My dad was confirmed to have hepatitis C and may require to have constant
medication.
My question is, what is hepatitis C?
How can a person get it?
Does eating certain kind of cooking.net">food will cause it?
My dad was adviced to go through the treatment by injecting the
medication 3 times a week for the period of one year, is it true that
one have to go this type of treatment or is there any other ?
I was told there'll side effect like lost of hairs, feeling like having
flu and depression. Should he go through with this treatment?

Hope someone can answer my questions.

Thanks

My dad was confirmed to have hepatitis C and may require to have constant
medication.
My question is, what is hepatitis C?
How can a person get it?
Does eating certain kind of cooking.net">food will cause it?
My dad was adviced to go through the treatment by injecting the
medication 3 times a week for the period of one year, is it true that
one have to go this type of treatment or is there any other ?
I was told there'll side effect like lost of hairs, feeling like having
flu and depression. Should he go through with this treatment?

Hope someone can answer my questions.

Thanks

My dad was confirmed to have hepatitis C and may require to have constant
medication.
My question is, what is hepatitis C?
How can a person get it?
Does eating certain kind of cooking.net">food will cause it?
My dad was adviced to go through the treatment by injecting the
medication 3 times a week for the period of one year, is it true that
one have to go this type of treatment or is there any other ?
I was told there'll side effect like lost of hairs, feeling like having
flu and depression. Should he go through with this treatment?

Hope someone can answer my questions.

Thanks

My dad was confirmed to have hepatitis C and may require to have constant
medication.
My question is, what is hepatitis C?
How can a person get it?
Does eating certain kind of cooking.net">food will cause it?
My dad was adviced to go through the treatment by injecting the
medication 3 times a week for the period of one year, is it true that
one have to go this type of treatment or is there any other ?
I was told there'll side effect like lost of hairs, feeling like having
flu and depression. Should he go through with this treatment?

Hope someone can answer my questions.

Thanks

MC>>HepC is a viral disease characterized by inflammation of the liver.

How can a person get it?

MC>>People at high risk include individuals who have had a {*filter*}
transfusion prior to routine screening of donated {*filter*}, anyone who has a
tattoo or body piercing, health care workers, intravenous drug users, and
hemodialysis patients. 1/3 of the people who have it have no identifiable
history of exposure to the virus though.

Does eating certain kind of cooking.net">food will cause it?

MC>>No, not HepC.

My dad was advised to go through the treatment by injecting the
medication 3 times a week for the period of one year, is it true that
one has to go w/ this type of treatment, or is there any other ?

It is the only safe and effective method of treatment available right now.
There are clinical trials testing alternatives as we speak however.

I was told there'll side effect like lost of hairs, feeling like having
flu and depression. Should he go through with this treatment?

MC>>It is possible to have those symtoms. Not all do. I didn't for the
three months I took INTRON A therapy. Just slight flu like muscle aches,
that's all.
Osman, I kept these answers short and to the point.  There are many
possibilities and things that can happen w/this disease. Keep reading
posts in this newsgroup and you'll learn as much as you need to know and
more to help your father combat this virus. Overall, do not let any cut or
abrasion on your body make contact w/any that might be on his. This virus
travels through {*filter*} to {*filter*} contact. Nothing to fear in a normal day,
just watch out for the little things like never share a toothbrush because
a gum might be nicked. Get the idea? Your father will need his rest, help
him when you can. you sound like an intelligent person and I'm sure you'll
support him in his fight. With a little luck the treatments will work and
life will be no different than what you are accoustomed to now.
For more info like the pamphlet I gleaned info from to answer your
questions call Schering's commitment to care # at 1-800-521-7157. They are
the ones that make the medicine your father is taking and try the American
Liver Foundation at
1-800-223-0179. This newsgroup is the best however. Ask questions and
you'll get answers from many of us.
Hope someone can answer my questions.

