Talk:Hepatitis C/Archive 1

Genotype 6
Would be good to have some more information included on genptype 6 treatment, since a larger amount of people infected are to be cathegorized under genotype 6. —Preceding unsigned comment added by 90.15.181.2 (talk) 13:42, 16 March 2008 (UTC)
 * Are there special treatment recommendations for genotypes 5 or 6 that have been peer-reviewed?
 * BTW, it seems to be conventional to add new sections to the bottom of the Talk page - elsewhere things tend to get overlooked.Scray (talk) 02:47, 19 March 2008 (UTC)

Spreading Hepatitis C Falsehoods
I fear that there may be an agenda here...

At the end of this article under "National Information" and "United States" we have:

"In the United States, those with a history of intravenous drug use, nasally inhaled drug usage, tattoos, or who have been exposed to blood via unsafe sex or social practices have an increased risk for this disease. Hepatitis C is the leading cause of liver transplants in the United States."

Interesting. Certiainly the CDC does show needle use to be far and away the biggest risk factor for the spread of HCV. The paragraph then goes on to conflate this fact with a list of practices where little documented evidence exists that there is danger anywhere near (if reasonably at all) the increased risk which exist for intravenous drug use. And you'll notice the "liver transplant" statement thrown in for rhetorical effect...

Drug use by nasal inhalation is mentioned under "Methods of Transmission" where the increased risk of transmission occurs from possible sharing of "even trace amounts of mucus and blood" according to the word "researchers." Oddly enough, even though these trace amounts give you HCV when you inhale drugs, the article later states that there is no risk at all from "kissing" and "sharing eating or cooking utensils." Gee, and I would have thought the "trace amounts of mucus and blood" from another persons drool/saliva, possible bleeding gums or canker sores, would have a risk of transmission. Go figure!

There is, however, a reference provided to back up the evidence. Of course, one click on that link and you get an article about...increased risk from tatoos, not drug inhalation.

The actual risk from tatoos according to the reference article exists because somebody in a prison with HCV apparently spread the virus to others via tatoo instruments. I doubt prisons produce model tatoo parlours and the statement seems anecdotal but, whatever. At least there is something purporting to be evidence...as far as evil tatoos are concerned.

The article also states:

"The CDC does not recommend the use of condoms between long-term monogamous discordant couples (where one partner is positive and the other is negative)."

So even where one of two people in a sexual relationship has HCV, the risk of transmission is not enough to warrant the use of condoms according to the CDC. Wow. So I guess that virtually rules out quite a bit of "unsafe sex" as risk factor to be mentioned on par with intravenous drug use. What is meant by "social practices" is a mystery to me but I'm sure it involves young, rebellious, ne'er do wells, since "slam dancing" is mentioned in the article in the same breath as "contact sports" (a much broader range of activities).

Folks. There are many good reasons to not snort drugs, have unsafe sex, and even get tatooed. Fear-mongering and dishonesty is not acceptable even if you think it's for a good cause. This should be a straight-forward and scientific look at who is truly at risk for the Hepatitis C Virus. Not a place to grind your ax or scare dumb teenagers. 72.221.86.224 (talk) 19:00, 4 May 2008 (UTC)
 * You make some strong points. Please sign in and edit the article, if you have specific changes you'd like to make.Scray (talk) 03:51, 5 May 2008 (UTC)

Apparently somebody did remove the category "National Information" with the paragraph in question. That was my main beef with the article, so I'm satisfied. Even though some of the "Methods of Transmission" described appear to show little evidence, I won't bother to remove them as they seem vague enough to not be equated with intravenous transmission. I just didn't want remote possibilities conflated with serious risks and the wording made me suspicious of an intent to do that. 72.221.86.224 (talk) 21:02, 16 May 2008 (UTC)

I
I have a question. Why is it that no one wants to deal with this disease. My Husband had a liver transplant last year because of Hep C. It was the worst time of our life. I dont want anyone to have to go through what he went through. But when I try to talk to people about it after they have told me they know someone with it. They seem like their in la la land. They dont want to hear what is going to happen.

From the article:

As a sample extract of silybum marianum and licorice are known for their HCV related effects. The first provides some generic help to the ephatic functions and the second one have a mild antiviral effect and rises blood pressure.


 * It is also well known that even small amounts of alcol makes HCV virus proliferation faster.

Can someone check these assertions, please?

-

http://www.clinicaltrials.gov/show/NCT00030030 suggests that at least the first assertion is unproven, but that there is at least some anecdotal evidence for it.

-

The link removed from article provides an analisys of the eventual effectiveness of alternative terapies Hepatitis C and Complementary and Alternative Medicine


 * Why not insert some information into the article body, e.g. the alternative methods used in HepC? Just providing external links is not helpful. JFW | T@lk  09:36, 29 Aug 2004 (UTC)

There is no doubt that alcohol can lead to a more rapid progression of HCV related liver disease, however there is no evidence that drinking alcohol increases viral load. I have altered this in the text.

I would be inclined to remove the line regarding HCV cell surface receptors. LDLR is one of a number of receptors proposed but it's significance is not clear. This is an area of on-going research where we really don't know the answers yet and I'm not sure it is relevant for a general review of the subject.

I will try and add to this page over the next few weeks.--Hog 21:08, Oct 28, 2004 (UTC)

Self-contradicting?
I think these two sentences contradict each other.

"Treatment during the acute infection phase has much higher success rates (greater than 90%) with a shorter duration of treatment (but balance this against the 80% chance of spontaneous clearance without treatment)."

