The information in this page aims to give a good general overview of hepatitis C. It is not meant to replace the advise you would get from a doctor or a specialist. If you have hepatitis C, it may be wise to seek medical advise regularly. A good medical practitioner can provide monitoring, up to date information and advise and counselling if needed.

Viruses are minute organisms capable for infecting almost all animals and plant. Most viruses only infect one species. Hepatitis C virus only infects humans.

A virus is a minute organism composed of an outer 'skin' encasing a core structure. It is capable of infecting almost all animals and plants, including bacteria.

They lack independence and are characterized by a complete reliance on their host for reproduction.

Hepatitis means inflammation of the liver, which causes damage to the liver cells. Hepatitis can be caused by chemicals, drinking too much alcohol, or by drugs or viruses.

There are several different hepatitis viruses that can cause hepatitis. They produce similar inflammation of the liver but result in different illnesses and may require different treatments.

The Hepatitis C Virus is often called HCV. This name is similar to HAV (for hepatitis A), HBV (for hepatitis B) and HIV (Human Immunodeficiency Virus), but all are completely different viruses. This means that hepatitis C cannot give you AIDS.

The hepatitis C virus is extremely virulent, which means that infection with only tiny amounts of HCV can cause illness. It is extremely infectious, meaning that it is easily passed from one person to another if there is opportunity via blood to blood contact and it is also extremely resilient, meaning it is very hard to kill.

When someone is infected with the hepatitis C virus, their body produces antibodies to try to destroy it. More often than not, the antibodies fail to identify the hepatitis C virus properly. The infection then remains long-term. Most infected people don't know that they have the virus. This is because for some people there will be no symptoms and for others, symptoms take an average 13 years to develop. Some people may have hepatitis C for 20 years or more before finding out.

The hepatitis C virus may damage the liver. This damage may be slight or serious. If people have symptoms, these might include tiredness, abdominal discomfort and nausea. There is no way to predict what will happen for any one person. Some things can worsen symptoms, alcohol being the most damaging.

The liver is vital to our body's good health. If enough liver cells are not functioning well, a number of important body systems will eventually suffer.

The hepatitis C virus has been around for at least 20 years. It used to be called non-A non-B hepatitis. Doctors first noticed it when some people who had been given blood transfusions in hospital developed hepatitis.

Using tests for hepatitis A & B, doctors proved that these two viruses weren't causing the symptoms. For years the doctors could only guess at what was causing non-A non-B hepatitis. In 1989, using genetic engineering, scientists discovered virus responsible for causing the non-A non-B hepatitis and called it the hepatitis C Virus or HCV.

Nobody is sure where the virus came from, Scientists initially discovered the hepatitis C antibody (the human bodies natural response to the virus) and through a scientific process of genetic examination, were able to map out the structure of the actual virus.

As world-wide research continues, we now know that the virus can mutate or change rapidly and there are several major sub-strains. Each sub-strain varies. This could be one explanation for why our antibody response does not eliminate the virus. By the time our antibodies are ready to attack the virus, it has changed and our antibodies have no effect on it.

Hepatitis C is different for different people. Some are not severely affected by the condition but others are affected very badly. We are learning more about what hepatitis C does all the time.

If 100 people are infected with hepatitis C, a simple model of what we thinks happens to them is:

	15 - 20 people may get rid of the virus within 2 -6 months (like we get rid of a flu virus).
	60 people will have long term infection that may cause little or no problems or may cause varying levels of liver damage and other symptoms ranging from mild to serious. These often include tiredness, nausea and abdominal pain.
	20-25 people will have long term infection that leads to serious liver damage up to 20 years after infection. Of these people 10-15 may remain stable and the other 5 - 10 may progress to liver failure or live cancer after another 10 - 15 years.

Hepatitis C infection does not always make people sick. When someone does get sick, symptoms can take a long time to develop (approx 13 years), although some people can get sick a lot earlier. Symptoms can often stay at a certain level for a long time. The symptoms do not always get worse. Symptoms can also come and go with no real pattern.

Hepatitis C infection involves an initial acute phase of infection which is usually not noticed and lasts two to six months. It usually occurs about 6 - 10 weeks after exposure to HCV. During this phase, levels of the virus in the blood rise dramatically until the body's immune response starts producing antibodies. Although our antibodies fight the virus, in 80 to 85% of cases the virus is not eliminated and following the acute phase of infection, most people are left with a long-term chronic infection.

