There is no known cure for hepatitis C, but interferon alfa-2b, or Intron A, and ribavirin, or Rebetol are sold by Schering-Plough, and the combination is sold under the name Rebetron. These drugs are used to treat the disease, but unfortunately, they help only about 40 percent of patients on the drug, and have side-effects so severe that one in five patients stops taking them. The "combo" costs Canadians about $1600 a month.

Part of the problem of finding a cure is that researchers have not been able to grow the virus in the laboratory to test it. Three papers in the journal Science report some progress.

Michael Lai and colleagues at the Howard Hughes Medical Institute at the University of Southern California School of Medicine in Los Angeles discovered that the virus produces a surface protein, called E2, that stops the immune system's attack.

"Not only have we solved a major clinical problem relating to the treatment of HCV, but researchers may be able to use this information to develop more effective HCV therapies," Lai was quoted as saying.

He contends that his paper may show that viruses may be alive. Scientists have long argued that viruses are not true life forms, since they cannot reproduce on their own. It is thought that they must utilise another organism's cells.

"Viruses do things that we don't expect. They adapt to the environment," Lai said. "They change themselves to survive. They can pick up pieces of cellular genes or incorporate their genes into the cell's genome. That means that evolution occurs all the time in viruses."

In another study, Ralf Bartenschlager and his colleagues from the University of Mainz in Germany said they created an artificial version of a cell infected with hepatitis C by putting together a strand of DNA that is a kind of mirror image of the virus's own RNA genetic material. They then used it to "infect" human cells. The model, called a replicon, acts almost like an infected cell.

"It replicates under its own control," Bartenschlager said. "...We now can identify and evaluate antiviral drugs by using this system." He said they will be able to use these replicons to study hepatitis C. This could not be done before because when human cells are infected with the virus, they do not grow in the laboratory. Chimpanzees are the only other animals that can be infected with the virus.

"In principle, viral RNAs can be generated in unlimited quantities, and the viral genome can be manipulated for genetic analyses of HCV functions that are essential for replication," Bartenschlager's team wrote in Science.

Researchers at Brown University at Providence, RI, say they now know the means by which the cells of a mouse embryo begin liver development. If scientists can learn how to control tissue growth of major organs and identify which cells are key players in organ development, they may be able to fight illnesses more effectively when an organ becomes diseased. This report appears in the June 18 issue of Science.

Patients with chronic hepatitis have been studied according to two major subgroups. Firstly, those patients with acute disease followed in a prospective manner. Since the confirmatory diagnosis has only been since 1990, these studies are limited to an 8-year course. Secondly, those patients assessed at some point (usually years) after acute infection and prospectively followed. Some studies attempt to determine the point of infection historically, and this may be possible in patients who have had single exposure such as a blood transfusion at a specific date and have no other risk factors. Progression of disease in this group will either be from assumed point of contact, but more often from point of diagnosis.

There are three groups within this subset:

a. Patients with normal enzymes: some will have chronic active hepatitis

b. Patients with evidence of chronic active hepatitis, elevated serum enzymes, and if biopsied showing active hepatitis

c. Patients with already established cirrhosis

There is little controversy over the fact that hepatitis C progresses gradually and inexorably over time, and the clinical severity may increase from mild to moderate, to severe, to fibrosis, cirrhosis, hepatic decompensation, and hepatocellular carcinoma. From point of diagnosis, the rate of progression of chronic hepatitis C is less likely and slower in patients with mild histological disease than in those with more advanced histological disease. It is generally accepted that hepatitis C, very much like herpes virus, may fluctuate in its activity, at times being active with liver inflammation and elevation of liver enzymes, at other times inactive with less inflammation and normal liver enzymes. More than 90% of patients with an original diagnosis of transfusion-related hepatitis C remain positive for antibody to hepatitis C. Two thirds of anti-HCV-positive patients have elevated serum enzymes whereas one third have persistently normal enzymes. The fact of persistently normal enzymes, however, does not always mean that there is no active hepatitis or that the liver pathology is normal. The activity may vary from person to person and from time to time. Certain independent factors such as route of infection, age at onset, male or female sex, and alcohol use have all been shown to influence the progression. The average time from point of infection to the diagnosis of chronic hepatitis of any degree is approximately 10 years. One study showed that following patients for 20 years after infection, 20.6% had mild hepatitis and 22.9% had moderate to more severe hepatitis.

You have great questions and the problem is that there really is no data from which to base an answer. No studies have been done to provide any type of guidance in this situation. I'll tackle these the best I can, but realize that the information is based on my conversations with the epidemiologist at the Hepatitis Branch at CDC and what they know about the vaccine's efficacy data and have learned in post marketing surveillance.

It is true that hepatitis B vaccine does not always induce antibodies in persons who are immunocompromised. In a person who has a normal immune system who has produced antibody titres (they must be measured within 2 months of completing the vaccine series), it is not uncommon for them to slowly lose measurable antibodies, however, their immune system is capable of regenerating antibodies (through a memory response) if they are exposed to the virus. This is not true for persons who are immunocompromised. They may elicit an antibody response; however, they too will lose the antibodies over time. The difference in this situation is that often the immune system in these individuals is not capable of remembering the antigen in order to make antibodies. In these individuals it is important to receive periodic testing (usually annually) and receive 'boosters' in order to maintain protection against the hepatitis B virus. It is the only situation in which booster doses of hepatitis B vaccine are necessary.