"Approximately 20-30% of persons infected with HCV clear the virus from their bodies during the acute phase as shown by normalization in liver function tests (LFTs) such as alanine transaminase (ALT) & aspartate transaminase (AST) normalization, as well as plasma HCV-RNA clearance (this is known as spontaneous viral clearance)."

ringm 22:14, 3 May 2007 (UTC)
 * This has now been resolved - see "Spontaneous Clearing?" section below.Scray (talk) 00:31, 23 February 2008 (UTC)

The sentence above, that people clear the infection based on normalization of liver function is nonsense. The liver is an amazing organ, and will compensate and function normally with the virus. This DOES NOT indicate that the virus is cleared. The only way to tell if the virus is there is by testing for it's presence. The liver will function normally for years, as mine did. Now, after nearly 30 years of carrying this virus around with me, my liver is failing. I believe that it's very rare that the virus would spontaneously clear without treatment. —Preceding unsigned comment added by 217.44.219.225 (talk) 18:04, 2 December 2007 (UTC)
 * Good point - normalization of liver enzymes is not a reliable marker of clearance, but persistently negative tests for HCV RNA in the blood (using RT-PCR and similar tests) is reliable and well-established. Perhaps the point about liver enzymes is relevant simply to support the notion that with long-term clearance of HCV RNA from blood, the liver does not show signs of ongoing injury.  There are studies that show that clearance of HCV RNA from the blood is associated with clearance of the virus from the liver as well.[]Scray (talk) 00:31, 23 February 2008 (UTC)

Typo?
What is "chronic acute hepatitis C infection"?

Response: Nope, no typo: many hepatitis C infections don't "heal" even if treated (depending on the virus subtype, between 20% and 40%) and become chronic. The illness continues at low activity, but sometimes has activitiy spikes, becoming acute. Then, after a while it reduces its activity again, returning to its chronic non-acute state.


 * Response to Response
 * The activity spikes you are referring to are termed "chronic active hepatitis", not "chronic acute hepatitis"Lindenb 19:10, 7 January 2006 (UTC)

what does this mean?
Approximately 40% of U.S. patients infected with HIV are also infected with the hepatitis C virus (HCV), mainly because both viruses are blood-borne

asking about the "mainly because both viruses are blood-borne", which doesn't seem like a causative agent here


 * I've improved it. JFW | T@lk  10:10, 20 November 2005 (UTC)

Pregnancy and breastfeeding
Added new section. The numbers on this vary. I am comfortable with this for now. They match the existing references and external links.--FloNight 10:44, 20 November 2005 (UTC)

History and future
Added new section about history and future. I changed the discovery date to 1988, CDC articles all use this date. --FloNight 14:44, 20 November 2005 (UTC)

Endnotes
Please note that inline external links mess up the endnote system. But then you don't need inline external links if you're doing endnotes... Also please note that changing the order of the paragraphs leads to a need for renumbering the notes. JFW | T@lk  16:36, 20 November 2005 (UTC)


 * Why does note 10 still link to reference #1? JFW | T@lk  22:57, 28 November 2005 (UTC)

Endnotes are still messed up... I just added two new references (Houghton, 1987 european patent; and Ulrich, 1990, semiquantitation of viral loads) and they show up okay in the endnotes but the numbering is messed up in the text. Somebody needs to go through and review all the endnote references and see where the error is; I suspect it's a matter of reordering the appearance of the references in the endnotes section. i'll give it a try soon if I get some time. lanephil 02:13, 15 May 2006 (UTC)

Images & graphs
I downloaded some Hepatitis images and graphs to my user page. I put one in the article. Does this work? Do any of the other ones work better?--FloNight 15:05, 21 November 2005 (UTC)

Hepatitis C image gallery
I started a Hepatitis C image gallery for the images in the article and others. --FloNight 15:39, 27 November 2005 (UTC)

number of genotypes
I took the liberty of changing the number of genotypes from eleven to six based on the Oct 2005 Simmonds paper in Hepatology. I am not sure how to add the reference. Could some kind person add it? B.Joppa


 * Well, the Single Citation Matcher on PubMed effortlessly generated:


 * Simmonds P, Bukh J, Combet C, Deleage G, Enomoto N, Feinstone S, Halfon P, Inchauspe G, Kuiken C, Maertens G, Mizokami M, Murphy DG, Okamoto H, Pawlotsky JM, Penin F, Sablon E, Shin-I T, Stuyver LJ, Thiel HJ, Viazov S, Weiner AJ, Widell A. Consensus proposals for a unified system of nomenclature of hepatitis C virus genotypes. Hepatology. 2005 Oct;42(4):962-73. Review. 


 * I'll stick it in. JFW | T@lk  22:21, 17 December 2005 (UTC)

Hello
I am an HCV virologist and new to Wiki. I just made a few edits within virology. Feel free to comment. —Preceding unsigned comment added by Lindenb (talk • contribs)


 * Fantastic. An expert! Please continue, and don't forget to cite your sources, with which you are likely to be more familiar than us. JFW | T@lk  22:48, 18 December 2005 (UTC)


 * Would you know if there are five or six types of Hepatitis. I am pretty sure that there is a Hep G so i added that. please verify. I too am new to wiki. do i have to cite sources for that bit of info? i mean, it seems to be knowledge that anyone can pick up, right?