Thanks

http://planetmaggie.pcchcs.saic.com/hepc.html
http://www.flash.net/~twb/BACafe/
http://ourworld.compuserve.com/homepages/BGARENS/

Hope this will help you :
HEPV-L's HEPATITIS C FAQ v1.0
September 13, 1996
------------------------------

PART 0:  ADMINISTRIVIA
     0.01     Introduction
     0.02     Disclaimer

PART I:  THE BASICS
     I.0.1    What is Hepatitis?
     I.0.2    What Happens in the Body?
     I.0.3    What is the Incubation Period?
     I.0.4    How Does Hepatitis C Usually Begin?
     I.0.5    What Are the Different Types of Hepatitis?
     I.0.6    What is the Function of the Liver?
     I.0.7    Hepatitis C (HCV)
     I.0.8    Who Gets Hepatitis?
     I.1.0    How is it Transmitted?
     I.1.0a   How is it NOT Transmitted?
     I.1.1    HCV and {*filter*} Transfusion
     I.1.2    HCV and Intravenous Drug Use
     I.1.3    HCV and IV Immunoglobulin
     I.1.4    Neonatal Transfer of HCV
     I.1.5    Other Means of HCV Transmission
     I.1.5a   {*filter*} Transmission
     I.1.5b   Occupational Exposure (Health Care Workers)
     I.1.5c   Toothbrushes/Razors/Nail Clippers
     I.1.5d   Hemodialysis
     I.1.6    Highly Speculative Modes of Transmission
     I.1.6a   Tears, Saliva, Urine, Other Body Fluids
     I.1.6b   Cat Scratches
     I.1.6c   Mosquitos
     I.1.6d   Alternative Medical Procedures
     I.1.6e   Other
     I.1.7    Prevention
     I.1.8    When and How Long Can it be Spread?
     I.1.9    How Can the Spread of HCV be Prevented?
     I.1.10   Can You Get Hepatitis More Than Once?
     I.1.11   Vaccines

PART II:     MEDICAL ISSUES
     II.0.1   How Do I Find Good Medical Care for Hepatitis
     II.0.2   Hepatologists and Gastroenterologists
     II.1.0   How is it Diagnosed?
     II.1.1   What is a PCR?
     II.1.2   Is it Possible the Test Could be Wrong?
     II.2.0   Biopsy
     II.2.0a  What is a Liver Biopsy
     II.2.0b  What Are the Dangers of Liver Biopsy?
     II.2.0c  Will it Hurt?
     II.2.1   Chronic Active and Chronic Persistant
     II.2.2   What Are the Main Symptoms of HCV?
     II.2.2a  Fatigue
     II.2.2b  Right-Side Pain
     II.2.2c  Loss of Libido
     II.2.2d  Red Palms
     II.2.2e  Nausea
     II.2.2f  Brain Fog (Confusion/Forgetfulness)
     II.2.2g  Itching
     II.2.2h  Vision Problems
     II.2.2i  Dizziness
     II.3.0   It's Not All In Your Head!
     II.3.1   What is the Evolution of the Disease?
     II.4.0   What Other Medical Problems Are Related to HCV?
     II.4.0a  Cryoglobulinemia
     II.4.0b  Thyroid and Autoimmune Problems
     II.4.0c  Rheumatoid Arthritis-Like Symptoms
     II.4.0d  Dermatological Manifestations
     II.4.0e  Porphyrins
     II.4.0f  Lichen Planus
     II.4.1   HCV and Women's Concerns
     II.5.0   Cycles and Flareups
     II.6.0   Should I be Vaccinated Against Other Types?
     II.7.0   How Does HCV Affect Children?
     II.8.0   How Does HCV Relate to Pregnancy?
     II.9.0   What Are the Different Clinical Indications?
     II.9.1   Elevated Liver Enzymes
     II.9.2   Jaundice
     II.9.3   Hepatomegaly/Splenomegaly
     II.9.4   Spider Nevi
     II.9.5   Ascites
     II.9.6   Portal Hypertension/Varices
     II.9.7   Hepatic Encephalopathy
     II.9.8   Cirrhosis
     II.9.9   Fulminant Hepatitis
     II.9.10  Does HCV Increase the Likelihood of Cancer?
     II.10.0  How Many of Us Are There?

