HEPATITIS C
What is hepatitis C?
Hepatitis C Virus (HCV) is a virus that infects the liver and causes hepatitis. Hepatitis is inflammation (swelling) of the liver, which can lead to cirrhosis and possible cancer in a small number of cases. Hepatitis C was identified in 1989. Before then it was called non-A, non-B hepatitis, meaning that it was not caused by hepatitis A or hepatitis B viruses. To date, six types of hepatitis have been identified (type 1, 2,3,4,5,6).
How widespread is hepatitis C?
It is estimated that between 1 to 4% of the world population is infected with hepatitis C. The infection rate in Canada is between 0.5% and 1%. Up to 270 000 Canadians are believed to have hepatitis C although only a small number know that they are infected.
The following are some statistic of hepatitis C in high-risk groups.
- Among needle drug users, the infection rate is 80%
- Within the population of people with hemophilia, 70% have been infected. People with severe hemophilia have a higher rate of hepatitis C infection than individuals with moderate or mild hemophilia. This is because they have received more blood products. The infection rate is low in children born after 1988 because they used blood products in which the virus has been inactivated. Hepatitis C infection is higher among people with hemophilia who are HIV positive than those who are HIV negative. As well, people with hemophilia who have hepatitis B, have a higher infection rate with hepatitis C.
How can I get infected by Hepatitis C?
People frequently get the virus through:
- Unclean needles and equipment shared among needle drug users.
There is a definite risk of infection for health care workers who are accidently stuck with contaminated needles.
It is less likely that people get hepatitis C through:
- Blood and blood products. Before 1990, many cases of hepatitis C were acquired through the use of blood or blood products. Improvements in blood product treatments and screening of blood has reduced the risk of getting hepatitis C. However, medical literature shows that a small risk still exists. As well, the blood product cryoprecipitate is not subject to viral inactivation procedures.
- Unprotected sex. Research indicates that a small number of people become infected through unprotected sexual intercourse.
People are rarely infected through:
- Infected mother to child at birth.
It is still not known how the hepatitis C virus is transmitted in a large number of cases.
How can I prevent the spread of hepatitis C?
If you are infected, take the following steps to make sure that you don’t spread the virus:
- Never donate blood, body organs, other tissue or semen.
- Clean blood spills with soap and water, then disinfect with a 10% solution of bleach.
- Throw out blood-stained articles in a plastic bag.
- Don’t share toothbrushes, razors or nail files.
- Tell your dentist, doctor and hospital staff that you have hepatitis C.
- Use a latex condom during sexual intercourse. If you are considering having children, please consult your physician about transmission risks and reproductive options.
- Cover cuts and sores.
- Avoid tattooing, body piercing and electrolysis.
- Never use a needle or syringe which has been used by someone else.
- For persons with hemophilia and related blood disorders on self-infusion programs, follow all instructions carefully.
DIAGNOSIS
How do I know if I have hepatitis C?
You can find out if you have hepatitis C by getting a blood test. The test for hepatitis C is based on the detection of antibodies to the virus, not the virus itself. Antibodies are produced by the body to fight viruses and they are found in your blood. The tests currently used to detect hepatitis C antibodies are the ELISA test, followed by the RIBA test. Positive tests indicate that you have been infected at some time in your life. You are then said to be hepatitis C positive.
Why do I need to be tested?
You need to be tested to detect, treat and prevent the spread of hepatitis C infection. Testing means that you will be able to:
- In the short term;
- prevent the spread of the virus,
- assess damage to the liver, and
- make lifestyle changes.
- In the long term;
- monitor the progression of the infection,
- detect liver problems early, and
- receive medical treatment.
Who needs to be tested for hepatitis C?
- People who had blood transfusions and blood products.
- Needle drug users.
- Individuals with multiple sexual partners.
- People exposed to needlestick injuries (e.g., health care workers)
- Organ transplant recipients
- Children of hepatitis C positive mothers.
What about pre/post test counselling?
At present, there are no standards for getting counselling before and after you are tested for hepatitis C. This means that people being tested across the country may not be well informed about the testing procedures and results.
Before being tested,
- Ask your doctor to explain the tests being done.
If you test positive,
- Ask for an explanation of what being positive means, e.g. symptoms, outcomes.
- Make sure that your family can access information they need.
If you test negative,
- Be aware that sometimes false negative results occur.
- If you have hemophilia or another blood related disorder, be tested regularly because you will still receive blood products.
What do I do if I test positive for hepatitis C?
- Be retested. Mistakes happen, so a second test can confirm the results.