Some people with chronic infection don't have any noticeable liver damage or symptoms. These people remain well, but they are infectious and should take care to reduce any risk of transmitting the virus to others..

A majority of infected people will eventually develop some level of liver damage. Clinically these begin to cause problems in the liver between 5 - 10 years after infection. Symptoms related to hepatitis C, such as tiredness, nausea or abdominal discomfort then begin to show up. Sometimes symptoms may be disproportionately disabling compared to the amount of liver damage. Also in some people, symptoms do not become sever until 20 - 30 years after infection. Doctors and specialists do not yet fully understand the cause of fatigue associated with hepatitis C.

Studies show that over a 20 year period, chronic infection may result in permanent scarring of the liver called cirrhosis. This is not life-threatening in itself but after a further 5 to 10 years, extensive cirrhosis may result in liver failure or cancer of the liver. Liver failure may be treated by liver transplant.

Women can be affected by hepatitis C in a different way from men.

Women with Hepatitis C may experience, in addition to the symptoms already mentioned above:

irregular periods

lower sex drive

sever pre menstrual tension

Hormonal effects of hepatitis C can involve menstrual irregularities, particularly if you are experiencing significant hepatitis C symptoms. It is important that your general health is checked as well as your hepatitis C monitored.

Birth control: If you are experiencing significant hepatitis C symptoms, using the estrogen-based contraceptive pill may be inadvisable. In these cases, the progesterone-only pill or Depo-Provera may be preferable. In any case, you should consult a woman's health practitioner.

Hormone Replacement Therapy: If you have severe hepatitis C symptoms you may need to discuss with your doctor or specialist whether hormones should be used for menopausal symptoms. If this is the case, external vaginal creams and skin patches are probably better than pills.

Breast Feeding - See in next section: How Is The Hepatitis C Virus Passed On?

Transmission is nearly always through blood to blood contact:

Sharing of injecting equipment very high risk

Unsafe tattooing and body piercing high risk

Blood transfusion and use of blood products before 1990 moderate risk

Mother to baby, before or at birth low risk

Health Care worker, needle stick and sharps injury low risk

Sharing of razor blades, toothbrushes etc very low risk

Sexual transmission very low risk

Blood transfusions / blood products, ^{after Feb 1990(In Australia)} extremely low risk

Breast feeding extremely low risk

Sharing of injecting drug equipment is now the most common way of becoming infected. All injecting equipment may be involved - syringes, spoons, filters, water, tourniquet and swabs. Stopping the bleeding with fingers also involves transmission risks. Any spilt blood, even amounts you cannot see, increases the risk of exposure to hepatitis C. Although it is safer to inject in the company of other people due to the risk of drug overdose (approximately 500 people overdose per year in Australia), sharing any equipment is likely to lead to transmission of hepatitis C and other viruses. People who are already infected can become re-infected with different strains of hepatitis C and experience another initial acute stage of infection. Because of the many possible risk factors involved with injecting drug use, some experts believe the safest way of taking drugs is to smoke, drink or eat them.

Unsafe tattooing and body piercing: Tattooing and body piercing are not always carried out under sterile conditions. Although single-use needles are commonly used, dye and dye tubs may be used for many customers. You should make sure that your tattooist or body piercer adopts infection control practices, ie. uses single use disposable surgical gloves, needles and dye tubs etc.

Blood banks began testing for hepatitis C virus as soon as tests became available in 1990. Before that, all blood transfusions and blood products carried some risk, with about 20% of people with hepatitis C having caught it through contaminated blood or blood products. Blood banks now test all donated blood and inform donors who have hepatitis C antibodies. Risk of hepatitis C transmission through blood transfusion is now considered extremely low.

Mother to baby transmission: If a baby is born to a hepatitis C positive mother and its blood was tested at birth for hepatitis C antibodies, the test would come back positive. This is because the baby has some of its mother's antibodies - these antibodies clear naturally over time. A test at 12 months usually confirms a toddler has the virus. Less than 10% of babies actually acquire the virus from a mother with hepatitis C. Mothers in the acute phase of infection, or those with serious liver damage, have a higher possibility of transmitting the virus.

Occupational transmission occurs mainly through needle stick (or sharps) injuries. For every 100 needle stick injuries involving hepatitis C positive blood, 4 result in transmission (4% risk). With hepatitis B needle stick injuries, the risk is 30% (30 in 100) and for HIV the risk is 0.4% (4 in 1000). Health Care workers are advised to always practice standard infection control precautions.

