It is spring 1997, 20 years from the original HBV infection in Germany, and Kevin is doing some light yard work. He is on his knees planting a few impatients along the inside of his front yard fence. Soon he must wash up and go coach High Jumping up at the local High School. His three step-daughters were all in the High School now, and on the girl's varsity track team. Coaching became a good way to keep an eye on the kids after school. He stands, moans and feels very tired. It is only 2:30 pm and he has been up since 10 am - four and a half hours now. He wonders how he could still have the ability to coach and, he himself, high jump almost 6 feet in the air at 38 years old, since, he finds it difficult to stand or kneel.

In Washington, D.C. the politicians continued to bicker. The President's choice for Surgeon General was
controversial beginning with the appointment of Doctor Jocelyn Elders. She was forced to resign in 1994 after she publically advocated "legalizing drugs", the President asked for, and received, her immediate resignation. This was to be the person that the nation looked to for guidance, and direction, in leading the fight against disease and sometimes ignorance. The Surgeon General directs the Centers for Disease Control (CDC). The seat has been unoccupied for three years by 1997.

Somewhere in San Antonio, Texas, a third HBV infected soldier from Germany was soon to be found. His name
was John. John had returned to his home in San Antonio with his wife and daughter, Christina, after he left
Germany. They had another two children and now had three in all. The former soldier was slowly inserting a
small 26 gauge needle into his abdomen, subcutaneously, to inject "Interferon" into his body. He grabbed a
handful of his flesh between his thumb and fore finger from the right side of his navel. He quickly stabbed at
the flesh at a 45 degree angle. As the needle pierced his skin, John winced in slight pain and slowly clenched
his jaw. He was required to "inject" himself five times a week. He tried to use different parts of the body, so
that no one place would be too sore. He hated this part! It made him so sick to his stomach. It also made him
feel like a dirty drug addict. John had gone back to Nursing School after Germany and was now an Operating
Room Nurse, until he was diagnosed with HCV in 1995. He had gone for a routine job physical and was told
to report to the Personnel Director's office.

When the body fights a "germ" it uses three lines of defense. The first line is a physical barrier, examples
would be; the hair in your nose, the skin and ear wax, etc The second line of defense is a "Systemic" response. The body produces mucous and elevates its temperature. Eyes begin to tear, throat closes up, and you feel aches and pains. The third line of defense may be broken into two parts. The first part is a "immune" response in the blood stream. White blood cells attack and destroy the "germ", or better "virus" if it can. It does this by attacking it and overwhelming it physically, and chemically. There are too many different types of White Blood Cells (WBC) to go into deeply here, however, what some WBC's have in them is of interest to patient with HCV. The second part of the third line of defense occurs in the cell's "cytoplasm" itself. Two substances that are used inside virus infected cells are "Interluken", and "Interferon". Interluken (luken = white) works to protect the cytoplasm of a White Blood Cell (WBC). The liver cell (hepatocyte) which helps store Iron in tissue, uses, and makes, "Interferon" (ferric = Iron) within a liver cell cytoplasm. Many HCV afflicted people inject themselves with Interferon in the hopes that they may "slow" the rate of liver cell destruction. The HCV virus is found only in hepatocytes. Up until now there has been no cure for HCV, only ways to slow the rate of destruction to the cells. Interferon is used because this is what the human body manufactures itself to use. Interferon may help - possibly forcing the virus activity into remission. This is what is meant by "active" levels of the virus. It could be dormant (asleep), mild, moderate or severe. The greater the severity, the faster it is attacking you. The faster it attacks you, the more destruction it does to your liver.

Back at Harvard, you the Doctor, are beginning to search the liver cell cytoplasm for a "vector" (molecular
carrier) that will allow you to introduce HBV into the nucleus of the hepatocyte. You and your team of
researches have tried and failed to make HBV insert itself into the cell. The research is being conducted in a
small series of "culture dishes". In some dishes you have success, but in most you do not. You can not move
ahead with your studies of the Hepatitis C virus until you solve this problem. You spend time, effort and a lot
of money without success. Your work has come to a screeching halt because of this problem.

Once a virus has entered a cell the body begins to find "keys" that will lock the virus up. The virus has to be
"unzipped" in order for this to happen. When it unzips, the body's own "nucleotides" line up and complete the zipper again. Once the body knows the "code" or "combination" of the virus, or its envelope(s), it produces this code as an "antibody". The part of the virus that stimulated this response is called a "surface antigen". Some antigens appear as "spikes" on a ball. In common laboratory tests for HCV, the way to see if you have, or have had a virus, is to check the "serum" of the blood for surface antigens, envelope- antibodies and more- antibodies. Serum is obtained in a test tube by placing it in a centrifuge and allowing it to spin quickly for a few minutes. The Red Blood Cells (RBC) make up most of the blood - 70%. The 30% clear liquid left in the test tube is the "Serum". Serum can contain antibodies or antigens. It can even carry a full HBV virus.