PART III:     TREATMENT (Conventional Medicine)
    III.1.0   Interferon
    III.1.0a  When is Interferon Treatment Not Indicated?
    III.1.0b  Interferon "Breakthrough"
    III.2.0   Iron Reduction Therapy
    III.3.0   Ribavirin
    III.3.1   Interferon and Ribivirin Combined
    III.4.0   Amantadine
    III.5.0   Ofloxacin
    III.6.0   Thymosin
    III.7.0   Reticulose
    III.8.0   Transplant
    III.9.0   Others

PART IV:      TREATMENT (Alternative Medicine)
     IV.0.1   Acupuncture
     IV.0.2   Chiropractic
     IV.0.3   Energy Healing
     IV.0.4   Reflexology
     IV.0.5   Homeopathy
     IV.1.0   Herbal Treatments and Vitamins
     IV.1.1   Kombucha Tea
     IV.1.2   Reishi/Shitake Mushrooms
     IV.1.3   Dandelion
     IV.1.4   Milk Thistle
     IV.1.5   Arti{*filter*}
     IV.1.6   Licorice Root
     IV.1.7   Spirulina
     IV.1.8   Garlic
     IV.1.9   Thymic Factors
     IV.1.10  Vitamin C
     IV.1.11  Vitamin B12
     IV.1.12  Vitamin E
     IV.1.13  Other Herbs or Vitamins
     IV.2.0   Exercise
     IV.3.0   Stress Management
     IV.4.0   Positive Attitude
     IV.5.0   Tai Chi/Chi Kung/Yoga/Meditation
     IV.6.0   Other Ways to Keep Yourself Healthy

PART V:       NUTRITION
      V.1.0   What Should I Do About Nutrition?
      V.2.0   Nutrition and Cirrhosis
      V.3.0   Coffee, Tea, Caffeine and Other Stimulants
      V.4.0   Salt

PART VI:      {*filter*} AND {*filter*}
     VI.1.0   {*filter*}
     VI.2.0   Tobacco
     VI.3.0   {*filter*}
     VI.4.0   What are the Effect of Recreational {*filter*}?

PART VII:     HOW CAN HCV AFFECT MY EMOTIONAL LIFE?
    VII.1.0   How is Depression Related to Hepatitis?
    VII.1.1   Mood Changes
    VII.1.2   Dealing with a Chronic Disease
    VII.1.3   Dealing with a Lower Level of Energy
    VII.1.4   Irritability
    VII.1.5   How Can HCV Affect My Sex Life?

PART VIII:    LIVING WITH HCV
   VIII.1.0   Life Problems Created by HCV

PART IX:      DEALING WITH INTERFERON THERAPY
     IX.1.1   Hair Loss
     IX.1.2   Nausea
     IX.1.3   Fatigue
     IX.1.4   Importance of Water
     IX.1.5   Timing of Injections
     IX.1.6   Injection Hints
     IX.1.7   Needle Size
     IX.1.8   Help!  I Think I Hit a Vein!
     IX.1.9   What to do When You Can't Afford the Interferon

PART X:       WHERE DO WE GO FROM HERE?
      X.1.0   Long-Term Prognosis (Am I Going to Die?)
      X.2.0   Current Research, Testing, New {*filter*}

PART XI:      EMPLOYMENT AND DISABILITY
     XI.1.0   Income Security: Job and/or Disability Benefits
     XI.1.1   How Do I Handle Problems About My Job?
     XI.1.2   Problems in Seeking Disability Benefits
     XI.1.3   Applying for SSI/SSDI

PART XII:     IMPORTANT INFORMATION
    XII.1.0   What Else is Important to Know About HCV?
    XII.1.1   HCV Information Resources
    XII.1.2   National (USA)
    XII.1.3   Canada
    XII.1.4   Australia/New Zealand
    XII.1.5   Great Britain
    XII.1.6   Germany
    XII.1.7   Local (USA) Associations and Support Groups
    XII.1.8   HCV Resources on the Internet and Usenet
    XII.1.9   Bibliography:  Suggested Reading
    XII.1.10  Newsletters, Magazines and Videos

APPENDIX A:   Where to Get the Current Version of the FAQ

APPENDIX B:   Common Abbreviations

APPENDIX C:   Diagnostic Terms Relating to the Liver

=================================================================

Subject: Part 0: Administrivia
------------------------------

Subject: 0.00 Copyright

The HEPV-L FAQ is copyright (c) 1996 by Patricia Johnson on behalf
of the HEPV-L Internet Mailing List. Permission is granted to
redistribute or quote this document for non-commercial purposes
provided that you include an attribution to HEPV-L, the contact

the FAQ's version number and date,  and at least two locations from
which a current version of this  FAQ may be retrieved (see Appendix
1). For any other use, permission must be obtained in writing from

This is a document whose development is in progress. Please make
comments to help improve it. Post "Suggestions to the FAQ:" topic
on the HEPV-L mailing list or send privately to the author

If you want your contribution to be anonymous, please state so.