I just want to add that in persons who have chronic liver disease, hepatitis B vaccination is recommended for those within a high risk group-and is not necessary for those whose risk of exposure is low. (This is a US CDC recommendation and may not match what your provider or what the Canadian Dept. of Health has recommended.) So if you are in a high risk group, you may want to get an additional dose of hepatitis B

vaccine now, before you finish your interferon course (if you will finish it)-just remember to check your titres 4-8 weeks following the dose of vaccine, any longer and a negative result is really meaningless.

As for hepatitis A vaccine. The difficulty with checking antibodies for this vaccine is that the available commercial tests are very unsophisticated and are not reliable in determining the response to the vaccine. When talking with Dr. Beth Bell at CDC, she felt that because this vaccine is very immunogenic-even after 1 dose, so that the majority (probably 60-70%) of immunocompromised individuals will respond-that vaccination is worth the investment. There is no information as to whether one additional dose of hepatitis A vaccine is necessary in this situation. It may not be necessary, but it will not harm you to get an additional dose. Testing afterward may not provide helpful information regarding your response to the vaccine. It is important to discuss this with your hepatologist and decide together on a course of action.

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DISCLAIMER: The hepc.bull cannot endorse any physician, product or treatment. Any guests invited to our groups to speak, do so to add to our information only. What they say should not necessarily be considered medical advice, unless they are medical doctors. The information you receive may help you make an informed decision. Please consult with your health practitioner before considering any therapy or therapy protocol. The opinions expressed in this newsletter are not necessarily those of the editors, of HeCSC, HepCBC or of any other group.

Castlegar/Grand Forks/Trail Contact: Robin, 365-6137

Kootenay Boundary Meetings: Second and fourth Tuesday of each month, 7 PM, 1159 Pine Ave. upstairs from Lordco auto parts. NEXT MEETINGS: August 10^th and 24^th. Contact: Brian, 368-1141, k9@wkpowerlink.com or Pat, 364-1555

New Westminster Support Group Meetings: Second Monday of each month, 7:00-8:30 PM, First Nation's Urban Community Society, Suite 301-668 Carnarvon Street, New Westminster. NEXT MEETING: August 9^th. Contact Dianne Morrissettie, 525-3790.

Prince Rupert Contact: April, 627-7083.

Quesnel Contact: Elaine, 992-3640.

Richmond Meetings: Fourth Tuesday of each month, 7 to 9 PM, Westminster Health Unit, 7000 Westminster Hwy, Main Floor, Room 3. NEXT MEETING: August 24^th. Contact: Carmel Tanner at Richmond Health Unit, 276-4069.

White Rock Support Group: Meeting Room #2, Peace Arch Hospital. Contact Lisa Peterson at 538-8704.

Yodie fokes: Cap'n Blastoff here:

We is recovering. Pooped, flooged and some of us too ill to even think about it. Hepfest was a success-if you call having hepc in the papers, on the radio and on tv for 3 days a success.

The quilts were absolutely breathtaking. The food was absolutely delish-thank you to Judith, Joan, Dave Fitz; Arlene Darlington; Tricia Plunkett and all the other volunteers in the kitchen.

The rummage sale made money (a great big thanks to Jean Day who made herself ill doing this), and to the many volunteers who showed up to help-Brad Cummings; Michelle Christianson; Alda Anderson; Wayne Dawe; Joy Hull; Nancy, Sue Kokkinis; Pat Holman and Linda Styles from PECSF-and Dave the Fitz who organized the pickup and delivery of the rummage.

The Hepcats actually played in tune (sometimes); people danced; & the PA showed up on time (THANKS Mucho to Ken Crews).

Thanks to Dave Smith, Sharen Barnard and Ed Conroy for showing up and doing the Transplant forum, which was well attended. Thanks to Jarad Gibbenhuck for the keynote address; to CHEK TV for being there, to CTV-VTV for coverage; to CFAX Radio and to Rick Wiertz of AM 900.

Thanks to Jim Wiggins of the Running Room for organizing the Run and a big one to Fatima Jones for putting it all together (really big hug); thanks to Ocean Promotion for doing the t-shirts (which are bootiful); and to the many sponsors who provided excellent prizes.

Thanks to Mel Krajden at the BCCDC for last minute help with the pamphlets and to Steve Orcherton for help with the FAQ's. Thanks to CLF for sending pamphlets; thanks to the speakers from the Canadian College of Chinese Medicine for their presentation; to Dr. Bob Hogg from St Paul's for his presentation on the Quality of Life Survey; and to Mike Orsini who came out to interview everyone as part of a PhD project on HCV. Thanks to Theresa and Werner Rothlisberger, Carolyn Romanow and Brad Cummings of the ACPD for speaking out on advocacy issues.

To JJ Camp, a special thanks for coming out and presenting his position and for offering to help our HepC community on the advocacy front with respect to disability pensions and disability benefits denied.

Thanks to Mount Royal Bagels for donating 100 bagel holes (with frames); and to all of Fatima's friends for marshalling the run and setting up the tent etc. etc etc. etc.-----and for cleaning up the mess we all made. Thanks to Bob Edwards for the pickies and the bonfire permit.

Thanks to Dr Ian Courtice, President of the BCMA for the address at the run and for his promise to get involved with the movement, push for testing and public awareness and for his encouragement and support.

Thanks to all of you who supported us with your words, your presence and your material goods.

And now I must ploop.

gleek