Household transmission is rare. It can occur where blood-to-blood contact happens. This could involve your blood spills coming into contact with someone's open cut, or to a lesser extent, the sharing of razor blades, toothbrushes and sharp personal grooming aids. It is advisable to wipe up blood spills with paper towels, cold soapy water (not hot, as it clots the blood) and bleach, and to keep razors and toothbrushes separate from those belonging to other family members.

Sexual transmission of hepatitis C is very uncommon, but can occur. All sexually active people should consider the benefits of safe sex in regard to the wide range of sexually transmissible diseases including HIV/AIDS. If you have any condition that involves scratching, sores or blisters (especially when these may come into contact during sexual activity) the possibility of blood-to-blood contact and transmission is increased.

When one partner is hepatitis C positive couples need to reassess their sexual practices to exclude the risk of blood-to-blood contact during sex. Using condoms and dams when a female partner is menstruating or when having anal sex is recommended. It is also advised to use a water-based lubricant to avoid condom breakage, skin damage or abrasion during sex.

Risk of sexual transmission is thought to be influenced by a person's viral load (virus levels in the blood). Risk of transmitting hepatitis C sexually is possibly increased during the initial acute phase of infection - lasting up to six months after being infected with the virus, because viral load is thought to be higher at this time. People who are already infected can become re-infected with different strains of hepatitis C and experience another initial acute stage of infection.

Breastfeeding: In worldwide studies, the hepatitis C virus has rarely been found in samples of breast milk taken from mothers who are HCV positive. Transmission risk via breast milk is therefore unlikely. If the mother is actively infected (this depends on finding virus in the blood by a test called PCR) this may increase the risk of transmission to a child.

There are many advantages to breast feeding. The choice to breastfeed or bottle feed is up to parents. As HCV is in the blood, anything that lets blood or serum into the breast milk, eg bleeding nipples, could pose a risk to a breastfeeding child. Breastfeeding mothers should check their nipples before each feed and avoid breastfeeding if they are cracked, grazed, bleeding infected or even bruised. To further prevent nipple trauma, consider weaning the baby to bottle feeds when s/he starts teething.

Not enough is known about hepatitis C to judge whether it physically affects children any differently than adults.

Although many studies have been done on adults, particularly people who have had blood transfusions, there have been few studies done on infants and children. It is difficult to say if there would be any major differences to the outcome of hepatitis C infection in children.

Except for blood to blood contact, the virus is quite difficult to pass on.

Each person's razor blades and toothbrushes should be kept separate. Blood spills should be washed up with paper towels and bleach and cuts or grazes should be cleaned and covered with water proof dressings.

Blood stained items should be placed in plastic bags before disposal in the garbage.

Most babies are not at risk of being infected with hepatitis C from their mothers.

Sexual transmission of hepatitis C is very uncommon.

Partners, family and friends can play a major role in supporting someone who has hepatitis C.

Vertical transmission: This relates to transmission of the virus from a hepatitis C positive mother to her baby during pregnancy or at birth. It occurs in less than one in 10 births. If a mother contracts hepatitis C during pregnancy, though, the risk of transmission is increased above one in ten (due to her increased viral load). For most hepatitis C positive women, the overall risk of vertical transmission is quite low and the outlook for babies who are born HCV positive does not warrant termination of pregnancies.

Breast feeding: See under How Is The Hepatitis C Virus Passed On?

Testing of infants: If you feel it is necessary to test babies and toddlers, it is important not to test them before the age of 12 months (see mother to baby transmission).

Transmission to sexual partners is very uncommon. Hepatitis C is not classified a sexually transmitted disease but all sexually active people should consider the necessity for safe sex in regard to the wide range of sexually transmitted diseases (see sexual transmission).

Disclosure: At some point in time, people who have hepatitis C may decide to tell their current sexual partner(s), or others (see section 'who should I tell'). When another partner is advised of HCV infection, it may assist to have written hepatitis C information on hand - such as this booklet or the brochure - 'What is Hepatitis C?'.

HCV transmission to family members is uncommon: Hepatitis C is NOT transmitted by ordinary social contact such as:

	hugging, kissing
	using the same cutlery and plates
	shaking hands
	using the same shower and toilet facilities
	sharing food and drinks
	using the same towels and washing machine.

