Newly Diagnosed With Hep C? Or Considering Treatment?

Newly Diagnosed With Hep C? Or Considering Treatment?

For anyone who has been diagnosed with a serious disease what follows is often fear of the unknown. As the weeks turn into months the realization sinks in that you have a heath crisis on your hands. Quickly you find yourself seeking out information, looking for the right answers and asking yourself a few familiar questions; What can I do to improve my condition? Can this disease be treated, if so, when should I start treatment, or should I wait ?

For the millions of people who have been diagnosed with hepatitis C, the same questions need to be answered.

In this blog post links are provided to help you understand more about hepatitis C, from necessary tests needed to distinguish between active or a previous HCV infection, to current FDA approved therapies to treat the virus, and so much more.

December 2019 Update -- AASLD has updated its Hepatitis C Guidance
The American Association for the Study of Liver Diseases (AASLD) and the Infectious Diseases Society of America (IDSA) with the International Antiviral Society developed a living document with ever evolving guidelines to treat HCV: HCV Guidelines.

Hepatitis A, B, C, D, and E
Everything You Need to Know

Need To Talk To Someone?
Patient Advocate Foundation Offers New CareLine for Hepatitis C Patients
Hepatitis C CareLine, providing individualized, sustained assistance to patients diagnosed with Hepatitis C. The CareLine will provide help to patients across the country to resolve healthcare access and insurance issues, at no charge to the patient.

Where Can I find a specialist to treat HCV?
Find a Specialist In Your Area

Testing, Diagnosis and Treatment
Who Should Get Tested: I have no idea how I contracted HCV.
Today we have two different groups of people that are at risk for hepatitis C, young people who have used IV drugs and well, older people. The latter falls under the baby boomer generation, that is people born between 1945 and 1965. Rather you contracted HCV recently through drug use, or years ago from another route of transmission, it really doesn't matter, does it? Get tested.

CDC Now Recommends All Baby Boomers Receive One-Time Hepatitis C Test

More On Transmission - Baby Boomers
​The Stigma Stops Here
Medical practices, not lifestyle choices, are actually behind the generation’s high HCV rates, so now will you go get tested?
A new report indicates the hepatitis C (HCV) epidemic peaked between 1940 and 1965 with reused medical syringes to blame, not injection drug use or high risk sexual practices among baby boomers, as has often been claimed.

Researchers and advocates alike hope this new information will help dispel some of the stigma attached to having hep C — particularly for older adults — and encourage more people to get tested and connected with potentially life-saving treatment. The research is further proof that anyone born between 1945 and 1964 should be tested for HCV, even if they feel like they've never been at risk. Published in The Lancet Infectious Diseases journal, the research shows that the hepatitis C epidemic can be traced to hospital transmissions caused by the practice of reusing needles in medical settings.

What Are The Symptoms Of Hepatitis C?
When you are first exposed to the hepatitis C virus and become infected, you are said to have "acute hepatitis C". Most people have no symptoms of infection during this time. The word "chronic" implies that the infection will be prolonged, or even lifelong, unless you get treatment that cures the infection.

Many people with chronic hepatitis C have no symptoms, even if there is serious liver damage. Of those who do develop symptoms, the most common symptom is fatigue; other less common symptoms include nausea, lack of appetite, muscle or joint aches, weakness, and weight loss.

Early and Late Symptoms of Hepatitis C
Many individuals with hepatitis C are asymptomatic. They are not aware that they have an infection. However, they will probably experience some symptoms as the condition progresses, because of the increasing damage to the liver. For this reason, it is extremely important to diagnose hepatitis C infection in its early stages to minimize or avert potential serious complications.

Related - Signs and symptoms of hepatitis C virus infection

Transmission Of Hepatitis C
How is hepatitis C spread? Who's at risk?
Hepatitis C virus (HCV) is transmitted through contact with an infected person's blood. The following list outlines sources of hepatitis C transmission
-Sharing needles and syringes (IV drug abuse); However, shared Drug Snorting Straws May Transmit Hepatitis C Virus
-Other possible risk behaviors: tattoos, body piercing, living and medical care in a developing country, folk medicine, intranasal cocaine;
-Extensive surgical procedures
-Unknown--up to 5% of patients have no identifiable risk factors;
-Sexual transmission is rare; the risk of sexual transmission to an individual is probably less than 3% when a person is in a stable monogamous relationship;
-Vertical transmission from mother to baby
-Reused needles in a medical or health care setting.