These Serology tests are called an; ELISA and RIBA. A PCR test looks for a small fragment of the viral RNA
sequence in the blood stream. The virus itself is protected until it gets into the cell by its own protein
envelope(s).

From 1994 until February, 1998, the Surgeon General's position has been unoccupied. Political posturing
became more important than the public's safety. Some in the nation thought that this was a "junkies" disease,
and if so, then "they got what they deserved" attitude would prevail. The President offered Doctor Foster, a
prominent Pediatrician, but the other side thought that unborn-life was more important than born-life. More
important than families and more important than our communities that we live in. The politicians argued over
"late-term" abortions. Meanwhile, people suffered and searched the medical field for help and answers - there were none! Without a Surgeon General, the CDC would "direct" themselves. Eventually, Dr. Satcher was named and was confirmed this February as our present Surgeon General. He will work closely with the Cabinet level Secretary of Housing and Human Services. Donna Shalela is our present Health and Human Services Secretary. Her job is to work closely with the Surgeon General's office in coordinating, blood banks, immunizations, emerging infectious disease, epidemiology, etc. The First Lady tried to speak about a health care crisis four years ago, but the "Harry and Louise" TV adds ended her campaign. The adds were paid for by the Insurance Companies that now dictate our health care.

Kevin had been feeling fatigued for over a year now. The summer of 1997 comes and goes, by the time it
leaves, so has Kevin's strength and energy. He senses something has been seriously wrong for some time
now. But what does he say to people? "Excuse me, could you look at this little spot?". Maybe, "I have a
stomach ache." ? There was never anything to put a finger on. His consumption of fluids increased
proportionately to the degree of damage incurred by his sinuses and respiratory system. This led to an
increase in urination, regardless of the time - day or night.

His sleep patterns became disturbed. He no longer could sleep for any period of time before one side-effect
or another had awaken him. He treated each symptom individually. If he had a sinus headache, he would take
aspirin and some cold medication. If his lips and nose were dried and cracking, he would use vaseline. A sore foot might be soaked and a tender hand would be wrapped. Slowly, insidiously, the virus was defeating Kevin's body. The virus was winning!

One day you are reading a Professional Journal in your old laboratory office and you read with great interest
an article about "Adenoviruses". The article is co-authored by a famous Virologist from Ft. Detrick, Maryland.
The Virologist has written from his many unpublished notes. He goes into great detail what an Adenovirus
does, and the harm it can do in a "host". The military was well versed in HBV, as well as Adenoviruses by this
time. You ask your assistant to order some Adenovirus and equipment from Canada's Quantum
Biotechnologies (dolly the sheep). It will be five days until delivery. During that time you review your writings
and other Professional Journals from around the world in your field - Molecular Genetics. You have been asked to head the "new" state-of-the-art Molecular Hepatology Laboratory, bequeathed by a prominent alumni that had recently succumbed to liver cancer. You are still unpacking boxes of Magic Wands for the new space-aged laboratory, complete with "argon lasers", when your Adenovirus arrives in a sealed refrigerated container. The virus must be kept and stored at 4 degrees Centigrade, or below. If the virus' temperature climbs above that, it will begin to "denature" and breakdown - rendering it useless for your research work. You instruct your assistants to "freeze with the keys" meaning, and referring to, the secured refrigerated unit that the dangerous Adenovirus will be stored in. The virus is locked up for a month until you can set up the most modern lab in the world, the lab that you Direct!

Mark begins to feel tired daily now, but he has been working long hours on a secret government project that
requires his full attention presently at work. His wife, Toni, had given birth to a third child, a boy named Adam,
eight years early bringing their total of children to three. All three soldiers from Germany had ended up with
three children each. (I know, good things come in threes) All three soldiers had returned to the Medical field
and all three soldiers were beginning to show serious signs of illness. Mark's left knee and his right hand had been bothering him since his Air Force days, ten years earlier. The pain was now more persistent and
increasing in frequency. It hurt to have little Adam sit on his lap now. A pain any good father would tolerate
considering the father-son relationship Mark had with Adam. Toni began to notice that Mark was frequently
up at nights. He would "moan" restlessly if he could get to sleep. Usually, it was just his sinuses, knee or hand. But now his liver began to "pang" with a slight pain each evening after dinner.

Kevin just never felt like himself anymore. He just did not want to do the things he use to love doing, running, bicycling, kyacking and a multitude of out door events.. He is was still in the military so he stayed in physical shape as he was required to do. All summer long he lifted weights and built his arms and chest up into a tanned muscular physique. In September he was 195 lbs when he waited for the children to leave the house for their first day of school. Two of the three step-daughters were seniors in high school and It was to be a special year because of this. He spoke of aches and pains with his wife and problems that were chronic and persistent. It was agreed to that a complete physical would be in order.