============================================================

HEPV-L is a list devoted to people with chronic hepatitis, and

Subscribe by addressing a message to:

and in the body of the message, on the first line, type:

SUB HEPV-L FIRSTNAME LASTNAME (substituting your name for the first
and last name)

Any questions, or problems signing on--or off--the list, please
contact one of the listowners:

------------------------------
0.01 INTRODUCTION

This document answers frequently asked questions (FAQ) about
Hepatitis C, (HCV), its treatment, and related complications.  This
FAQ is not comprehensive, and there will be further FAQs describing
other types of hepatitis (viral - A,B,D,E,G, autoimmune, toxic) and
related liver disorders and complications, as well as treatments,
electronic resources and other specialized topics  sometime in the
near future.  These related FAQs will likely be found near where
you have found this one.
------------------------------

0.02 DISCLAIMER

The information presented in this document was written and
developed by patients and members of the HEPV-L mailing list. It
represents an informal catalog of accumulated knowledge by people
who for the most part are not medical professionals. As this file
is developed further, we hope to include references and citations
which will document more of the statements that are made here.
Much of the information contained in this FAQ was compiled from the
varied and personal experiences and opinions on the HEPV-L mailing
list.  As useful as this information may be, it must not be
considered medical advice, and must not be used as a substitute for
medical advice.  And as always, don't forget to use your common
sense. It is important that anyone who has, or thinks they may
have, hepatitis should consult with a licensed health care
practitioner who is familiar with liver disease.
================================================================

PART I - THE BASICS
---

I.0.1  WHAT IS HEPATITIS?

Hepatitis is an inflammation of the liver.  "Hepato" is Greek for
"liver," and "itis" means "inflammation."  The different types of
hepatitis are caused by different things, but they all produce
inflammation of the liver.  Viral hepatitis refers to several
common contagious diseases ...

read more »

formula is called Thymic Factors, and the vitamins are made by
Sundown (super multiple, minus iron).

Carson B. Burgstiner,M.D.
5354 Reynolds St. # 304
Candler Professional Bl.
Savannah, GA 31405
Phone (912)355-5755
fax   (912)355-5759
---

IV.1.10  VITAMIN C

Linus Pauling the two time Nobel Prize winner said that vitamin C
is very beneficial to hepatitis patients. He recommends a bare
minimum of 10,000 milligrams = 10 grams a day.  20,000 - 50,000
milligrams a day is much better = 20 to 50 grams.  Take pure
vitamin C. Take the pills three to four times a day instead of once
a day. Vitamin C is an antiviral agent. The only side effect known
is diarrhea which should slow down and stop as you get used to the
vitamin C.  You can get Linus Paulings books at your local library.
---

IV.1.11   VITAMIN B12

Some hepatitis patients report having more energy when they take
extra vitamin B12.
---

IV.1.12  VITAMIN E

Vitamin E is reported to assist the liver in detoxifying the {*filter*}.
---

IV.1.13  OTHER HERBS OR VITAMINS

Some people have found Essiac Tea to be helpful.
---

IV.2.0  EXERCISE

Symptomatic hepatitis patients may need to avoid stressful
activities, and each person's tolerance for stress will be
different, and can change. It is nonetheless important for people
who can exercise to do so, up to their level of tolerance. This
should be done with care, since crossing the "invisible line" of
exercise intolerance may prompt a flareup.
---

IV.3.0  STRESS MANAGEMENT

Typically, one of the most beneficial things a person with
hepatitis can do is to avoid stress and get lots of rest.  Stress
does not merely mean only unpleasant experiences, but rather any
biological stressors, physical or emotional, which prompt a
protective reaction in the body.  Failure to avoid stress often
leads to short-term and long-term set-backs which may be serious.