It is better not to share razors, toothbrushes or any items able to be contaminated by blood. All homes should have good first-aid kits regardless of whether anyone has hepatitis C. If you have hepatitis C, you should clean and cover cuts with waterproof dressings. Spilt blood should be cleaned up using paper towels and bleach straight from the bottle. Bloodstained items such as band-aids, dressings, tampons and pads should be secured in plastic bags before going into a bin.

If you have hepatitis C, you are under no legal obligation to tell others. It is up to you to decide whether to tell anyone of your hepatitis C status.

Carefully consider any decision to tell others as they may act with prejudice.

Hepatitis C positive health care workers who perform 'exposure prone procedures' should be guided by their State or Territory health authority's guidelines on the performance of exposure prone procedures.

Coping with diseases like hepatitis C can be easier when you can talk to someone close to you about what is happening. Although this usually is helpful, disclosure can sometimes result in rejection.

Individuals are not personally obliged to inform anyone of their status. General Practitioners and blood testing laboratories inform health department disease monitoring authorities of HCV positive test results. This information is treated confidentially and used for statistics to help in planning health services where they are most needed.

Within workplaces and health care settings, government-endorsed standard blood and body fluid precautions and other procedures are intended to reduce the risk of transmission of HCV. Health authorities recommend that people with HCV inform health care workers fully of their health status as this is often necessary for good health care.

Some health care workers may have judgmental attitudes or unnecessarily exaggerated fears of infection. People should carefully consider whether to inform health care workers, or which health care workers to inform, in light of possible discrimination.

Surgeons, operating theatre nurses, dentists, dental assistants and other health care workers who carry out 'exposure prone procedures' should be guided by their State or Territory health department policies. In NSW, if you are a hepatitis C positive health care worker who performs 'exposure-prone procedures' and are unsure of the implications for your career, you could contact the Hepatitis C Council who can put you in anonymous contact with the NSW Advisory Panel on Blood Borne Viruses.

If you have hepatitis C you should not donate blood, semen or organs.

People who ever had a blood transfusions or blood products before screening was introduced in February 1990, and people who have ever shared any injecting equipment for drugs, including steroids, should consider being tested.

Other people who should consider having the test are those who have been tattooed, had body piercing or needle stick injuries. People with abnormal liver function tests with no apparent cause may also benefit from having a hepatitis C antibody test. Health care workers who perform 'exposure prone procedures' should also have themselves tested.

Initial screening tests for hepatitis C do not look directly for the virus itself, they look for antibodies (which are produced by our bodies to fight the virus).

Antibody tests results are usually positive or negative, but sometimes they come back unclear. Tests that come back positive are redone to confirm they are right. Unclear results are repeated and if still unclear, different types of blood tests are done.

There are also blood tests called liver functions tests which look for signs of liver damage.

Antibody tests indicate whether the body has been exposed to the virus and has produced antibodies to fight it. They do not determine whether or not someone still has the virus or how long they've been infected.

does not destroy the virus,

does not provide immunity to the virus, that is will not protect a person from being re-infected

is usually produced by the body's immune system within 6 to 8 weeks of infection

is present in significant quantity within 3 to 6 months after infection.

The 3 to 6 months time from the initial infection to having detectable HCV antibodies is called the window period. If testing is done during the window period a false negative result may be obtained. Repeated testing is therefor recommended for those who have may have been recently exposed to HCV.

The most infectious period is thought to be during the window period, as the virus is able to reproduce completely unchecked by the bodies immune system and the viral levels in the blood are quite high. During this time a person may be unaware that they have been exposed to hepatitis C and are infectious. This is when they may unknowingly transmit the virus to others.

If you get a positive test result and have no risk background - eg. blood transfusions or injecting drug use - it's a good idea to check with your doctor that the blood laboratory double checked the result by using confirmatory tests.

Results usually take between 7 and 14 days to be returned to your doctor. Many people who have had blood tests and are waiting for their results find this a difficult time. It is not uncommon for people to become preoccupied about concerns about HCV when waiting for test results. If this happens, people are advised to consult their doctor, or talk to the friendly staff at the Todd Street Centre or other counseling service.

A positive result usually means that the person has at some in their life been infected with hepatitis C. In a small number of people, being HCV antibody positive is a marker of past infection. In their case the virus has been eliminated from the body and the body has recovered from infection.

