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General reply to all:

I am an Infectious Disease RN Clinic Coordinator at the Department of Veterans Affairs, and currently run a clinic with 500+ Hepatitis C patients, and utilize a budget of close to $3.4 million dollars for treatment of Hepatitis C. I have presented nationally on the topic. LOTS and LOTS of misconceptions and outright incorrect information in this thread. Let’s set the record straight.

There are 3 kinds of hepatitis, A, B and C. They are viruses that affect your liver that are completely distinct from each other. A is as different from B as strep throat is different than chicken pox. People say they have no risk because they never injected drugs. If you ever had a paper cut in your life, you are at risk of any of the viruses (Hep B, Hep C, HIV, etc...) that are spread by blood. Certain types of viruses CAN be cured with medication, as I discuss below.

Hep A is generally self limiting, and as previously mentioned, spread by fecal-oral route. There is a vaccine for Hep A that takes 2 injections 6 months apart to achieve immunity. For most people, Hep A won’t cause permanent liver damage.

Hep B is spread by blood to blood contact only. It is a lifelong disease that can be suppressed but not cured. There is a 3 part vaccine for Hep B that occasionally has to be repeated but you can be protected against Hep B if you don’t already have it. You can’t get Hep B by sharing a drink or hugging or kissing. Sexual transmission is possible but quite unlikely.

Hep C also requires blood to blood contact. There is no vaccine for Hepatitis C, although it can be cured. It wasn’t identified until 1989 in Japan, and there weren’t blood tests available for it until 1992. There are 7 different kinds of Hepatitis C, called genotypes: 1a, 1b,2,3,4, 5 and 6. One isn’t worse than the other, they are often geographically based....but that said, there are fewer medications for GT3. Different meds work against different genotypes, and there are now drugs (Zepatier, Epclusa) that work against all genotypes.

As we have learned more about the long term implications of Hep C (HCV), it’s been found to be the leading risk factor for liver cancer. That’s why you’re seeing such a push for it...medicare would rather pay for meds than liver cancer or a transplant. HCV is very uncommonly spread by sexual contact...it is not found in semen or vaginal fluid, but microscopic tears in the skin during sex could allow it to be transmitted via blood. This type of transmission accounts for less than 1% of known cases. HCV has few if any symptoms and is a very slow moving virus, so no, it’s not “dormant”....it just takes a long time to have enough virus to start causing scar tissue and eventually cirrhosis, liver cancer and liver failure. Alcohol hastens that process if you’re a heavy drinker....don’t get me started on YOUR definition of “heavy” versus the medical definition of “heavy”..... The amount of shared medical equipment, etc, is why baby boomers (born 1945-1964) are at the greatest risk. All of the major pharmaceutical companies have programs to provide medications for the uninsured or for those whose insurance won’t cover it....just check their websites. I have utilized these programs many times for my patients.

Harvoni is a commonly known med effective for GT 1a, which is the most common in the US. Those are the ads you see on TV most often. It used to be $1100 per pill, and competition has dropped it to about $300-ish per pill depending on sourcing and contracts, etc. (Check out the price of those Shingles vaccines everyone wants.....) I fully agree that the big pharms are lining their pockets somewhat......same med can be had in India for $4/pill. Not going to try to explain that...there is no justification. The new meds work completely differently than the previous peg-interferon and interferon based injections of yesteryear, which were horrific and of limited success for those who could complete the treatments at all. The new meds are pills only and for most people, 8-12 weeks. OCCASIONALLY, an adjunctive medication called Ribavarin is added to these new meds. Ribavarin isn’t pleasant and can cause horrible birth defects, but there are times depending on genotype and treatment-naive vs treatment-experienced (if you had interferon before but failed to achieve a cure) that it is an important supplement. We avoid it if at all possible.

And even after HCV is cured? There is never immunity...if you go out and share needles with someone who has hep c, you WILL get it again, and it’s much harder to treat the second time around. There is NEVER immunity to HCV...no vaccine, previously treated, etc. Come in contact with someone else’s blood and you are at risk. Period. And it doesn’t take a lot of blood at all to spread it.

The reason HCV can be cured is because it is an RNA virus, which is how the virus replicates in your cells. Hepatitis B and HIV are DNA viruses. DNA is like the “brain” of your cell...kinda hard to kill off HBV and HIV without killing the whole cell. Polio is also an RNA virus. Both HIV and HBV can be fully suppressed but will require a lifetime of medications. HIV IS found in sexual fluids as well as blood, and hence can be spread by sexual activity or by sharing needles, tattoos, airguns in the military (I am also a veteran) blood transfusion, re-usable medical equipment, current heroin epidemic among young people, etc....etc. HBV and HCV are not found in sexual fluids.

Oh, and for the record? The government has had no hand in developing ANY of the 15+ HCV meds on the market today. They are all private pharmaceutical companies: Gilead, Abbvie, Merck Pharmaceuticals, etc. This is not a government conspiracy. (are ya kidding? Take off the damn tin foil hat.....)

Please...please...people...STOP the hysteria and don’t speak out about something you don’t know anything about just to continue the drama. I am HAPPY to receive messages here and speak to anyone one on one who has questions. But the amount of utterly ridiculous misinformation is why HCV is still an issue. It’s ONE FREAKING TUBE OF BLOOD that requires no special preparation to get tested and is generally covered fully by most of the free clinics anywhere in America. They’d rather spend $25-50K (the current cost of most 12 week treatments) to cure your HCV than to pay for a liver transplant or liver cancer. Is there any reason not to do it? It takes 2 different tests to confirm HCV infection, but the first step is at least getting tested for exposure.

And on that note...I bid you adieu.....