High-stress events sometimes seem to "trigger" the flareups of the
virus and they will usually worsen the symptoms if the virus is
already active. Medical studies show that stress plays an important
role in several immune-mediated illnesses.
---

IV.4.0  POSITIVE ATTITUDE

Laughter and a positive spirit are good for the body.  They provide
interferon, the body's natural infection fighter, and produce
endorphins to combat depression and anxiety.
---

IV.5.0  TAI CHI / CHI KUNG / YOGA / MEDITATION
---

IV.6.0  OTHER WAYS TO HELP KEEP YOURSELF HEALTHY

- Avoid exposure to chemical fumes, gasoline fumes, etc.
- Use the least toxic products (cleaning products, health and
beauty aids, etc) available in your home and on your body
---

PART V - NUTRITION

V.1.0  WHAT SHOULD I DO ABOUT NUTRITION?
------
Nutrition and the liver are interrelated in many ways. Some
functions are well understood; others are not. Since everything we
eat, breathe and absorb through our skin must be refined and
detoxified by the liver, special attention to nutrition and diet
can help keep the liver healthy. In a number of different kinds of
liver disease, nutrition takes on considerably more importance.

Everything we eat, breathe and absorb through our skin must be
refined and detoxified by the liver, so special attention to
nutrition and diet can help keep the the liver healthy.

85-90% of the {*filter*} that leaves the stomach and intestines caries
important nutrients to the liver where they are converted into
substances the body can use.

The juice of carrots, beets, cucumber, spinach, celery , wheat
grass and parsley are all used in liver cleansing fasts. So I'm
assuming they're good for livers.

As for diets in particular, The Alternative Medicine Guide says:

Jonathan Wright, M.D. recommends a diet low in protein to minimize
stress on the liver.  Whole foods diet that follows a hypoglycemic
regime, of small meals throughout the day, avoiding stressor foods
such as refined sugars, {*filter*}, and caffeine.  Consume plenty of
filtered water.  Drinking fresh lemon juice water every morning and
evening followed by vegetable juice is one of the most therapeutic
regimes for the liver.  Do this consistently for two to four weeks
and then several mornings a week for several months and whenever
liver symptoms reoccur. Have lots of vegetables each day.  Ideal is
at least one salad and one meal of steamed or lightly sauteed
vegetables per day.  Grains that are easily digestible, such as
millet, buckwheat, and quinoa are very good.

According to the Encyclopedia of Natural Medicine:

A natural diet, low in natural and synthetically saturated fats,
simple carbohydrates (sugar, white flour, fruit juice, honey, etc),
oxidised fatty acids (fried oils) and animal fat, and high in fibre
is recommended.
---

... Natural substances to help your liver detoxify are as close as
your kitchen cupboard. Eating foods rich in lecithin (soybean),
essential fatty acids (salmon, flax oil) and green leafy vegetables
rich in fibre and antioxidants like vitamins C and E, are all
gourmet cuisine for your liver. Lowering your intake of saturated
fats, refined carbohydrates and animal protein and avoiding
excessive amounts of {*filter*} are other recommmendations that are
good both for your liver and overall body health.

Dandelion root and arti{*filter*}are both excellent spring time dietary
condiments that are very helpful in improving liver bile flow. In
addition to these cooking.net">food choices, supplements like L-methionine are
an excellent choice for a congested liver. This sulfur-containing
amino acid not only improves bile flow but also helps protect liver
glutathione.  Glutathione peroxidase is one of the body's major
detoxification enzymes and is in part defended by methionine during
a toxic challenge to the liver...

The article goes on to describe the function of Milk Thistle.  It
concludes that the most potent substances for protecting the liver
are Milk Thistle, Dandelion and L-methionine.  L-methionine is
classed as a "supplement," and Milk Thistle and Dandelion as
"botanical medicines."  -  "Protecting and Enhancing Liver
Function," by  Ronald G. Reichert, ND ,  _Alive: Canadian Journal
of Health and Nutrition_ (#161, March 1996): pp. 14-16.
---

V.2.0  NUTRITION AND CIRRHOSIS

Many chronic liver diseases are associated with malnutrition. One
of the most common of these is cirrhosis. Cirrhosis refers to the
replacement of damaged liver cells by fibrous scar tissue which
disrupts the liver's important functions. Cirrhosis occurs as a
result of excessive {*filter*} intake (most common), common viral
hepatitis, obstruction of the bile ducts, and exposure to certain
{*filter*} or toxic substances.