If you look on hepatitis you will see that there is hepatitis A, B, C, D, E and G. However, the six types discussed here are subtypes of the hepatitis C virus depending on their RNA sequence. You are free to add material but do not forget to WP:CITE. If it is incorrect it may be removed or put in another, more relevant article. JFW | T@lk  21:30, 22 December 2005 (UTC)
 * I am unclear of what you mean, JFW. HCV comes in six "genotypes", or distinct flavors, which differ from each other via sequence variation.  They all cause hepatitis C.  "Subtypes" is used to refer to subdivisions within a genotype.  For more information, see the Simmonds et al reference, above.  There are also six different hepatitis viruses, A through G. They are all distinct viruses that are largely unrelated.  The one exception to this is that "hepatitis G virus", more formally called "GBV-C", is within the same virus family as HCV, the Flaviviridae.  However, the medical literature is still in doubt as to whether GBV-C actually causes hepatitis.  We need to clarify this on that page, and I recently added a comment to hepatitis G. Lindenb 19:36, 7 January 2006 (UTC)

You were correct: hepatitis G can cause acute hepatitis. JFW | T@lk  21:31, 22 December 2005 (UTC)


 * Well, in conflict with the web page you found, in the peer-reviewed medical literature it is still unclear as to whether GBV-C causes hepatitis. I recommend you read the excellent review of Simons et al, "The GB viruses." Current Top Microbiol Immunol 2000;242:241-375.  Lindenb 19:36, 7 January 2006 (UTC)

Hey, virons and virions are the same things, right?
 * "virions" refers to physical virus particles. I have never heard the term "virons". Lindenb 19:36, 7 January 2006 (UTC)

A QUESTION FOR YOU How are people doing with HCV who have had trasplants. The transplant obviously doesn't get rid of the virus, and the new liver becomes infected again. Also, the immunosupressive theapy must have some effect on the body's ability to fight the virus. Are there any useful statistics yet?

Hello #2
Hi there to all. I'm also a HCV virologist, albeit from the early days of the virus discovery (1987-1990 timeframe), also new to Wikipedia. will be working on the page as I get time. cheers. lanephil 02:58, 14 May 2006 (UTC)

Hi, I'm not a HCV virologist, but I do have Hepatitis C. Anybody feel free to ask me any questions that you have on that topic. Yes Hepatitis is deadly, but people get a bit carried away by this term. The only reason that this virus would be deadly is if a the person infected doesn't take care of him/herself. As for me, I had it since I was born. I was born seven months premature so I needed a blood diffusion. I have a rare blood type, blood type O, and the only person who had this blood type was someone infected with Hep C. He donated his blood to me and I was infected with this virus. But my parents and I didn't know about this until I was nine. I was fortunate enough to have a strong liver that was able to fight Hep C. Now, I drink vitamins before or after meals twice a day, eat right, excercise, I don't drink at all (not even a drop of wine), and I basically take care of myself. If anybody with Hep C would do the same, then they would have no problem. —Preceding unsigned comment added by LeeMulod333 (talk • contribs)

I'm glad you aren't having problems with your infection, but I do take care of myself and now, after more than 30 years with the virus, I am having serious problems. Like you, I was infected with a blood transfusion. I think that for most people, it is inevitable that the disease will eventually take it's toll. Some are lucky, that's all. I don't mean to downplay the importance of taking care of yourself. I was told three years ago that I would need a transplant within six months. I eat well, get exercise, "take care of myself", and that is probably why I haven't needed the transplant yet. But things get worse each day. So, if I don't hang in there long enough for some big medical breakthrough, I will eventually need a transplant no matter how well I take care of myself. —Preceding unsigned comment added by 217.44.219.225 (talk) 18:18, 2 December 2007 (UTC)

Move text to talk for discussion
Chronic Hepatitis C The NIH Concensus Statement on Hepatitis C, NIH Concensus and State-of-the-Science Statements, Volume 19 Number 3; published June 12, 2002 states the following: "Currently, persons aged 40 to 59 years have the highest prevelance of HCV infection. In this age group, 6.1% of African Americans are thought to be infected." This contrasts with The Centers for Disease Control documentation stating the infections are most prevalent in the aged 25 to 39 years group. Since the CDC figures are based on the aformentioned reseach paper, there is some motivation for the CDC to report an incorrect age group. Further Stated: "All data is based on chronic infections lasting 20 years, or less. There is little or no knowledge on chronic hepatitis infections lasting more than 20 years." This sharply contrasts with the omission by the CDC that almost all data pertains to infections lasting 20 or less. This omission by the CDC alludes to pacification of HCV infected persons, who are under the illusion that only 20% of HCV infections will ever result in cirrhosis. The figure of 20% pertains only to a 20 year time duration. Given disease models for similar pathogens, it can be reasonably expected that the disease will continue to progress past the 20 year time frame. The NIH further found "HCV treatment sees diminishing returns as the infection progresses. Treatment should be begin as soon as possible after a patient is diagnosed." This is in conflict with the CDC documentation given to health care providers intimating treatment should be held off until digestive or psychiatric complications occur. When these complications occur, treatment is least effective, and the infected individual faces a minimal chance of recovery. The NIH goes on to state: "Psychiatric complications, owing to HCV infection, including depression, are seen in 20% to 30% of cases." This is omitted in CDC documentation. The NIH paper states: 2/3 of new infections are by intravenous drug abuse, yet the sectors of the populayion most effected have extremely low incidences of IV drug abuse, but very high incidences of sodomy. Sodomy is a known mode of transmission of HCV, yet the CDC and NIH make no mention of it. International studies have shown the highest incidence of HCV infection among sodomites, or those who mix blood with sodomites; up to 59%. --FloNight 08:50, 31 January 2006 (UTC)
 * I notified AwesomeMachine that I moved this text here for discussion. It is interesting but needs to evaluated and then worked in to the flow of the article if needed. The way it is written now, it is a comparison of two U.S. agency papers. I'll look at the papers and see what's up.--FloNight 00:47, 1 February 2006 (UTC)

It's downright frightening to find out that the CDC has made such stupid recommendations about when to begin treatment. If anyone has the virus, they should get the treatment ASAP. Don't do what I did. I was very very healthy in the beginning and thought I was one of the lucky ones who wouldn't develop problems, so I put off treatment. I started too late and I couldn't tolerate it. My platelets became dangerously low and I had to stop. That was my only chance at clearing the virus. Now I am faced with the complications of having the virus after the transplant when I am on immunosupresive drugs. It is very likely that the virus will do it's dirty work again, only with a vengence. I could develop cirrhosis within the year, instead of after 20 years as before. —Preceding unsigned comment added by 217.44.219.225 (talk) 18:31, 2 December 2007 (UTC)

# of Infections
"Hepatitis C infects an estimated 150-200 million people worldwide." Is this the number of annual infections? Also, what three countries have the highest number of infections?

