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Different forms of Hepatitis work differently in the body. Hepatitis B (HBV) floods the system with virus in the beginning, but almost always reduces levels from that initial period onwards. So, the most dangerous time for HBV is in the beginning, right after being infected. From that point on a person might still be a carrier, but the dangerous period has passed. In general the body is able to clear itself of this virus rather quickly.

It is first of all important to understand what it means when viral levels are low or high. A virus cannot be "killed" because it is not alive in the sense that a bacteria or a living organism is alive. Viruses are said to be active and "alive" when they are duplicating, and dormant or "asleep" when they cease duplicating. So, when a virus stops duplicating it ceases to wreak havoc in the system and stops trying to inject its RNA into healthy cells to destroy them, or more accurately, ceases to make the cells "self destruct" due to the introduction of the nasty viral RNA.

Low or undetectable viral levels mean that the virus is not actively duplicating and has retreated to someplace deep in the body and is dormant or asleep. This is a good phase for viral infections, because during this period the virus causes little or no damage.

High or rising viral levels usually mean the virus is active, duplicating, and doing its thing, destroying cells.

Now liver enzyme levels such as ALT and AST and a few others record activity in the liver. When these are normal, it usually means that the liver is functioning properly and not being damaged. When these are elevated, it usually indicates that liver damage is ongoing, such as from viral replication and virus' efforts to destroy cells.

It is important to understand that with people infected with hepatitis, the gold standard for figuring out whether there is liver damage is a biopsy. There is hope for some new tests that will determine liver damage from a breath test, but for now biopsy is the only way to know for sure if there is liver damage.

The second best way to check for danger due to hepatitis is to do a viral load blood test, using methods such as PCR (polymerase chain reaction) or the more accurate TMA (Transcription Mediated Amplification) tests. These test for levels of virus in the blood. When there is not enough virus in the blood for a positive, the results come back "undetectable." This does not necessarily mean that there is no virus in the blood, but that the test is not accurate enough to detect any. TMA is more sensitive than PCR and has a lower threshold.

An undetectable viral load test usually means that the virus is dormant, and not causing any damage.

The third best tests are the liver enzyme tests, but these are the least accurate in that a person could have no elevated enzymes and very bad liver damage, or elevated enzymes that have nothing to do with liver damage from hepatitis.

Now back to the forms of hepatitis. Hepatitis C (HCV), like HBV, also has a very high level of viral load in the beginning, but this tapers off usually within a few weeks, and then drops drastically and usually stays at these very low levels for many years. For some people, the virus stays at these very low levels or is even somehow suppressed. A person whose viral load remains undetectable for HCV after the initial infection is said to have "cleared" the virus. ALT/AST will usually stay normal as well. This is a good thing. In most cases, this is all there is to it and the person will not have to worry about HCV again.

However, the thing about HCV is that it tends to lie dormant for many years - the usual period is about twenty years - and then for reasons unknown just suddenly wake up and start replicating like crazy. This is part of why HCV is known as the "silent killer." It lies dormant for years and then suddenly without warning wakes up and wreaks havoc like there is no tomorrow.

Because of this ever present danger, it is recommended that people with HCV not drink or take drugs at all and maintain healthy lifestyles - lots of fluids, exercise, good not fatty diets, etc. - so that their immune systems in general and their livers especially stay strong, just in case the HCV comes back to life. They should also be immunized for Hepatitis A and B, because if they contract these, in conjunction with the HCV they already have, they may have some serious problems.

The statistics for people who are not treated are that about 25% of people who contract HCV will eventually have "problems." These problems range from death due to cirrhosis to mild scarring of the liver. In general damage to the liver results in a range of symptoms starting at the low end with fatigue, and ranging all the way to complete liver failure and corresponding incapacitation.

One study that has not been conducted is what percentage of those who develop problems continue with an abusive lifestyle of drinking or drugs. I personally think that the statistics of those who develop problems among those with HCV is very high among those who abuse their bodies and very low among those who really take care of themselves. While HCV may be for many a time bomb that eventually can cause a lot of issues, if the body is kept strong the hepatitis often is unable to cause enough problems before the individual dies of natural causes.

This is somewhat like prostate cancer in men - 100% of men who live long enough will develop prostate cancer, but not all men will die of prostate cancer - usually the lucky and strong body stays one step ahead of a death due to prostate cancer.

The good news for HCV sufferers is that there are now treatments out there, such as pegelated interferon combined with ribavirin, that have success rates of up to 85%. The length of treatment required and the success rate depends partly on the genotype of the virus. HCV is classified into different genotypes - the first forms are known as type 1 (1a or 1b) and the more recent strains type 3 or 4. Typically, treatment of genotype 1 is the most difficult and requires the longest treatment (at least one full year), and genotypes 3 and 4 are easier to treat.

So, a person with HCV should also find out what genotype he or she has. There are blood tests for this too.

The final question is - when to start treatment. Most doctors will not start someone on the treatments, which have some nasty side effects such as feeling flu like sickness constantly, until a biopsy detects at least some liver damage, but some doctors will start a person up when the liver enzymes are elevated and the viral load high, even without the presence of much if any liver damage.

Another thing to note is that while HBV is readily transmitted through close contact or sex during the initial period of infection especially, HCV requires blood to blood contact and is not even thought to be transmitted sexually (at least, there are no certain cases of it having been transmitted through heterosexual vaginal sex). Also, once a person is treated or has cleared the virus and the viral levels are undetectable, the danger of transmission through any means is almost none - no virus in the blood, no virus to infect someone else with.

The bottom line is: take this silent killer very seriously. Cease all potentially abusive or body weakening behaviors including drinking. Get checked regularly with blood tests and if necessary a biopsy. And, stay vigilant and be aware that no problems today do not mean no problems ever.

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