A high proportion of those with HCV antibodies are, however, chronically infected with the virus. The diagnosis of chronic infection with HCV in not made solely on being HCV antibody positive. The PCR test may be undertaken to establish continued presence of the virus in the body (see below)

Other investigations include ALT liver function tests (see below), test to exclude other viral infections and tests for other processes that cause chronic liver inflammation.

A false positive antibody test occurs when other diseases or illnesses cause the test to register positive when, in fact, HCV is not present. A number of diseases including certain immune system disorders may produce false positive HCV antibody test results in people with known HCV risks factors.

False positive results are more uncommon with the current tests. Special supplementary tests may help differentiate true positive results from false positive ones.

A negative result may mean that:

	the person is not infected with HCV, OR
	the test was done during the window period (see above), in which case a false negative result may have been obtained, OR
	the person is not making detectable amounts of antibody even though they are infected with HCV. This is also known as a false negative result.

Retesting is recommended if a person suspects they have been exposed to HCV and their result is negative.

PCR tests are a newly developed test that came onto the market in late 1994. PCR (polymerase chain reaction) permits the detection of hepatitis C virus in the blood. It actually detects a characteristic segment of the genetic material (ribonucleic acid or RNA) of the virus. The test amplifies this segment and renders it detectable, except if it is in very low concentrations. The PCR test cannot tell how long someone has been infected.

The PCR test requires many steps and is expensive. They are not currently covered by Medicare. PCR tests look for the presence of the virus. The tests are generally used for assessing someone for Interferon and monitoring their treatment. Information gained can also be useful in interpreting unclear antibody test results. Like the hepatitis C antibody test, the PCR cannot tell how long someone has been infected.

A negative PCR test result may mean

	the virus is no longer present in the person (the person has eliminated the virus and no longer has HCV), OR
	the virus is in such low concentration that it is undetectable by this test. The person may still be infected and infectious, OR
	the virus is not present in the blood, but may still be in the liver and other tissue.

Identifying those people who have positive antibody tests results, but may have cleared the virus from their system.

early detection of HCV.

monitoring HCV.

monitoring response to treatment of HCV.

testing babies, who may have their mother's HCV antibodies in their blood, to detect true infection with HCV.

With all test results, it may be advisable to ask for photocopies of the written test results. If you change doctors or wish to get a second opinion, you then have your own records to show to other doctors or specialists.

Pre and post-test counseling should always be offered to people having HCV tests. The counselling has three main aims: to prevent transmission of the virus, to provide support and to help ensure good management and treatment. In pre/post-test counseling, your doctor should briefly discuss: reason for having a test, history of HCV, meaning of test results, routes of transmission, general outcome of infection, treatment options, lifestyle issues, implications for life assurance and confidentiality. Your doctor should also check if you have adequate emotional support in case of a positive test result.

Your doctor should also provide all the information that allows you to make your own decision whether or not to be tested. He or she should also be able to refer you to health services and/or community support services.

If you are considering a test and would like to discuss it with someone before you see your doctor, you can talk to the staff at the Todd Street Centre.

The liver is the largest organ inside the abdomen and is classified as part of the digestive system.

The liver is not the only organ in the body that is affected by HCV, but the effects on this organ are the most likely to result in a life threatening illness.

Your liver can be looked at as the chemical regulator for the body, converting raw products into other materials essential to maintaining your whole bodies function. The liver deals with everything that enters the body from digestion and also a large proportion of chemicals produced by other organs in the body via the blood supply.

The liver also produces bile which is very important component for digesting food. Low bile levels may cause problems in digesting fats. Other functions of the liver include storing and producing energy, storage of vitamins, regulation of cholesterol and hormone levels, production of protein and blood clotting agents.

Because the liver is such an important organ, if it is not functioning well it may mean that it can upset the functioning of other organs and systems in the body.

Regular blood tests can be used to measure the general condition of your liver. These are called liver function tests. These tests give useful information but other tests may be needed to give an accurate indication of the condition of the liver cells.

Your doctor and/or specialist will also monitor whether you have any hepatitis C related symptoms and your general level of health.

Liver function tests measure levels of particular enzymes in your blood. These enzymes are found in increased levels if liver cells are damaged and excess enzyme 'leaks' into your bloodstream Liver function tests are only a rough guide to the severity of liver damage from hepatitis C - if damage exists.

A doctor can offer ongoing evaluation of your condition by interpreting differences in liver function test results over the last 6 months or so, and whether or not you have physical symptoms or signs of liver disease. Liver function tests are done monthly, quarterly, twice a year or annually, depending on the individual case. It is advisable to ask for your own photocopies of all test results.