- Be monitored by your doctor.
- Learn more about hepatitis C and how it may affect you.
- Take steps to prevent the spread of infection.
OUTCOMES
What is the course of the hepatitis C infection?
The initial phase of hepatitis C infection is called acute hepatitis. It may last from two days to twelve weeks
After acute hepatitis, there can be either one of two possible outcomes. In some people, the virus can no longer be detected. We don’t know whether the virus goes away forever or only for a short period of time. In 50% to 70% of the cases, hepatitis C infection becomes chronic. This means that it lasts longer than six months.
What is the effect of chronic hepatitis C?
For some people with chronic hepatitis C have no apparent negative effects on their health or lifespan. In others, liver damage will develop slowly for years or decades. Of the people who will get chronic hepatitis, 20% will develop cirrhosis within 25 to 30 years after infection. Cirrhosis is liver damage where healthy liver cells are replaced by scar tissue reducing the liver’s ability to perform its functions. Cirrhosis can not be detected in the early stages of the infection without a liver biopsy. Liver damage caused by cirrhosis is not reversible. A person with chronic hepatitis C may remain healthy for years even in the presence of cirrhosis but nonetheless, life may be threatened once cirrhosis has started. Cirrhosis may lead to liver failure or cancer of the liver in a small number of people. Up to half the people with chronic hepatitis C will develop cryoglobulinemia (an abnormal protein in the blood). Most people with cryoglobulinemia have no symptoms. A small number may experience weakness, intense itching and/or skin rash.
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How do I medically manage chronic hepatitis C?
- Visit your doctor for regular check-ups.
- Have your situation reviewed by a hepatologist (doctor specializing in liver disorders).
- Have liver function tests at least once each year or more often if recommended by your doctor.
- If you have advanced chronic hepatitis C and especially cirrhosis, be monitored frequently for liver cancer.
- Be aware of your health on a daily basis.
- Make lifestyle changes (see the Wellness Program section).
How can I tell if my liver is damaged?
The first tests used to determine if your liver is damaged are called ‘liver enzyme’ tests. Liver enzymes leak into the blood when your liver is damaged, and an increased level of these enzymes can be measured by blood tests. Liver enzyme tests do not indicate the extent of the damage.
When the results from blood tests are not definite, a liver biopsy may be performed. A liver biopsy is the medical procedure to remove a small sample of the liver for analysis. It is helpful in assessing the amount of damage as well as the response to treatment. A liver biopsy can be performed by;
- inserting a needle through the skin on the right side of the body above the lower ribs with local freezing, or
- inserting a tube into the vein just above the collar bone on the right side, through to the liver.
A liver biopsy is may not be recommended for people with hemophilia because of the risk of internal bleeding. However, if a biopsy is necessary, the second procedure (presented above) is usually performed.
SYMPTOMS
What are the symptoms of hepatitis C?
Most people have no symptoms. During the acute phase, less than 10% of those infected show any symptoms. In some people, the only symptom is fatigue. Other symptoms may include nausea, vomiting, muscle and joint aches, abdominal pain and weight loss.
Hepatitis C may persist for many years without any symptoms, although it may be destroying livers cells at a low level. The reason why you may not have symptoms is because the liver has a large reserve and it can function normally even when most of it has been destroyed.
Some of the symptoms related to cirrhosis are;
- swelling of the abdomen and ankles;
- bleeding caused by varicose veins in the esophagus or stomach;
- mental confusion due to toxins present in the blood because the liver can’t remove;
- jaundice (a person’s skin and eyes turn yellow); and
- tiredness.
These symptoms develop gradually. Occasionally, liver failure may happen suddenly and bleeding from the stomach or drowsiness may occur.
GETTING TREAMENT
Principles of treatment.
- All medical treatment should be informed. This means that you should fully understand what you will be taking, the length of time of the treatment, the risks and benefits and the cost.
- Seek medical advice and consider early treatment
- Use treatments only under the care of your doctor.
- Evaluate the success or failure of each treatment.
- Be prepared to have the treatment strategy adjusted.
- You have the right to refuse medical treatment.
Tips for going to the Doctor
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TREATMENT OPTIONS FOR
HEPATITIS C
I. Alpha Interferon
Hepatitis C is most commonly treated with alpha interferon. It is a synthetic form of a natural hormone produced by your body to fight viruses. Injections of the synthetic hormone increase the level of interferon normally found in your body. Doctors sometimes refer to the drug by its brand names.
*Note: for the rest of this section interferon means the drug alpha interferon.