The human body's immune system is an amazing biological system. In fact the body can protect itself from
just about anything on this planet. If you consider the millions of "germs" that enter the human body daily it
is a wonder that we survive. We do because of our immune systems. The HBV virus may have been slick
enough to enter the body and head for the liver, but it can not defeat us. The virus slipped through the liver
cell wall and has a problem trying to enter the nucleus, where the blue prints are stored. It has "unwrapped",
"uncoiled" and "unzipped". Once unzipped it starts to "encode" and produce "protease" and "helicase". But
it still can not easily get into the the nucleus. It knocks on the door, but no one answers.

Kevin's insurance company said to wait three months until December of 1997. In mid December Kevin pees
into a cup and has a routine tube of blood drawn and serologically tested. One week later he see his first
Medical Doctor in years (as a patient). He has never really been sick enough to have to see a Doctor, even
though he has not been well in years. All the small symptoms have magnified and grown into lifestyle changing behaviors. Instead of an outdoors person, Kevin begins to remain inside even on beautiful days. Depression sinks in as his struggle to overcome the virus fails. His thinking "dulls" at times and his mind wandered and was constantly "Fogged". As where in the past he could focus like a laser on an issue, he no longer had the drive or energy to want to do so. There was no motivation left, there was no energy left, there were no more good days left!

From Thanksgiving, 1975 until Kevin contracted HBV, in 1977, the Adenovirus was in his body reproducing.
It had more than two years to replicate and position itself in the body. Remember, it loves liver cells. It has an
affinity for hepatocytes! As Kevin was smuggling the virus out of Germany, the Adenovirus began smuggling
the HBV DNA into the liver cell nucleus. These two viruses know each other. they are almost best friends. When the Adenovirus was lurking in the cell for two years, there was nothing for it to do - it became bored. When HBV arrived it was time to party and raise hell! From the corner of the liver, in a little used region, a muffled sound was heard to say, "I'm back!". It was not Adenovirus. It was something being created in the cell's own cytoplasm. It was a "Frankenstein" like virus that was beginning to be assembled in that little used region of the liver.

Kevin and his wife are told that he is positive for HCV and shows an "old" HBV infection. Only the core and
envelope antibodies remain from the original HBV infection. The virus had integrated itself in his DNA and was "gone from sight", but it still lurked.

The Doctor said that the HCV probably came from "the old HBV". The virus had sero-converted within 18
months after infection possibly up to a few years, but it was gone from the cytoplasm. It was gone from the
blood. Only the "extra keys" (antibodies) remained. When the body initially gets infected it shows antigens,
when the infection is old it shows antibodies.

On March 5, 1998, the New Surgeon General, the Centers for Disease Control, the American Liver Foundation
and the Veterans Administration (spoken for by C. Everett Koop) were summoned to Capital Hill by the
Congressional House Subcommittee on Human Resources, to account for the HCV cases prior to 1990.
"Human Resources" includes the Blood Banks. In 1988 HCV is discovered at Chiron, by Dr. Choo et al (and his
associates). By 1989 a test is developed to screen the blood for HCV. And by 1990 the test is being
commercially used in medical laboratories around the country.

This House Subcommittee comes under the direction of the House Oversight and Reform Committee in the
House of representatives. The Subcommittee wants to know where 300,000 cases of HCV came from prior to
1990, and before the development of an accurate screening test. The new Surgeon General holds his own. He is two weeks into office and already has many honest answers for the posturing Congressman. He bluntly
states that "a decision was made not to warn the public concerning HCV". The Surgeon General does not
quibble about being recently confirmed. He tells of "not wanting to create a panic" in referring to why the
public was not warned of the impending HCV crisis looming over the nation. How convenient gentleman that
there is no one to blame.

Next up comes the CDC with their "slanted" numbers. The American Liver Foundation (ALF) informs Congress
of the recent advances made in many fine Research Laboratories and University Centers around the nation.
Finally the VA steps to the plate....and....they do not speak! They have mouths, but the former Surgeon General of the United States, C. Everett Koop, speaks for them. "Up to 80% of some prisons are infected, both at the State and Federal level", he tells. He continues with "Overall 40% of all prisoners in U.S. jails are testing positive for HCV". The man from the VA never blinks. He just sits there stoicly. Koop finishes with "one half of all soldiers reporting to the VA for health care today are testing positive for HCV." ( Excuse me General, what did you say? One-half?)

Kevin began to think of all his friends in Germany that were also sick with HBV. If this was true, if HBV mutated to HCV,"how could this be?". The doctor speaks of Chronic Liver Disease, Transplants and Antiviral Therapy, including Interferon. It is 4 days before Xmas. Kevin goes home that night and tells his 3 step-daughters what he has been told by the Doctor. All are stunned and unsure of what this means. Kevin searches on the internet that night for anything related to HCV and finds "The Hepatitis Place", and soon he begins to understand that he has been much sicker than even he was willing to admit.