People with cirrhosis often experience loss of appetite, nausea,
vomiting and weight loss, giving them an emaciated appearance. Diet
alone does not contribute to the development of this liver disease.
People who are well nourished, for example, but drink large amounts
of {*filter*}, are also susceptible to {*filter*}ic disease.

{*filter*}s with cirrhosis require a balanced diet rich in protein,
providing 2,000 to 3,000 calories a day to allow the liver cells to
regenerate. However, too much protein will result in an increased
amount of ammonia in the {*filter*}; too little protein can reduce
healing of the liver. Doctors must carefully prescribe the correct
amount of protein for a person with cirrhosis. In addition, the
physician can use two medications (lactulose and neomycin) to
control {*filter*} ammonia levels.

Persons with cirrhosis often experience an uncomfortable buildup of
fluid in the abdomen (ascites) or a swelling of the feet, legs, or
back (edema). Both conditions are a result of portal hypertension
(increased pressure in the veins entering the liver). Since sodium
(salt) encourages the body to retain water, patients with fluid
retention can cut their sodium intake by avoiding such foods as
canned soups and vegetables, cold cuts, dairy products, and
condiments like mayonnaise and ketchup. In fact, most prepared
foods contain liberal amounts of sodium, while fresh foods contain
almost no sodium at all. The best-tasting salt substitute is lemon
juice. In general, a reduction in meat protein which is the most
toxic protein to the brain and substituting vegetable protein is
advised when cirrhosis is present.

Food to avoid: Shellfish if uncooked can be very dangerous to take
in patients with cirrhosis. Either avoid or be careful. Vibro
vulnificus, a bacteria can be contracted by eating raw oysters,
etc.
---

V.3.0  COFFEE, TEA, CAFFEINE AND OTHER STIMULANTS

In the book "Healthy Healing" by  Linda Rector-Paige, N.D., PhD,
she says: "...Some of the health problems of caffeine are...well
known--headaches and migraines, irritability, stomach and digestive
problems, anxiety, and high {*filter*} pressure.  As an {*filter*}ive
stimulant, it works as a drug, causing jumpiness and nerves, heart
disease, heart palpitations.  Caffeine in excessive amounts, can
produce oxalic acid in the system, causing a host of problems
waiting to become diseases. It can lodge in the liver, restricting
proper function, and constrict arterial {*filter*} flow. It leaches out
B vitamins from the body...It depletes some essential minerals,
including calcium and potassium...however the caricinogenic effects
often blamed on caffeine are now thought to be caused by the
roasting process used in making coffee, tea and chocolate. Since
decaffeinated coffee has been implicated in some forms of organ
cancer, conclusions are being drawn that caffeine is not the
culprit-- the roasted hydro-carbons are..."
---

V.4.0  SALT

Those who are prone to episodes of ascites should try to maintain a
very low sodium diet (less than 3 gr/day - I shoot for 1-2gr/day).
---

PART VI - {*filter*} AND {*filter*}

VI.1.0   {*filter*}

There is no question that {*filter*} is bad in HCV. Studies have shown
that patients that drink 3 drinks per day have a higher incidence
of cirrhosis.  Our own center has shown that patients with HCV and
drink have a worse activity index on the liver biopsy.

{*filter*} is thought to magnify the progression of hepatitis C and
vice ...

read more »

in San Diego. The latest findings are sobering because about 1.4%
of the U.S. population is infected with the virus - "Hepatitis C
Chronic 75% of the Time", USA Today, 05-15-1995
---

At least 50-80% of people infected with HCV will develop chronic
hepatitis; ultimately, 20-30% of those will progress to cirrhosis.
Another 20-30% may develop chronic HCV infection without abnormal
elevations of liver enzymes in the {*filter*}. "Prevention, Diagnosis,
and Management of Viral Hepatitis", AMA
---

II.4.0  WHAT OTHER MEDICAL PROBLEMS CAN BE RELATED TO HCV?