Questions About HCV Transmission: Hey Can I Get Hepatitis C From......

Is Hep C Transmitted Sexually?
According to studies in the Journal of the American Medical Association, a low sexual transmission rate of hepatitis C was suggested. Of the 62 patients studied, none of the monogamous heterosexual partners had developed the hepatitis C antibody. In general, the probable risk of heterosexual transmission of hepatitis C is less than 3%. It is recommend that all patients in a non-monogamous relationship use a condom or spermicide and patients in a monogamous relationship use a barrier method only if they are anxious or concerned about transmission.

For patients with hepatitis C, testing of spouses, babies and significant others is recommended by Centers for Disease Control(CDC). Please discuss these issues with your physician.

The HCV partners study
Listen to Dec 2013 AUDIO - Drs. Stephen A. Harrison and Norah A. Terrault discuss the article:
Sexual transmission of hepatitis C virus among monogamous heterosexual couples: The HCV partners study.

Is hepatitis C transmitted by breast milk to infants?
There is no substantial evidence that hepatitis C is transmitted through breast milk, however, a few studies have been performed that tested breast milk and very rarely is hepatitis C found in the breast milk--even using the most sensitive tests such as PCR. The CDC has issued a statement explaining that mothers who have HCV can breast feed, but should avoid it if there are sores around the nipple.

Can hepatitis C be transmitted to other members of my family (household contacts)?
There is a slight risk of hepatitis C transmission among household contacts, so family members should not share items such as razors or toothbrushes that may transmit blood or secretions. Women who have hepatitis C and are menstruating as well as men or women with hepatitis C and sores in the genital area should avoid sexual contact. The CDC recommends that spouses or partners of a hepatitis C patient be tested for hepatitis C.

Can a pregnant woman give hepatitis C to her baby?
A report in New England Journal of Medicine suggested a 7% transmission rate of hepatitis C from mother to child at birth. Though this is a high estimate, the possibility of transmission must be considered when a woman with hepatitis C is deciding whether to have children.

For infants who have received the hepatitis C virus from their mother, brief elevations of liver enzymes may occur, but no chronic liver disease has been reported. There have been no reports of cirrhosis in newborns, infants or child due to mother-to-child hepatitis C infection. It is recommended that all babies born to mothers with HCV be tested annually until age three with antibody tests.

Podcast: What happens when a pregnant woman has hepatitis C

July 2016
(MMWR) Increased Hepatitis C Detection in Women of Childbearing Age and Potential Risk for Vertical Transmission

Is Hep C Transmitted By Insects?
There is no documented transmission of hepatitis C through insects. The virus, however, is related to a group of viruses including yellow fever and Dengue, and those are known to have been spread by insects.

Exams and Tests
February 3, 2017
Update - New Liver Test Guidelines

Liver function tests are blood tests used to help diagnose and monitor liver disease or damage. The tests measure the levels of certain enzymes and proteins in your blood. Some of these tests measure how well the liver is performing its normal functions of producing protein and clearing bilirubin, a blood waste product. Other liver function tests measure enzymes that liver cells release in response to damage or disease. Abnormal liver function test results don't always indicate liver disease. Your doctor will explain your results and what they mean.

Tests that reflect liver injury (AST, ALT, alkaline phosphatase, GGT, 5'Nucleotidase)
Tests that reflect liver function (serum albumin, prothrombin time)
Tests that reflect liver injury and/or liver function (bilirubin)

All About Fibroscan
A non-invasive test to measure liver inflammation and fibrosis
Understanding Fibroscan results - Score Card

Hepatitis C Testing - In The News
People with HCV Should Be Tested for HBV Before Starting Antiviral Therapies
The updated information can be found in the Monitoring Patients Who Are Starting Hepatitis C Treatment, Are On Treatment, or Have Completed Therapy section of the Guidance.

Feb 2, 2018
Hep B reactivation common during direct-acting antiviral therapy for hep C
Last Updated: 2018-02-02
By Will Boggs MD
NEW YORK (Reuters Health) - Hepatitis B virus (HBV) reactivation is common in patients with chronic HBV and hepatitis C virus (HCV) coinfection receiving direct-acting antiviral (DAA) therapy, according to a systematic review and meta-analysis...