How is interferon given?
Generally, interferon is given by injection under the skin 3 times per week over a period of 6 to 12 months. Treatment progress is monitored by liver enzyme tests and PCR test. PCR tests detect the amount of hepatitis C virus in the blood.
How effective is interferon?
Research has shown that interferon can suppress the virus and reduce the swelling and damage to the liver caused by hepatitis C. Interferon is not effective in 50% of people with hepatitis C; the other 50% respond to interferon treatment in varying degrees. Better response to interferon treatment will occur in individuals who
- have not yet developed cirrhosis;
- have low amounts of the virus; or
- have type 2 hepatitis C.
Of the people who respond to interferon, only 20% will remain free of the virus once the treatment is stopped. Most people respond temporarily and the virus becomes active again. Furthermore, current research presents varying opinions on the efficacy of interferon with different groups of patients. Persons with hemophilia that are undertaking treatments may have lower response rates than average.
If you do not respond to the initial treatment, you may be given interferon
- for a longer period of time;
- in higher doses; or
- in combination with other treatments.
Recent research shows that increasing the duration of interferon treatment to twelve to eighteen months is likely to improve the success rate.
What are the benefits of interferon treatment?
Interferon treatment may;
- reduce or suppress hepatitis C; and
- possibly prevent liver damage and cirrhosis.
What are the side effects of interferon?
The drug may cause the following side effects; “flu like” symptoms, fever, depression, hair loss, nausea and vomitting.
Some people have prolonged side effects. In others, the side effects may go away after two to three weeks of treatment. The side effects may also be reduced by lowering the dosage or stopping the medication. There is a percentage of people who cannot continue the treatment because of the severity of side effects. Children seem to be less affected by interferon. Some side effects which may continue are fatigue, loss of appetite, diarrhea, sleep problems, irritability or a lack of energy. It is not possible to determine the long term side effects related to interferon because this is a recent treatment that has only been used and studied for a short period of time.
When is interferon not given?
Interferon treatment is not recommended if you;
- are HIV positive,
- are older, healthy and have had hepatitis C for many years,
- are actively using illegal drugs or alcohol, or
- have autoimmune hepatitis.
You need to be closely monitored if you have;
- a mental illness (depression);
- diabetes;
- respiratory problems; or
- a heart condition;
- antibodies to hemophilic factors.
How much does interferon cost?
Interferon costs a lot of money and cost varies depending on the dosage and the length of treatment. For example, one person paid $580 a month for treatment three times per week. Drug costs can reach $3000 or more for a six month treatment of interferon.
Most provincial health insurance plans do not cover prescription drugs. If you are receiving social assistance or old-age pension, you may have a drug card which pays for most of the cost of the drug costs. If you are working or on long-term disability, your private insurance plan may cover the costs of approved drugs only. If you have no private insurance, you will have to pay for the drug yourself.
Insurance companies and provincial health ministries have different policies on reimbursing people the cost of the drug. Contact your doctor, your local chapter of the Canadian Hemophilia Society or call your provincial health ministry for more information.
II. Experimental Drugs
Some drugs that are being tested to treat hepatitis C are:
- Ribavirin, This drug in combination with interferon may be more effective than interferon alone.
- N-Acetyl Cysteine (NAC). It may enhance the effectiveness of interferon.
- Beta interferon. This second type of interferon, has shown promise in small studies for treatment of chronic and acute hepatitis C.
- Viragen
Should I consider taking experimental drugs, how can I get access to them?
Experimental drugs are not approved by Health Canada and may be risky to your health. Before taking any experimental drug:
- consult your doctor;
- be fully informed of all the risks; and
- weigh the possible risks with the benefits.
If I decide to take experimental drugs, how can I get access to them?
- Clinical Trials. Clinical trials are controlled studies in which people take a certain drug to find out whether it is effective and/or safe. Each trial has rules about who can join and often people with hemophilia or other blood related disorders are excluded. If you join a trial you get free access to a drug but the effects on your health may not be known. Your doctor may by able to refer you to a trial.
- The Emergency Drug Release Program. Your doctor can request experimental drugs that have not been approved in Canada through this government program. Requests can be made in a medical emergency where regular treatment is not working. However, drug companies don’t have to give you the drugs and you may have to pay for them.
III. Liver Transplant
Liver transplants are only performed in advanced cases of hepatitis C when the liver fails. The success rate of liver transplants is above 70%. Only a few people with hemophilia have had liver transplants. Having a liver transplant means that you will have to take medication for the rest of your life so that your body doesn’t reject the liver. For more information contact the Canadian Liver Foundation and/or a doctor specializing in liver disorders.