Chronic hepatitis C infection occasionally causes problems for
parts of the body beyond the liver. The organs most often affected
include the {*filter*} vessels, skin, joints, kidneys, and thyroid
gland. If chronic hepatitis C infection causes liver cirrhosis
(severe scarring of the liver rarely caused by hepatitis C), many
problems may arise from the cirrhosis, per se. Potential problems

Hepatitis has so many symptoms that it's easy to ascribe all new
anomalies to this disease. But HCV patients are not exempt from getting
other illnesses also, therefore it is important to regularly
monitor your health and to consult with your doctor about the
changes as they progress.
---

II.4.0a  CRYOGLOBULINEMIA

One-third to one-half of people with chronic hepatitis C infection
have cryoglobulinemia (antibodies in the {*filter*}stream attached to
the hepatitis C RNA that happen to solidify when cold).  Hepatitis
C is recognized as the most common cause of mixed cryoglobulinemia.
Most of the people with cryoglobulinemia from hepatitis C have had
their hepatitis for a long time or have cirrhosis. People with
higher concentrations of hepatitis C RNA in their {*filter*} do not seem
to have a higher risk of having cryoglobulinemia. Usually the
cryoglobulins are in low concentration and cause no symptoms. About
twenty-percent of people with hepatitis C and cryoglobulinemia have
symptoms. Symptoms most often associated with cryoglobulinemia
include mild fatigue, joint pains, or itching.

Occasionally, people with cryoglobulinemia develop vasculitis
(inflammation of the {*filter*} vessels) which can cause purpura (purple
skin lesions), Raynaud's phenomenon (the hands turn white, then
blue, and then red from constriction and subsequent dilation of the
{*filter*} vessels), or numbness in the hands and feet. The presence of
cryoglobulinemia does not effect people's response to interferon.
In fact, some people with vasculitis have improvement in the
vasculitis as their liver tests improve on interferon.
---

II.4.0b  THYROID AND AUTOIMMUNE PROBLEMS

Chronic hepatitis C infection is also associated with many
autoimmune diseases (where the body develops antibodies which
attack parts of itself). For example, about one-tenth of people
with chronic hepatitis C infection (more often in women and older
people) have antibodies to the thyroid gland, one-half of whom may
develop hypothyroidism (an underactive thyroid gland).

Additionally, interferon therapy causes hypothyroidism or
hyperthyroidism (an overactive thyroid gland) in about one-tenth of
those treated. People with hypothyroidism may suffer from fatigue
poor memory, weakness, constipation, weight gain, muscle cramps,
intolerance to cold, hoarse voice, coarse skin, and brittle hair.
People with hyperthyroidism may suffer from anxiety, insomnia,
weakness, diarrhea, weight loss, intolerance to heat, velvet-like
skin, and brittle nails. Hypothyroidism can be treated with thyroid
hormone pills. Hyperthyroidism can be treated with pills that block
thyroid hormone synthesis. If the thyroid gland dysfunction is from
interferon treatment and is caught early, the thyroid gland will
return to normal once interferon is stopped.
---

II.4.0c  RHEUMATOID ARTHRITIS-LIKE SYMPTOMS

Hepatitis C infection can present with rheumatic manifestations
indistinguishable from RA.  The pre{*filter*} clinical findings
include palmar tenosynovitis:  small joint synovitis, and carpal
tunnel syndrome.  Risk factors such as transfusions and IV drug
abuse or a history of hepatitis or jaundice should be included in
the history of present illness of any patient with acute or chronic
polyarthritis or unexplained positive RF.  In such patients,
gammaglutamyl aminotransferase, serologic studies for hepatitis C,
and other tests appropriate for chronic liver disease should be
performed." Journal of Rheumatology, June 1996;23(6):979-983.
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II.4.0d  DERMATOLOGICAL MANIFESTATIONS

The main dermatologic disorders in HCV infection include (1)
vasculitis (mainly cryoglobulin-associated vasculitis, the cause of
which is HCV in most cases, and, possibly, some cases of
polyarteritis nodosa); (2) sporadic porphyria cutanea tarda; (3)
cutaneous and/or mucosal lichen planus; and (4) salivary gland
lesions, characterized by lymphocytic capillaritis, sometimes
associated with lymphocytic sialadenitis resembling that of
Sjoegren's syndrome.

Hepatitis C virus is the cause of, or is associated with, various
dermatologic disorders. In patients with such disorders, HCV
infection must be sought routinely because antiviral therapy may be
beneficial in some of them. - Arch Dermatol. 1995; 131:1185-1193
---

II.4.0e  PORPHYRINS

Porphyrins are a group of compounds that are mainly synthesized in
the bone marrow. They play an important role in many chemical
reactions in the body, e.g. with proteins to build hemoglobin.
They are later converted to bile pigments mainly in the liver.
Porphyrinuria (increase of porphyrins in the urine) may be caused
by chronic liver diseases. Hepatitis C is a major cause of
porphyria throughout the world and may cause many symptoms,
including excess {*filter*} iron - important in conjunction with an
interferon therapy (since elevated {*filter*} iron seems to reduce the
effect of interferon).