​Tests Used To Diagnose Hep C
The Hepatitis C Antibody Test, sometimes called the Anti-HCV Test, is used to diagnosis HCV infection and is based on the detection of HCV antibodies.

What Are Antibodies?
Excerpt from TAG's Fact Sheet;
Antibodies are Y-shaped proteins made by a person’s immune system. They are part of the immune system’s response to viruses, bacteria, and other harmful substances (called antigens). When HCV enters a person's bloodstream, it triggers an immune response. The immune system makes HCV-fighting antibodies. Sometimes, the immune system gets rid of hepatitis C virus by itself (this is called spontaneous viral clearance). About a quarter of people with hepatitis C will spontaneously clear the virus.
Read the in-depth Fact Sheet to learn more. 

What is the hepatitis C antibody test? 
Anti-HCV test detects the presence of antibodies to the virus, indicating exposure to HCV. If there are antibodies in the body, it means that a person has been infected with the virus at some point. However, it does not always mean that they still have the virus.

This test cannot distinguish between someone with an active or a previous HCV infection. Usually, the test is reported as "positive" or "negative."

Other Hep C Tests - Do I have Hep C Or Not?
Unlike antibody tests, HCV RNA tests directly measure for the presence of the hepatitis C virus. There are two HCV RNA tests; qualitative or quantitative.

Qualitative or Quantitative Test

1- Qualitative test checks to see whether a person still has the virus, a positive result means that a person has the hepatitis C virus. A negative result means that the body has cleared the virus without treatment, again call spontaneous viral clearance.

2- Quantitative measures the amount of the virus in the blood, the number given as a result of this test is referred to as the viral load. In patients with chronic hepatitis C infection, viral loads vary widely from 50,000 to 5 million copies per milliliter. A higher viral load may not necessarily be a sign of more severe or more advanced disease.

There are two types of HCV RNA tests: qualitative and quantitative
​Qualitative testing checks whether there is hepatitis C virus in the bloodstream (detectable or undetectable).

Quantitative testing measures the amount of hepatitis C virus in the bloodstream (viral load). These tests are used during and after HCV treatment to see if it is working and whether a person is cured.

Viral genotyping is used to determine the kind, or genotype, of the HCV virus present. Genotyping is often ordered before treatment is started to give an idea of the likelihood of success and how long treatment may be needed Treatment

The Disease
Following initial infection with HCV, approximately 75 to 85% of persons develop chronic infection, 20% to 30% of people will spontaneously clear the infection without treatment, and the virus will completely disappear from their blood. Research has shown the following factors associated with spontaneously clearance is sex, ethnicity, immune status, and genetics.

Disease Progression
The rate of developing cirrhosis can evolve in 10–20% of chronic hepatitis C cases over a period of 20 to 30 years. However, longer duration of infection, infected at a later age in life, alcohol consumption, HCV genotype, male sex, fatty liver disease, diabetes, and coinfection with human immunodeficiency virus (HIV) or chronic hepatitis B (HBV), increases the risk for developing cirrhosis as high as 25% to 50%. In addition, burden of disease can be significant for those people with HCV-related cirrhosis, putting them at risk for hepatocellular carcinoma, liver failure, and in some cases a need for liver transplantation. In 2013, data presented at IDWeek, reported people with hepatitis C virus (HCV) die 15 years earlier and have a 12-times greater risk of death when compared with those without the virus.

New Drugs Approved To Treat Hepatitis C
FDA approved hepatitis C treatments

Cost Of Treatment
Sept 24, 2018
-- List Price of Authorized Generics to Reflect Discounts in the System Today 

Where Can I find current information on treating HCV?
Treatment Action Group (TAG)
New Fact Sheets On Hepatitis C Drugs And Genotypes
Treatment Action Group announces - New and Updated HCV Treatment Fact Sheets Now Online

HCV Guidelines
December 2019 Update -- AASLD has updated its Hepatitis C Guidance
The American Association for the Study of Liver Diseases (AASLD) and the Infectious Diseases Society of America (IDSA) with the International Antiviral Society developed a living document with ever evolving guidelines to treat HCV.

The guidelines will have a complex algorithm for practitioners around the country to follow and see what's the right treatment, for the right patients, for the right about of time. The document is easy to comprehend, which benefit patients considering HCV therapy. When new HCV drugs are approved, and new real world data is established, the guidelines are updated.