Patchouli 03:06, 20 March 2006 (UTC)

Alfa and Beta interferons
I have a question concerning medicines used to treat multiple sclerosis--particularly inteferons--and those used to treat chronic hepatitis C.

A few years back, I underwent therapy consisting of injections of pegalated alfa 2b interferon and ribaviron to treat hepatitis C. I feel blessed; my therapy was a success and I haven't felt better in years! They say I could be in remission for the rest of my life (I'm 50 years old).

Unfortunately, the side-effects of the treatment were not so kind to me; I even had to quit work for four months. My sister (while being treated with interferons for MS) suffered little or no side-effects while being treated for her MS.

So often people ask the question, "Aren't the medications for both illnesses the same, and if so, why did you suffer so severely while your sister's side effects have been so minimal?"

So, are both the meds(interferons) for MS and HCV basically the same?

I'd like to be able to supply and answere once and for all; because, frankly, I'm getting a little tired of the question?

A professional (or knowledgable) opinion would be welcomed.

Thanks,

--Debbie122756 18:22, 16 May 2006 (UTC)


 * Your Immune system is probably not exactly the same. Interferons are immunoimodulators. If you have a different immune system, then side effects will have differences too. I think this is the answer for your first question. The others: I don't want to answer, I'm not a doctor (just 4th year :)). NCurse [[Image:Edu science.png|22px]]work 20:03, 7 August 2006 (UTC)


 * I'm not a doctor either, just a hep C nurse and I have no experience with MS. But I do know that MS is generally treated with beta interferons, as opposed to alpha interferons for hep C, and they do have somewhat different effects (beta has more anti-inflammatory action); and hep C patients also get ribavirin, which MS patients don't, and a few of the side effects in hep C treatment (anemia, mostly) are due to ribavirin. But as NCurse said, everyone is different. I've had hep C patients on identical treatment, with similar health prior to treatment, and they had very different levels of side effects. &#8592;Hob 16:49, 16 November 2006 (UTC)

Article split
I would like to propose splitting this article into hepatitis C and hepatitis C virus, just like HIV and AIDS, EBV and mononucleosis infectiosa. What do others think??


 * I'm all for it. There is certainly a ton of information about the virus which would simply overwhelm this article when we start to add it. We will have to discuss the virology quite a bit still in the hepatitis C article due to the treatment differences, epidemiologic differences, and the non-curative role of liver transplantation. But I think that there's much more to be said that shouldn't all be said here. I think that this page can stay hepatitis C instead of hepatitis C infection (etc) but I would be open to discussion if others felt strongly otherwise. InvictaHOG 01:08, 17 August 2006 (UTC)
 * I second that proposal. I planned to propose the same. Kpjas 08:53, 17 August 2006 (UTC)


 * Me too. It won't be an easy work. :) NCurse [[Image:Edu science.png|16px]]work 09:03, 17 August 2006 (UTC)


 * As a first cut, I've split out the 'virology' section into the new hepatitis C virus page. --Arcadian 10:31, 17 August 2006 (UTC)

Lymphoma
Should we mention lymphoma? suggests a strong link + implications for treatment. JFW | T@lk  22:15, 10 September 2006 (UTC)


 * Didn't look properly. Samir has been working on this behind my back (it's been off my watchlist). JFW | T@lk  22:28, 10 September 2006 (UTC)

Steven Tyler
It seems every Aerosmith fan in the whole world is pushing for Steven Tyler to be mentioned here. As I have elsewhere, I will also dispute here the need for a long list of people who have stated they have hepatitis on the record. We may never hear of it again. In contrast, Naomi Judd, Pamela Anderson and Phil Lesh have engaged in activism to increase awareness of the disease or its treatment. I will continue to remove Steven Tyler, with an RFC if necessary. JFW | T@lk  06:53, 27 September 2006 (UTC)
 * Any plans to have an RfC on the whole celebrity disease thing? We've been doing the separate list thing on other pages. It would be nice to better codify it. Otherwise you're fighting a losing battle, I'm afraid. InvictaHOG 12:00, 27 September 2006 (UTC)
 * FYI: I've compliled a small list of informal RFCs related to this under JFW's post at Wikipedia talk:WikiProject Clinical medicine. I think most agree that the Steven Tyler factoid does not belong here, but there doesn't yet appear to be any consensus on whether or not a separate list should be created. -AED 21:40, 2 October 2006 (UTC)

I am opposed to "lists of patients" for reasons of WP:NOT, WP:V (sometimes there is no adequate proof rather than word-of-mouth) and WP:N. I have never bothered with an RFC, but this may be the time to do this. JFW | T@lk  16:42, 27 September 2006 (UTC)
 * It's a continually vexing problem. The list of epilepsy patients is a great article, but most lists of patients are unverified and seemingly unverifiable. InvictaHOG 16:46, 27 September 2006 (UTC)