HEPATITIS C AND
HIV CO-INFECTION
What does hepatitis C and HIV (the AIDS virus) co-infection mean?
Hepatitis C and HIV co-infection means that a person is infected with both viruses. Studies show that people with HIV often have hepatitis C. Nearly all person with hemophilia and HIV are also co-infected with hepatitis C because both viruses were transmitted by blood products.
Hepatitis C and HIV co-infection may increase the risk of getting serious liver disease. This might be due to a decreased immunity caused by HIV, which enables hepatitis C to progress more easily. For people with hemophilia, it may also be due to the fact that people were infected with HIV generally received more factor concentrates and hence more hepatitis C virus.
How is treatment different for people co-infected with HIV and hepatitis C compared to those with hepatitis C only.
- Hepatitis C can be more severe and difficult to treat in people with HIV so it is important that you consider treatment options before serious illness develops.
- Some drugs used to treat HIV are toxic to the liver and can damage it. The liver processes toxic compounds absorbed by the body and so its cells are sensitive to the side effects of medications. Some of the drugs that are toxic to the liver include clarithromycin, dapsome, dilantin, fluconazole, fluctosine, isoniazid, ketoconazole, rifabutin, rifampin, DDI, DDC, AZT and TMP/SMX (bactrim or septra). Most of the negative effects to the liver can be reversed when the drug is discontinued or the dose is lowered.
- It is not known whether multiple drug combinations in certain doses are appropriate for people with hemophilia who are infected with HIV/hepatitis C.
- People with HIV and hepatitis C have a lower response to interferon treatment and often relapse after treatment is stopped.
- One side effect of interferon is that it lowers the white blood cell and platelet counts. For people on AZT, this can result in unusual bacterial infections.
- Generally people with HIV and hepatitis C are not given liver transplants.
What should I do if I have hepatitis C and HIV?
- Discuss potential risks of any drug with your physician and pharmacist.
- Be cautious about using combinations of drugs.
- Have your liver enzymes checked regularly.
STANDARDS OF CARE
What kind of comprehensive standards of care exist for people with hepatitis C?
- At present, there are different standards of comprehensive care in the various hematology and hepatology clinics across the country. The clinics are set up and managed differently, and they follow different procedures. This means that you may receive different care depending on where you live. Individual chapters, such as Hemophilia Ontario, are trying to establish provincial standards of care.
Until guidelines for standards of care are established, what can I do?
- If you are a person with hemophili or a related bleeding disorder, make sure that you are followed by a doctor in a hemophilia treatment centre.
- Ask for a referral to see a hepatologist.
- Make sure that your doctor and hepatologist are communicating about your case by asking for copies of correspondence.
- Ask for counselling for yourself and your family on hepatitis C, possible treatments, and how to prevent spread of the virus.
- If you live in a rural or isolated community, ask your doctor to phone the nearest hematology and hepatology clinic to get information for you.
WELLNESS PROGRAMS
How can I live well with hepatitis C?
Living well with hepatitis C means adopting a healthy lifestyle. A healthy lifestyle is not the cure but part of the overall treatment to manage hepatitis C. It is all about learning to make healthy choices.
- AVOID ALCOHOL. Not drinking any alcohol is ideal. If you do drink, drink moderately (one drink once per day). Alcohol worsens liver damage caused by hepatitis C and may speed up the development of cirrhosis and possible liver cancer.
- Avoid smoking and illicit drugs.
- Eat a nutritionally balanced diet. Healthy eating is important
for everyone. It helps keep us healthy and contributes to our sense
of well-being. Because everything we eat is refined and detoxified
by the liver, good nutrition can help keep the liver healthy. A
balanced diet with adequate calories, proteins, fats and
carbohydrates can actually help a damaged liver regenerate new liver
cells.
- Monitor the amount of protein you consume.
- See your doctor about any special diet considerations.
- Eat a balanced diet as outlined in Canada’s Food Guide. This guide is available from your doctor.
- Don’t take megavitamin therapy or use nutritional products bought in special stores without consulting your doctor.
- Don’t take megavitamin therapy or use nutritional products bought in special stores without consulting your doctor.
- Get enough sleep. Pay attention to your body’s need for rest. Take a break or naps if you find yourself feeling tired during the day.
- Reduce stress because it affects your overall health. Stress can
be reduced by:
- adjusting your working schedule (or daily activities);
- resting;
- exercising;
- having a massage or meditating; and
- getting emotional support from others.