What Drugs Will Be Used To Treat My Hep C?
The following guidelines offer treatment recommendations using current HCV medications based on HCV Genotype and history of treatment. Which include treatment-naive patients (never have used HCV medications to treat the virus) and treatment-experienced patients (has previously taken HCV medications).

What If I Never Have Been On Treatment For Hep C?
The following pages include guidance for management of treatment-naive patients.
Genotype 1
Genotype 2
Genotype 3
Genotype 4
Genotype 5 or 6

What If I Have Been On Treatment - But It Didn't Work?
The following pages include guidance for management of treatment-experienced patients.
Genotype 1
Genotype 2
Genotype 3
Genotype 4
Genotype 5 or 6

Stay current with all guideline updates, "click here."

Of Interest - Ira M. Jacobson MD: 8-week therapy for patients with HCV infection
Ira M. Jacobson MD - 1/9/2018
Several studies presented at the 2017 AASLD meeting in Washington, DC, assessed 8-week therapy for patients with HCV infection. In this commentary, I discuss how key data from these studies may have an impact on management of patients with HCV infection.

Treatment According To Genotypes - News and Updates
A better understanding of genotypes and treatment
​Offered on this page is current research updates with a focus on treating HCV according to genotype using FDA approved and investigational medicines. Information is extracted from news articles, peer-reviewed journals, as well as liver meetings/conferences, research manuscripts and interactive learning activities.

What If I Have Substance Abuse Issues?
According to the HCV treatment guidelines the only contraindication to current chronic HCV treatment is in a patient with a short life expectancy that cannot be lengthened with treatment, with liver transplant, or with any other treatments.

Overtime we have learned that treating people with lower-stage fibrosis increases SVR rates, and for persons who inject drugs, adherence and efficacy rates are comparable to those of patients who do not use injected drugs. In other words, treat all.

How Will I Know If Treatment Is Working?
Monitoring Patients Who Are Starting HCV Treatment, Are on Treatment, or Have Completed Therapy
This section provides guidance on monitoring patients with chronic hepatitis C who are starting treatment, are on treatment, or have completed treatment. The section is divided into 3 parts: pretreatment and on-treatment monitoring; post-treatment follow-up for persons in whom treatment has failed to clear the virus; and post-treatment follow-up for those who achieved a sustained virologic response (SVR; virologic cure).
Begin here.....

A cure is defined as a sustained virologic response (SVR) determined after no virus (HCV RNA) is detected in the blood when measured with a blood test (quantitative HCV viral load) 3 months after treatment is completed. Data has shown in long term follow-up studies that persons who achieve SVR are considered to be “cured” virologically.

*The Federal Drug Administration (FDA) and the European Medical Agency (EMA) have shortened the post-treatment follow-up period necessary to define an SVR by introducing the so called SVR12, defined as HCV RNA undetectability 12 weeks following therapy.

Am I Cured? Can The Virus Come Back?
Treatment for hepatitis C virus (HCV) can lead to sustained virological response (SVR) or cure - in over 90% of people. It is rare for people who have an undetectable viral load 12 weeks after treatment to experience relapse, recurrence of HCV from reinfection is more likely, rarely is a late relapse seen.

Researchers reported how uncommon it is for a late relapse to occur after achieving SVR in two articles published in Clinical Infectious Diseases (an overview of both articles is provided below). The first in the March 2016 issue; Risk of Late Relapse or Reinfection With Hepatitis C Virus After Achieving a Sustained Virological Response: A Systematic Review and Meta-analysis, the second January 2017; Late relapse versus hepatitis C virus reinfection in patients with sustained virologic response after sofosbuvir-based therapies.

First Article Summary
Risk of Late Relapse or Reinfection With Hepatitis C Virus After Achieving a Sustained Virological Response: A Systematic Review and Meta-analysis.
The following overview is published online at Hep.

The three risks groups in the study were as follows
1- low-risk group included those who had only HCV, or were (HCV monoinfected) and no recognized risk factors for reinfection,
2- high-risk group, including HCV-monoinfected individuals who had at least one identified risk factor for reinfection with hep C, such as injection drug use or being incarcerated
3- coinfection with HCV and HIV.