 * Maybe we need that RfC on the appropriateness of "List of people (famous or not) who have had X"....InvictaHOG is right, the problem is just with Steven Tyler fanboys here, its creeping-up on many pages. -- MarcoTolo 02:51, 28 September 2006 (UTC)


 * In general I am critical of list sections in articles which begin as a tangential topic but develop into unwieldy and often unverified exhaustive lists. In this particular case (and similar cases with other medical conditions), I think it is appropriate to list only those patients/sufferers who are known at least in part for having the disease; for example, Brooke Shields and post-partum depression. All entries should be verified and cite a reliable source, of course. Listing sufferers who are famous for other reasons and happen to have the disease is not appropriate, in my opinion; it is enough (assuming verification is done) to mention it on the person's article. --Ginkgo100 talk · e@ 20:36, 2 October 2006 (UTC)


 * I'm a bit unfamiliar with the RFC thing. Is this the place to discuss, or somewhere else? I have some sympathy with JFW, having fought a battle to keep computer-game trivia out of Diazepam. However, the argument (regardless of merit) for this particular article/RFC needs to be strengthened. Weaknesses:
 * The RFC says "not famous because of that disease". Almost nobody is famous because of a disease. The Elephant Man perhaps. But certainly not Steven Hawking or Christopher Reeve, for example. Nobody would have heard of them if they weren't a genius or a famous actor. Lots of people know they have certain medical conditions, but not everybody. Likewise, anyone with a radio or TV currently knows Steve Tyler has/had hepatitis. Who knows if this particular "notability" will last. Probably longer in the hep community than outside, if other diseases are anything to go by.
 * A quick Google hasn't turned up any more support for Pams activism than Steves. In fact, this press release by The American Liver Foundation, and other quotes that suggest he may go on Oprah to discuss it, indicate that Steve is just as public about it as Pamela.
 * The text currently reads "Celebrities Naomi Judd and Pamela Anderson have been infected with hepatitis C and gone public with their experiences." The same is true of Steve Tyler. So is it really fair to blame editors for adding just one more name to the list. How are they to know where to draw the line? A list on Wikipedia needs clear entry criteria (not a hidden HTML comment).
 * The article current has no sources for any of the celebrities (only one obscure Chilean biologist). WP:BLP is crystal clear about this. Remove it without question or hesitation.
 * Avoid trivia sections in articles contains some wisdom on the practicalities of such sections.
 * Colin°Talk 23:16, 2 October 2006 (UTC)


 * In general I agree that notable people not notable for a disease should be removed, but Colin makes a good point here... --Steven Fruitsmaak (Reply) 12:19, 3 October 2006 (UTC)

The complete "prominent patients" section should be deleted. --Pjacobi 16:10, 3 October 2006 (UTC)

A modest proposal
Instead of deleting the information, I suggest branching it into a daughter article. What Colin modestly refrains from mentioning is that he created the featured List of people with epilepsy and made vast improvements to the featured List of notable brain tumor patients. Patients and families who cope with a serious illness often gain comfort from knowing they're not alone. This type of list can also be a useful tool for educators who want to put a human face on a condition.  Durova  03:58, 4 October 2006 (UTC)


 * This would be acceptable to me as long as the important issues of verifiability are addressed. --Ginkgo100 talk · e@ 17:38, 4 October 2006 (UTC)


 * It's been pretty much the de facto rule that's been followed from prior discussions. There are circumstances, such as when there are not enough referenced people to make a nice list, that this RfC should try to address. InvictaHOG 18:35, 4 October 2006 (UTC)


 * There is now a modest List of people with hepatitis C. I think there is a consensus forming that having a section for a list of notable people within a medical article is usually a bad idea, largely for the reasons discussed in Avoid trivia sections in articles. That's not to say that the article mustn't mention notable people at all. Sections covering the history of the disease, its place in popular culture, or social issues such as awareness, stigma and acceptance might well be enhanced by the mention of such people. Dealing with this in prose, within the body of the article, will discourage unsourced and speculative additions. Colin°Talk 20:11, 4 October 2006 (UTC)

If there are too few people to start a list (e.g. POEMS syndrome) are we just going to leave the names on the main article page? "Going public" isn't enough - I hadn't realised that Pamela was not in the campaigning circuit at all. My guiding characteristic has generally been that if mention of a celebrity's name immediately brings to mind his/her diagnosis (Michael J. Fox and Parkinson's, Stephen Hawking and motor neuron disease), then this celebrity might be worth including. JFW | T@lk  23:39, 4 October 2006 (UTC)
 * What I did with List of notable brain tumor patients was include anyone who was famous enough for WP:BIO and whose case could be confirmed through reliable sources. For this particular condition many don't survive long enough to campaign, but some who might such as Elizabeth Taylor have chosen not to for understandable reasons.  What I heard informally was that she had made a long term commitment to AIDS research and awareness and was concerned that additional efforts on behalf of another disease might dilute the value of her AIDS efforts.  People who have a serious condition face a variety of pressures.  If they're willing to share the diagnosis with journalists, that's good enough for me.  Durova  05:30, 6 October 2006 (UTC)

The List of people with hepatitis C is currently being considered for deletion. You may wish to comment here. Colin°Talk 14:20, 15 October 2006 (UTC)

GA Review

 * GA review (see here for criteria)