- Be aware of the following issues.
- Avoid taking medication when it is not necessary, e.g. acetaminophen.
- For a person with hemophilia or a related bleeding disorder, monitor liver function if you are on anti-inflammatory medications for chronic joint disease.
- Avoid toxins in the environment such as pesticides and aerosols.
- At work, reduce exposure to chemicals toxic to the liver.
- Liver damage can be aggravated by general anaesthetics.
- Take care of your mental health.
- Avoid blaming or criticizing yourself.
- Share your grief and problems with supportive people.
- Practice your spirituality/religious beliefs.
- Keep a sense of humour.
- Never lose hope.
COMPLEMENTARY THERAPIES
What are complementary therapies?
Complimentary therapies are alternative ways of treating an illness beyond regular medical treatments. They are not meant to be used in place of medical therapy, but rather to compliment it. A good health management plan can use both medical and complimentary therapies to keep you emotionally, mentally, and spiritually healthy. Most of these therapies are not covered by provincial health insurance plans so you will have to pay yourself. To find out if a therapy is right for and will not be harmful, talk to:
- your doctor
- people who have used the therapy, and
- qualified people who practice it.
Be sure to talk to your doctor before trying any complimentary therapy.
- Holistic therapies
- These therapies are based on the belief that staying healthy means treating the whole person addressing your mental, emotional, spiritual, and physical needs. Some types of holistic therapies are traditional Chinese medicine, naturopathy, homeopathy, and herbal medicine.
- Massage and touch therapies
- These ancient health arts are used to relax your body, improve circulation, reduce stress and give you a sense of well-being. They can be done by professionals or friends. Massage and touch therapies include swedish massage, reflexology, therapeutic touch, reiki, rolfing, shiatsu and chiropractic.
- Other therapies
- Yoga helps establish balance between body and mind by using deep breathing, stretching, holding of positions and meditation techniques.
- Tai Chi is a series of slow, rhythmic movements which promote a relaxed mental attitude which relaxes the body.
- Meditation also helps you relax. Most people meditate by sitting and concentrating on an image, a mantra (a meaningless word that you repeat in your mind) or breathing.
- Visualization or guided imagery helps promote positive attitudes and thinking which contributes to healing. In visualization, you use your imagination to make images of the ways you would like your health to improve. You need to believe in your own inner strength.
PSYCHOSOCIAL ASPECTS
How can I deal with financial difficulties?
Severe symptoms of hepatitis C or the treatment may affect your employment. If you have to leave work because of illness, you may be able to collect benefits from the following places:
- Unemployment insurance sick benefits. These benefits are 55% of your salary, up to a maximum amount, and paid up to 15 weeks.
- Social assistance. When your unemployment insurance benefits run out or if you don’t qualify for them, you may be able to get social assistance. This varies throughout provinces so call your local welfare office for more information.
- Canada Pension Plan/Quebec Pension Plan (CPP/QPPP) disability pension. If you have paid CPP/QPP premiums for a certain amount of time and then stop working due to illness, you may qualify for a disability pension.
- Private insurance plans. Sometimes disability pensions are provided through work. Obtain a copy of your policy fromt eh personnel department and ask any questions about coverage.
What is the impact of hepatitis C on family relations?
Family relations may be affected. Illness (even hepatitis with no symptoms) can cause stress. This can lead to tension or friction until people learn to adjust.
- Keep communications open.
- Don’t be afraid to see a counsellor.
- Try to maintain usual family activities.
- Adapt your lifestyle if needed.
- Remember that adjustment takes time.
As a family member or friend, how can I support a person with hepatitis C?
- Learn about hepatitis C.
- Listen to the person. See where you fit in: don’t try to take over.
- Avoid judging the person and be supportive.
- Expect the person’s moods and outlook to vary.
- Avoid blaming yourself.
- Try not to neglect other relationships in your family.
- Share your grief and problems with supportive people.
- Take care of yourself.
As a young man with hemophilia, how will hepatitis C affect me?
Having hemophilia and hepatitis C or hepatitis C/HIV can be an impact on your sexuality, self-esteem and lifestyle. Young people commonly experiment with alcohol, sex or drugs, especially if that is what friends are doing. It is hard to be different and it can be hard to say no to your friends. To protect your health:
- follow your treatment;
- avoid risky behaviours, e.g. drinking too much at parties; and
- practice safe sex.
As a parent, how can I deal with my teenager with hepatitis C?