The researchers estimated that the low-risk group had a post-SVR relapse rate of 0.82 per 1,000 person-years (person-years are the cumulative years participants spend in a study; this figure translates to 0.082 percent per year), and a reinfection rate of zero. This translated to a five-year risk of relapse of 0.4 percent.

Among the high-risk individuals, the late relapse rate was zero, while the reinfection rate was an estimated 19.06 per 1,000 person-years. Prisoners had the highest reinfection rate, at 45.48 per 1,000 person-years.

The coinfected individuals had a late relapse rate of zero and a reinfection rate of 32.02 per 1,000 person-years.

Overall, the five-year rate of hep C recurrence was 0.95 for the low-risk group, 10.67 percent for the high-risk group, and 15.02 percent for the coinfected group.

A summary with commentary published by Reuters is available here, as well.

Second Article - Summary With Commentary
January 2017; Late relapse versus hepatitis C virus reinfection in patients with sustained virologic response after sofosbuvir-based therapies.
Commentary - NEJM Journal Watch

Late Relapse After Hepatitis C Virus Treatment Is Rare
Few patients treated with a sofosbuvir-containing regimen for hepatitis C virus infection had late recurrent viremia, and most occurrences appeared to be reinfections.

Use of direct antiviral agents (DAAs) for the treatment of hepatitis C virus (HCV) infection has been associated with sustained viral suppression by 12 weeks after therapy (SVR12) in >90% of patients. Because HCV infection does not confer full protective immunity, it is important to determine the frequency of recurrences after SVR12 is achieved and to distinguish between posttreatment relapse and reinfection.

To explore these issues, researchers in Germany, Russia, France, and the U.S. conducted an industry-supported study, examining samples from 11 phase III trials that used the NS5B inhibitor sofosbuvir, alone or in combination. To distinguish late relapse from reinfection, they conducted NS5B deep sequencing analysis, short-fragment NS5B population sequencing, and phylogenetic analyses.

Among 3004 patients, only 12 (0.4%) were found to have detectable HCV RNA by 24 weeks after SVR12. Deep genetic sequencing and phylogenetic analyses revealed that 5 of these 12 patients had HCV with minimal genetic changes in the NS5B sequence, suggesting that the recurrence was due to relapse. In the other 7, the sequences prior to and after DAA therapy were significantly unrelated, indicating reinfection.

This well-performed study indicates that absence of detectable HCV RNA by 12 weeks after DAA therapy is a good measure of SVR. It also demonstrates that most cases of recurrence are due to reinfection. Unfortunately, the tools needed to distinguish reinfection from relapse are not generally available to clinicians, suggesting the need for longer follow-up of patients after DAA therapy and better strategies to prevent reinfection.

I Have Been Cured - Does This Mean I Am Immune to Hepatitis C?
No. Reinfection after cure is possible. In addition, superinfection (infection with more than one strain of HCV) is possible if risk behaviors such as injection drug use occur.

What do we know about hepatitis C re-infection?
Excerpt from; Risks, realities and responses: Hepatitis C re-infection among people who inject drugs and HIV-positive MSM, published online at Catie
Two of the routes of hepatitis C transmission in Canada are sharing needles/syringes and other drug use equipment, and high-risk sexual practices among HIV-positive men who have sex with men (MSM). As such, people who inject drugs and MSM are the main two priority populations at risk of re-infection for hepatitis C. This section will explore re-infection rates in these two populations.
Begin here.....

After Curing Hep C - Do I Need Follow-Up Care?
The AASLD-IDSA Guidance stratifies the follow-up for persons who achieve an SVR based on the degree of hepatic fibrosis and the risk of developing reinfection.

Patients with Minimal to Moderate Fibrosis (F0-F2): These patients do not need special monitoring or follow-up specifically for hepatitis C or liver care. This recommendation is based on data that show patients with SVR following hepatitis C treatment generally do not have further progression of HCV-related liver fibrosis.

Patients with Advanced Fibrosis (F3-F4): Although fibrosis may improve in these patients, they are considered to have persistent risk for developing hepatocellular carcinoma (HCC). Accordingly, these patients should have surveillance for HCC with hepatic ultrasound every 6 months. In addition, patients with cirrhosis (F4 fibrosis) should have a baseline upper endoscopy to screen for varices, unless this has previously been done. Patients identified with varices should receive appropriate management and follow-up.