 * 1) It is reasonably well written.
 * a (prose): b (MoS):
 * 1) It is factually accurate and verifiable.
 * a (references): b (citations to reliable sources):  c (OR):
 * 1) It is broad in its coverage.
 * a (major aspects): b (focused):
 * 1) It follows the neutral point of view policy.
 * a (fair representation): b (all significant views):
 * 1) It is stable.
 * 2) It contains images, where possible, to illustrate the topic.
 * a (tagged and captioned): b lack of images (does not in itself exclude GA):  c (non-free images have fair use rationales):
 * 1) Overall:
 * a Pass/Fail:
 * 1d: Some technical jaron. like "cirrhosis" is not defined.
 * 3b: The secton "Transmission::Potential sources of exposure" is superflous, as the relative source of transmittion, is blood.
 * 4a: Much of the article is based on "U.S. in specific, rest of the world in generic", either ditch all US specific points of views, or include more different local examples.
 * 5: There has been a reecent edit war, but it seems it's over now, but's it's on the limit.
 * 6a: The only image is showing a cartoon of a person and a liver, the caption is totally non-succinct/descriptive
 * 6a: The only image is showing a cartoon of a person and a liver, the caption is totally non-succinct/descriptive

As I think this is points that you can fix rather quickly, I'll place article on hold in 7 days. → A z a  Toth 13:38, 15 October 2006 (UTC)
 * Sorry for the delay. Havking checked out the progress, I must say that the problem arised hasn't been handled totally. → Aza Toth 19:15, 12 November 2006 (UTC)

Lymphoma risk
Risk of lymphoma and Waldenstrom's 20-30% increased JFW | T@lk  23:15, 9 May 2007 (UTC)

Cure announced
Someone with expertise in this subject may like to consider Cure for Hepatitis C Announced by VCU researcher, from the Virginia Commonwealth University, for inclusion in this article.angela26 00:04, 22 May 2007 (UTC)

Cure for hepatitis C announced
"The use of peginterferon alone, or in combination with ribavirin, points to a cure for hepatitis C, the leading cause of cirrhosis, liver cancer and the need for liver transplant, a Virginia Commonwealth University researcher said today." Brian Pearson 00:08, 22 May 2007 (UTC)


 * Uhh, the fact that interferon can cure hepatitis C is already well-established. Shiffman is merely stating how PEG-IFN has markedly increased the rate of complete remissions. I would not call the need for ongoing treatment a "cure". JFW | T@lk  07:13, 7 August 2007 (UTC)
 * "Hepatitis treatment is expensive and only successful in half of patients. Untreated or unresponsive patients can go on to develop cirrhosis of the liver, with life affecting consequences or the need for a transplant."
 * ...Now scientists have found monoclonal antibodies which may make a successful vaccine a reality, researchers heard today... Brian Pearson 03:23, 5 September 2007 (UTC)
 * Food is a cure for hunger, yet it is an ongoing requirement. :( lawl 64.230.93.135 (talk) 06:51, 22 April 2008 (UTC)

In hemophilia
There is a perception that hemophilia attenuates fibrosis risk JFW |  T@lk  07:13, 7 August 2007 (UTC)

Well known people
Would it be a good idea to have a list of famous people with Hepatitis C? Snowman 15:55, 30 August 2007 (UTC)
 * In the absence of any comment, I will start a list. Snowman 09:07, 11 September 2007 (UTC)
 * Not needed as there is a link to a list of people in "See also", perhaps this link could be worked in the text somewhere. Snowman 14:37, 11 September 2007 (UTC)

Anita Roddick, found of The Body Shop had HCV. See  —Preceding unsigned comment added by 217.44.219.225 (talk) 02:41, 3 December 2007 (UTC)

A change please about transmission
I am greatly bothered by this one sentence *The virus may be sexually transmitted, although this is rare, and usually only occurs when a second STD makes blood contact more likely.[11]*

The way this is stated leads people to believe that Hepatitis C is an STD and it is NOT. The more appropriate sentence would be *The virus may be sexually transmitted, although this is rare, and usually only occurs when an STD (like HIV) is also present and makes blood contact more likely.[11 hi —Preceding unsigned comment added by 209.173.5.130 (talk) 16:19, 15 November 2007 (UTC)

I think it would be better to just say that the tiny abrasions that may occur during sex can provide a path for the virus to spread. These abrasion are not uncommon and can occur whether there is an STD or not. I am not happy at all about anyone making a link between STD and HCV. There are no real facts to back this up. This sort of statement only leads to misconceptions about people who have HCV.

The virus can also be spread by sharing a toothbrush, again, because of the abrasions that may occur. People with HCV should make sure that no one borrows their toothbrush. It's been proven in the lab that the virus can survive on a toothbrush for a very long time. Even still, it is believed that getting the virus from a toothbrush would be unlikely. I've been married for 17 years and have had the virus for over 30. I've asked to have my husband tested, and I've been told by experts (top notch researchers in this field) that I don't need to worry about it. —Preceding unsigned comment added by 217.44.219.225 (talk) 02:34, 3 December 2007 (UTC)

I'd also add that the CDC graph is crap, 15% of hep c cases are not transmitted via sex, this graph reflects how patients CLAIM they got HCV, not how they actually did. Actual studies of partners, gay or straight, where one partner is + and the other - show much, much lower rates of transmission, even with coinfection with HIV!