ALT is the most commonly monitored enzyme in liver function tests. ALT (alanine aminotransferase) is a chemical released by the liver cells. It is normally present in small amounts in the blood stream. When a liver cell is damaged there is sometimes an elevation of the amount of this enzyme detectable in the blood.

In hepatitis C, ALT levels may be detected in above normal amounts at certain times,. Normal ALT levels are considered to be below 40.

In some people with active hepatitis C, ALT may be normal (ie below 40) throughout the disease. A normal ALT result does not mean that hepatitis C has been eradicated or that the liver is not being damaged by HCV. The PCR test is a better indicator of whether your liver is being damaged by HCV

When ALT is elevated, the elevation may fluctuate from normal to abnormally high over a period of several week, and back again. Because of this it is important to have regular and frequent checks of ALT's.

In some cases, where ALT readings are consistently high for a long time, where they fluctuate greatly or if the readings don't correlate with presence or lack of symptoms, a specialist may suggest a liver biopsy is done. Factors like stress, illness and alcohol can elevate ALT's. Some doctors recommend a liver biopsy after 10 to 15 years of infection and every 5 years thereafter.

AST (aspartane aminotransferase) is another enzyme that may be monitored. It is also produced by the liver. Testing ALT levels is thought to be a better test as AST is also produced in other organs such as the heart.

Alk. Phos. (Alkaline Phosphate) is a test that may indicate obstruction of the biliary system which is a problem with progressive disease. Alkaline Phosphate may also be high if you have gall stone disease or drink excessive alcohol.

Gamma GT (gamma-glutamyl transpeptidase) is another test that may indicate obstruction of the biliary system which is a problem with progressive disease.

Bilirubin is a bile pigment which is usually removed by the liver if it is functioning properly. Increased levels of Bilirubin may indicate decreased efficiency of the liver or obstructions to the bile flow from the liver.

Albumin is a major protein normally found in the blood. Levels of albumin indicate the liver's effectiveness in producing protein. Finding low levels of this protein may indicate liver damage.

Because of differences in technology and available tests, 'normal ranges' quoted by laboratories may differ. This means you shouldn't compare your results from one laboratory with results from a different laboratory. Be guided instead by the normal range quoted by your lab at the time of your test.

Using a special needle, a specialist takes a small sample of you liver. This is then examined under a microscope. The specialist can then give an accurate report on the condition of your liver.

A biopsy is the best way of determining the condition of liver cells. After the skin is sterilized and an injection of local anesthetic given, a special needle is passed between the ribs into the liver. A small sample is taken for microscopic examination. Sometimes doctors may do the procedure using an ultrasound machine to guide them.

For people with blood clotting disorders, liver biopsies are not advised because of the small risk of internal bleeding. Discuss the procedure and possible risks with your doctor. Some people experience pain during the procedure, others don't even realize it has been done. Local anesthetic is always used, but if you are concerned, ask for some pain killing tablets and something to calm you down.

After the procedure, you will be asked to lie still for several hours, so you might like to take a book or a personal radio-cassette.

The biopsy result outlines the condition of various parts of the liver and individual types of liver cells in great detail. The biopsy results will be given to you to take back to your GP. You should ask for a photocopy for your personal records.

Doctors may suggest interferon treatment. The treatment is currently lasts for up to 12 months. In one out of four cases, it results in long term benefit to the liver. Because interferon has only been used for hepatitis C for a relatively short time, doctors aren't sure if the long term benefits are permanent. The treatment does have side effects.

Some people with hepatitis C try natural or alternative treatments. Traditional Chinese Medicine is a common option. This can include a mixture of acupuncture and Chinese herbs. Homoeopathy and herbalism are other options. If you decide to try alternative therapies, it is important to see a qualified natural therapy practitioner

Whatever treatment choice you make, it is important to find out as much as possible about the different options. Natural therapists should work alongside GP's who can monitor progress and side effects.

Interferon, or Alpha interferon, is currently the only treatment shown to have any effect on hepatitis C, although trials are being conducted to examine the effectiveness of a number of other treatments including Ribavirin, herbs and other natural therapies.

People with significant symptoms, high ALT levels and chronic persistent hepatitis, and all those with chronic active hepatitis on biopsy, irrespective of symptoms, can be considered for interferon treatment. Treatment involves injections, three times a week, currently for six months to twelve months.