Porphyria cutanea tarda is a rare deficiency of a liver enzyme
essential for cellular metabolism. The enzyme deficiency may cause
sun exposed skin to blister, ulcerate, turn dark, or bruise. Hair
may increase on the forehead, cheeks, or forearms, and the urine
may turn pink or brown. It now appears that hepatitis C is the most
common trigger of porphyria in people who are predisposed. Topical
sunscreens do not prevent the skin lesions.  Avoidance of {*filter*}
and removal of iron by repeated phlebotomy ({*filter*} removal) or
taking medication that binds to iron sometimes helps. Chloroquine
(an anti-malaria drug), which removes a toxic by-product of the
enzyme deficiency, may help, as well.
---

II.4.0f LICHEN PLANUS

Occasionally, people with chronic hepatitis C develop a skin
condition called lichen planus. It is a grouping of small, itchy,
irregular, flat-topped reddened bumps. The bumps often have a
network of very fine gray lines on their tops. The bumps show up
most often on the wrists, shins, lower back, or {*filter*}s. Lichen
planus also frequently occurs in the mouth, where it looks like a
white, net-like plaque.   It sometimes shows up as mouth ulcers and
can be treated with a steroid mouth rinse called Dexamethasone
Elixir or Nystatin tablets.
---

II.4.1  HCV AND WOMEN'S CONCERNS (HORMONAL/{*filter*} LUMPS/MENSTRUATION)
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II.5.0  CYCLES AND FLAREUPS

Hepatitis flareups tend to occur in cycles, where for a while you
may feel pretty good, then bad (maybe days to weeks for each
period), then good again. It can be frustrating to obtain some
relief, but then not know whether you have recovered or if you are
merely between cycles.

Some people claim that they begin to feel better in the Spring,
then start to feel worse again in August/September, with a low
point usually around November/December.
---

II.6.0  SHOULD I BE VACCINATED AGAINST OTHER TYPES OF HEPATITIS?

Patients with chronic hepatitis C who are at risk for hepatitis B
should be offered vaccination during their first contact with
healthcare professionals, according to a report from Great
Britain's University of Cambridge.  ("Prospective Study of
Hepatitis B Vaccination in Patients with Chronic Hepatitis C,"
British Medical Journal, May 25, 1996;312:1336-1337).

Chronic hepatitis C (HCV) infection is estimated to occur in
between 70- and 92 percent of intravenous drug users.  These IV
drug users are also at risk for parenterally or {*filter*}ly
transmitted hepatitis B. Coinfection with hepatitis B virus (HBV)
may accelerate underlying liver damage due to hepatitis C.
---

II.7.0  HOW DOES HCV AFFECT CHILDREN?

Children with chronic hepatitis cannot be treated simply like
miniature {*filter*}s. Specific issues and questions need to be
addressed when dealing with the pediatric age group.

 Pediatric patients are less likely than {*filter*}s to have symptoms of
infection with hepatitis C, leaving the viruses undetected and
possibly unknowingly spread.   According to information available
on the natural history of HCV,  the percentage of children who
become chronic and the long-term outcomes are similar to the
percentage of {*filter*}s. Children who are chronic carriers of HCV have
normal growth patterns.

Liver biopsy appears to be less valuable in children than {*filter*}s.
Chronic hepatitis rarely progresses to cirrhosis in children. In 16
HCV children followed for up to 14 years, encephalopathy (mental
confusion), ascites (swollen stomach), or bleeding did not develop.
The lack of cirrhosis in children with HCV is consistent that a
time period of 10 to 20 years or more is required for cirrhosis to
occur.   Hepatocellular carcinoma occurs very rarely in the
pediatric group.

Few studies exist examining interferon use in children with chronic
HCV, however a recent study in Hepatology suggests that interferon
therapy may be beneficial The rates of initial and long-lasting
response were higher in the study than those observed in {*filter*}s
treated with standard schedules. Possible explanations include the
shorter time of infection ...

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