Diagnosis
Changed "uncommon" to "rare" the statement about false-negative antibody testing for HCV. It's extremely rare, as well documented in the medical literature. No sense creating doubt about a reliable test. Did add a qualifier about RNA testing when false-negative is suspected, consistent with AASLD and other guidelines. Scray (talk) 05:45, 11 January 2008 (UTC)

Extrahepatic manifestations of HCV?
No section on extrahepatic concerns? I'll have to plug in my project on Hepatitis C Virus Associated Nephropathies. &mdash; Gaff ταλκ 07:49, 18 January 2008 (UTC)


 * I added cryoglobulinaemia some time ago. Which other nephropathies are there, and can the whole lot be summarised in a few sentences? We also need to address lymphoma risk. JFW | T@lk  07:12, 3 February 2008 (UTC)

Smoking pot
Cannabis use increases steatosis risk in Hep C. All sorts of clever things being said about cannabinoids, but I thought cannabis increased appetite anyway: JFW |  T@lk  07:12, 3 February 2008 (UTC)

History paragraph
The history section contains the paragraph
 * Dr. D.W. Bradley filed suit against Chiron, challenging the status of U.S. patent 5,350,671 covering HCV clones, diagnostics, and vaccines. Dr. Bradley sought to invalidate the patent, have himself included as a co-inventor, and receive damages and royalty income from Chiron. Dr. Bradley claimed he supplied Chiron with HCV-infected plasma that was instrumental in Chiron's isolation and cloning of HCV, that he developed critical findings about the virus, and that he provided Chiron with assistance regarding cloning methods. Dr. Bradley began work on what was then called non-A, non-B hepatitis in 1977 and the dispute between Dr. Bradley and Chiron can be traced back to 1986 when the parties failed to agree on terms for Dr. Bradley to provide infected plasma to Chiron.

This paragraph is followed by several references, but those references are unrelated and don't support the given statements. Do we have a reference for the above, and what was the outcome of the lawsuit? AxelBoldt (talk) 16:56, 19 February 2008 (UTC)


 * Ok, I tracked down some sources for the history section and incorporated them. AxelBoldt (talk) 18:12, 20 February 2008 (UTC)

Spontaneous clearing?
What percentage of infected patients clear the virus from their body during the acute phase? Our article gives two different numbers: 20-30% and 80%.
 * Approximately 20-30% of persons infected with HCV clear the virus from their bodies during the acute phase

versus
 * Treatment during the acute infection phase has much higher success rates (greater than 90%) with a shorter duration of treatment (but balance this against the 80% chance of spontaneous clearance without treatment).

I added the self-contradict template. AxelBoldt (talk) 18:12, 20 February 2008 (UTC)
 * I fixed the self-contradiction, and provided references for the rates quoted. Probably the broadest and most authoritative reference is the NIH Consensus statement from 2002, which is publicly available, but I also cited primary literature.Scray (talk) 00:23, 23 February 2008 (UTC)


 * Thank you! AxelBoldt (talk) 17:00, 24 February 2008 (UTC)

Question on origin of virus image?
See Note on discussion page of Hepatitis C Virus page for details. the origin of the virus image is uncertain. if provenance of that image cannot be established, it may need to be deleted. lanephil, 2/25/08. Lanephil (talk) 22:15, 25 February 2008 (UTC)

Sexual exposure to blood
The anonymous edits by 75.15.151.119 under "Methods of transmission" were not substantiated by reference and not consistent with CDC recommendations, now referenced. Also, the meaning of the statement later in the same paragraph regarding trauma and anogenital mucosa was changed by 75.15.151.119's edit in a way that did not make sense.Scray (talk) 16:22, 1 March 2008 (UTC)

Citalopram
If interferon makes a hep C patient depressed, citalopram may improve matters pretty well JFW |  T@lk  15:08, 6 April 2008 (UTC)
 * Probably true for a variety of antidepressantsScray (talk) 17:10, 6 April 2008 (UTC)

Condoms in a monogamous relationship
Just wanted to take the talk out of the history list and into the Talk page. 64.230.93.135 may not be aware that the CDC site specifically states that there is little evidence to support using condoms to prevent HCV transmission in a long-term monogamous couple in which one partner has HCV. Reasons might include the very low transmission rate due to heterosexual contact (established in a number of studies), the possibility that HCV could be spread by non-sexual routes when it is transmitted within a couple, and the limitations of condoms (breakage, improper use, etc). Certainly, couples are advised to consider using condoms, particularly if there are other reasons to do so. The "Sexual exposure" section of this page cites the CDC guidance and some relevant studies. There are recent reports of acute HCV infection of gay men in a number of cities, but the men getting infected are characteristically promiscuous and engaging in high-risk behaviors (with serious mucosal trauma), so that's a different situation.Scray (talk) 03:06, 23 April 2008 (UTC)

High prevalence of HCV in IV drug users
Hi, I am not so great at using wikipedia, but I find this statement very hard to believe unless it is backed up by a good source: "An estimated 60% to 80% of all IV drug users in the United States have been infected with HCV." I found this in the section regarding how hcv is transmitted via injection drug use. If no one can find a source on this, I strongly suggest it be removed. It absolutely needs a source. Thanks! —Preceding unsigned comment added by 99.137.213.81 (talk) 06:52, 3 June 2008 (UTC)
 * Citation added (from CDC). Please note that you should add new comments to the bottom, not top, of a talk page.Scray (talk) 04:29, 4 June 2008 (UTC)

Casual contact
"HCV is not spread through casual contact such as hugging, kissing, or sharing eating or cooking utensils."

There are many instances in which these behaviors could result in the direct transmission of blood from person to person. Gums can freely bleed from many medical conditions. Some common examples include aphthous ulcers, oral ulcers, and flossing. As for hugging, it is (albeit extremely unlikely) possible to transmit blood between two seriously injured persons. If a bleeding STD can result in transmission, so can any of the aforesaid.