Patients with Ongoing Risk of HCV Reinfection: Regardless of the degree of hepatic fibrosis, all patients with ongoing risk for acquiring HCV should have periodic assessment for HCV reinfection and counseling on prevention of reinfection. Obtaining HCV antibody does not provide useful information in these individuals with known prior HCV infection since they are highly likely to remain antibody positive. Thus, reassessment should consist of a quantitative HCV RNA level. In addition, for these patients, any flare in liver enzyme tests should prompt evaluation for reinfection with a quantitative HCV RNA level.

Patients with Persistently Abnormal Liver Tests: Any patient that develops persistently elevated liver tests should undergo evaluation for possible other causes of liver disease, such as alcohol use, iron overload, or fatty liver disease.
Begin here....

Learn More
Management of Patients With HCV Who Have Achieved SVR - With recommendations for HCC monitoring
Recently Clinical Care Options launched a new slideset reviewing the management of patients with HCV after achieving SVR, with recommendations for monitoring liver cancer: Which patients need it? 

Editorial - Healio
Published in HCV Next January/February 2018 Issue
Managing the Fruits of HCV Cure: How Much Care do the Cured Need?
The feature by Eric Lawitz, MD, very nicely encapsulates the revolutionary changes occurring within hepatitis C therapy over the past few years. As he explains, this extraordinary newfound ability to cure almost all patients with chronic HCV raises many questions about clinical outcomes.

Letter to the editor - The American Journal of Medicine
Hepatocellular Carcinoma Screening in Patients Treated for Hepatitis C
January 2018 AASLD Updated Practice Guideline - NAFLD and Treatment of Hepatocellular Carcinoma 
Lancet - 2018: Hepatocellular carcinoma - Updated and evidence-based review
Liver International Special Issue: Treatment of HCV with direct-acting antiviral agents: 100% cure?

If I'm Cured Can I Drink Alcohol? 
First off congratulations for achieving SVR, not everyone with HCV has been fortunate enough to achieve what you have. Starting life again, without HCV is a gift, staying healthy, eating better, and maybe even exercising is all good for the liver. If you treated early, before developing liver damage,   you may ask yourself; is it okay to drink alcohol? Only you can decide if drinking a glass of wine, beer or other alcoholic beverage is justified or not, but before you celebrate make sure you understand what the recommended daily intake of alcohol is for healthy men and women. For people with HCV or liver damage - its pretty much zero.

To learn more watch a video hosted by Dr. Joseph S. Galati. The good doctor will breakdown alcohol content in beer, wine and other types of alcohol. Or read what other people had to say about "Drinking after Hep C cure," over at Hep Forums.

Other Health Concerns - Conditions that may be associated with HCV
Patients chronically infected by the hepatitis C virus (HCV) are at risk of developing major liver complications. Up to two-thirds of HCV-infected patients also experienced extrahepatic manifestations that include HCV-related autoimmune and/or lymphoproliferative disorders, and cardiovascular, renal, metabolic and central nervous system diseases. The link between extrahepatic manifestations and HCV infection has been demonstrated for many years for lymphoproliferative disorders (mixed cryoglobulinemia, lymphoma), whereas it became more recently evident for cardiovascular, renal and metabolic diseases. Nevertheless, HCV infection showed higher morbidity and mortality rates for extra-hepatic complications, while viral eradication reduced the rate of extra-hepatic complications and deaths.
View the full-text article, here.

Recommended Reading
Extrahepatic manifestations of HCV & Treatment

Updates on the blog - Other Conditions Related To HCV

The New Era Of Hepatitis C Drugs
Today we have effective drugs to cure HCV, across all six HCV genotypes, including direct-acting antiviral therapy for people with severe liver damage, such as compensated cirrhosis, or kidney disease. HCV eradication is associated with the reversal of fibrosis, improvement of fibrosis and quality of life, as well as overall reduction of liver cancer, liver failure, risk of liver transplant, and liver-related mortality, including extrahepatic manifestations of HCV in patients who achieve SVR.

More importantly the controversy over direct-acting antiviral therapy increasing the risk of developing liver cancer was addressed at The Liver Meeting 2017. At the end of 2017 Healio reported on this retrospective study that found: Liver cancer incidence after HCV therapy linked to risk factors, not treatment. Read a collection of articles on the subject, here.

Finally, here is another interesting Podcast for anyone who wants to learn more about HCV.

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