Adolescence is a time of independence and strong relationships with peers. Teenagers tend to think of the present and believe that nothing bad can happen to them. These are obstacles to getting your teenager to understand the possible long-term effects of hepatitis C. A lack of symptoms and the desire to fit in with friends, may result in risky behaviour. Try the following:
- promote healthy options for personal exploration, e.g. sports;
- keep communication open;
- encourage your teenager to talk about his or her feeling about hepatitis C; and
- avoid overprotecting your teenager.
How do I tell my children that I have hepatitis C?
Sometimes children suffer more from fear of not knowing than from knowing the truth. If you decide to tell your children about hepatitis C, do so honestly and openly.
- Carefully choose a time to tell your children.
- Tailor your explanations to the age level of your children.
- Be prepared to explain any visible effects of hepatitis C or the treatment.
- Young children avoid the subject, provide information in a non-threatening way, e.g. leave an information booklet on the table.
- Adult children also need reassurance and information.
- Just like you, children of all ages will have to adjust. This takes time. Be patient with them and yourself.
What are some common emotions people with hepatitis C may experience?
Many of the common emotions that people with hepatitis may experience, can be summed up in what is called the grieving process. We often associate grieving with death but it usually follows any kind of loss, e.g. loss of a job or a friend moving away. In the case of hepatitis C, you are dealing with a loss of health, routine and perhaps opportunity. Feelings of loss and pain are normal. Grieving follows a pattern that eventually will be resolved. Your family will grieve too. If you understand feelings that you may have, you will be better prepared to deal with them. The stages that people pass through when coming to terms with a loss are:
- Denial and isolation.You may deny that you have hepatitis C or you may avoid family and friends. This may help you initially cope although it can become a problem if you don’t take care of yourself (e.g. drinking alcohol) instead of trying to stay healthy. Denial and guilt are common emotions for family members
- Anger.You may lash out at those close to you, be negative, or blame others for the situation. Anger is a normal and necessary emotion but it is the most difficult to live through. Appropriate ways of dealing with anger can be learned.
- Bargaining. You try to negotiate your health. This means trying to negotiate your health. You promise to something and hope that hepatitis C will go away. E.g. “if I watch my diet, I will be fine”
- Depression. You may sleep a lot, lose your appetite, avoid family and friends and lose interest in things that gave you pleasure. You may also worry too much or be afraid. One way to cope with fear is to find out as much about hepatitis C as possible.
- Acceptance. You adjust to any limitations, adapt your choices in life, setnew goals, an learning to appreciate your new life.
How can I deal with my emotions?
- Remember that it is natural and human to experience emotions. Sometimes you may have too many feelings to deal with or they may change suddenly. This is normal.
- Deal with your emotions as they happen, don’t store them.
- Name the emotion.
- Considering why you are feeling that way.
- Reflecting on what you did with the emotion, e.g. express or deny it.
- Choosing the most useful course of action, e.g. let it go.
- Write down your emotions.
How can I get emotional support?
- Talk to people.
- Supportive family members and friends.
- A qualified therapist.
- Sexual partners. Although h epatitis C is rarely transmitted sexually, your partner may want to be tested. You need to also think of telling anyone who you may have had unsafe sex with.
- Other people with hepatitis C.
Talking can make problems easier to understand and may help you deal with your feelings.
- Get involved. People who are active feel better. You can volunteer or engage in political activism.
FINAL THOUGHTS
Current research
- Improved ways of eliminating viruses in blood products are being investigated.
- New ways of producing blood components (factors VIII and IX) will eliminate the small risk that still exists despite the available screening tests.
- New therapies are being developed for treatment, e.g. experimental drugs, artificial liver, gene therapy.
What else can I do?
- Advocate for change. This means presenting the views and special
needs of people with hepatitis C to those in authority. Advocate
for:
- more research on treatments; or
- government assistance in paying for treatment costs.
- Set up or join a support group.
Where can I get more information or assistance?
- The Canadian Hemophilia Society (CHS) or your local chapter can provide you with additional information and resources on hepatitis C and support. Hepatitis C positive people, their families and health care professionals are welcome to contact CHS.
- Hemophilia Comprehensive Care Clinics. (contact the CHS for the clinic nearest you.)
- Canadian Liver Foundation at 1-800-563-5483
- Your doctor.
Additional Reading Material
Borysenko, J. (1988). Minding the Body, Mending the Mind Toronto: Bantam Books.
Pitzele, S.K. (1985). We are not alone: Learning to Live with Chronic Illness. New York: Workman Publishing.