national groups, and when your national group calls for letters and phone calls to be sent to public officials and media, please get your family and friends to assist you in responding to those requests. We may be able to make greater achievements if we act in unison. In the USA, the largest source of research money comes from government allocations. Therefore, contacting your Congressman about the importance of Hepatitis research is very important.

Did you know?

• The World Health Organization estimates that *one in every hundred* humans have the hepatitis C virus, and that this number is increasing!
• The World Health Report states that Worldwide: 200,000 Million people are chronically infected with Hep C.
• 28.5 times MORE people are infected with Hepatitis than with HIV. 150,000 - 180,000 new cases of Hepatitis C areexpected this year. 200,000 - 250,000 new cases of Hepatitis B are expected this year. 40,000 new cases of HIV are expected this year.
• 10,000 - 13,000 Hep C patients are expected to die in 1998-1999
• Since approximately 5 million people in the U.S. have HCV, it is the most prevalent chronic viral infection in the United States, and possibly the world.
• Interferon (alone) successfully treats between only 10%-12% of CHCV (Chronic Hepatitis C Virus) patients.
• The HCV virus has a half-life of approximately six hours - in other words, if you start with two million, six hours later there are three million, etc. Hence the 3mu three times per week interferon dosage is not the most effective.
• HCV is the leading cause for liver transplants.

According to the New York Blood Center, as many as 25% of people receiving blood transfusions in the early 1960s, 1970s, and 1980s were being infected with contagious diseases and the majority were infected with hepatitis. About one-third of hepatitis B and C cases result from unknown sources. This means someone does not have to be among the high-risk groups to become infected with the virus.

• Know that it's not you. It takes a lot to adjust to your new, lessened capabilities, and the adjustment is made more difficult by the expectations of you and those around you who have been long accustomed to dealing with your "normal, healthy self".
• Patients often find an equilibrium point at which they can function. As in combating any chronic illness, a positive hopeful attitude is essential.
• Be prepared for a possible lack of acceptance from some from whom you might expect support. This may be a shock, but when you cannot regularly "go bowling" with the gang, or you increasingly depend on being accommodated at home or on the job, and when you have a condition that your doctor may not certify or that other people have already heard of as "that disease that junkies get", then your emotional world will become quite different.
• Find new sources of support. It will be important to create a new family-and-friends support structure. This can be done through HCV support groups, electronic networking, pen pals, and other means.

You will need to take the time to create a new self image for yourself, to know that your new physical limitations do not limit you as a person, as a soul, no matter what other people are thinking. And take some advice from those who have traveled this difficult road before you.
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SOURCES:    Centers for Disease Control
                        National Institutes of Health
                        Hepatitis Foundation International