While may be statistically improbable, it is possible in theory to contract Hepatitis C this way, and therefore it is inappropriate to make this assertion in an encyclopedia unless scientifically proven otherwise. I have modified the excerpted text in the article, carefully trying to avoid WP:OR, as opposing this statement is even contradictory to statements made on the CDC's website. The fact that the disease may be transmitted from blood-blood is made abundantly clear in this article and those elsewhere, and therefore is self-evident that this statement in its current form is misleading and inappropriate for an encyclopedia. —  C M B J  10:21, 13 June 2008 (UTC)


 * Care while trying to avoid WP:OR does not ensure success, and in this case I think the edit crosses that line. I have rearranged a bit to put the cautionary bits about personal care objects and bleeding risks together, but I have restored the info about hugging, kissing, and sharing food utensils along with the CDC reference that specifically makes this statement.  It's appropriate to stick with the preponderance of evidence and reputable sources, rather than speculating on theoretical risks in an encyclopedia. Scray (talk) 04:23, 14 June 2008 (UTC)


 * I also urge you to review WP:minor_edit before flagging such edits as "minor". This edit  clearly violates the spirit of that guidance. Scray (talk) 04:28, 14 June 2008 (UTC)

Lancet
- 15% hepatitis C is acute (although symptoms are limited). Some diagnostic and therapeutic advice. JFW | T@lk  13:06, 25 July 2008 (UTC)

Hep C Nomads
Dear All,

Please see the following ling to hep C Nomads support page * A support website

I respectfully ask fellow Wikipedians to review and assess whether this is worthy of submission to the site.

Hepatitis C is a very serious health condition that is worryingly underestimated and apparently somewhat ignored by Government and the Health services. Most people receiving diagnosis receive very little information from their doctor because of the ignorance surrounding the condition. As a consequence the internet is usually the first port of call for the newly diagnosed.

Whilst there is some good info on the net and there is an informative section on Wikipedia there are myriad snake oil sites offering bogus cures and promulgating false, misleading and dangerous information.

Hep C Nomads is an English language forum, UK based but with a global membership which is free and managed and controlled by Hepatitis C sufferers. It brings together a broad spectrum of people from the newly diagnosed to the successfully treated with everything in-between, including people who have undergone liver transplants etc.

It is a vibrant, important and ever growing resource and is credited with supplying a vital lifeline to persons who are often in dire isolation as a result of their condition.

I urge that this site be considered for inclusion as it serves a worthy and vital function in bonding sufferers socially and also providing accredited scientific material for individuals who might not otherwise have access.

banch1965 —Preceding unsigned comment added by Banch1965 (talk • contribs) 10:33, 21 August 2008 (UTC)
 * An article here about the site, Hepcnomads was recently created by Banch1965 in liaison with the webmasters. I nominated it for deletion by me with &#123;{db|spam for nn-website}} and it was deleted with the reason "A7 (group): Doesn't indicate importance or significance of a group/company/etc.". A copy of the deleted text is available here. I was contacted by actual human-to-human telephone contact by Banch1965 requesting re-instatement of the article. Clearly it needs a bit of licking into shape but my view is now totally neutral: if someone else thinks the subject is notable, post it. I shall take no action. &mdash; RHaworth (Talk | contribs) 10:56, 21 August 2008 (UTC)


 * Per the guidelines found at WP:LINKS, #10 clearly states discussion forums are to be avoided. The proposed site falls under this category. It belongs in a directory, not on wikipedia. See also: WP:NOT. —Preceding unsigned comment added by Chaldor (talk • contribs) 06:17, 22 August 2008 (UTC)

Please see these three important links: http://www.thisishampshire.net/news/hampshirenews/display.var.2278867.0.my_life_with_hepatitis_c.php http://www.hepctrust.org.uk/OneStopCMS/Core/TemplateHandler.aspx?NRMODE=Published&NRNODEGUID=%7B7E111296-7AD0-447A-B733-7F84F41768A9%7D&NRORIGINALURL=%2fnews%2f2008%2fWorld%2bHepatitis%2bDay%2bNews%2fMy%2blife%2bwith%2bHepatitis%2bC.htm&NRCACHEHINT=NoModifyGuest http://www.timesonline.co.uk/tol/life_and_style/health/article3990791.ece

It is my belief that the nomenclature or styling of the Nomads merely as 'discussion forum' underestimates the work the group engages in in bringing public awareness to the global hepatitis c time-bomb. The site is more than a forum but a burgeoning social phenomenon actively working in the real world to bring attention to the threats presented to society, the exchequer, and sufferers by virus. I urge you to reconsider on these grounds. respectfully, Banch1965 Banch1965 (talk) 18:29, 22 August 2008 (UTC) Banch1965 (talk) 18:36, 22 August 2008 (UTC)Banch 1965Banch1965 (talk) 18:42, 22 August 2008 (UTC)

US Obsession
Excuse me, but is it really necessary for the US statistics to be the first available, and the first listed? Down in the section of the article that deals with infection of Hep C worldwide, the article states this: ''Hepatitis C infects nearly 200 million people worldwide and 4 million in the United States. '' This statement is so extremely bias and is followed by a long script dealing with the disease in the US. The information on the virus in other countries is minimal and short. I warrant it to be rewritten and to have the bias and slander of other countries removed. Why this article needs to focus on the US I'll never know, they're not the most important people in the world. —Preceding unsigned comment added by 202.67.69.215 (talk) 08:51, 27 November 2008 (UTC)


 * Sounds like you have some good ideas for editing the page, feel free to be bold and do so. --Scray (talk) 04:31, 28 November 2008 (UTC)

Risk of ITP
Risk of ITP is increased in all, while AIHA seems to be caused mainly by treatment: http://archinte.ama-assn.org/cgi/content/abstract/169/4/357 JFW | T@lk  09:52, 1 March 2009 (UTC)
 * I have not read that article yet. Did they confirm ITP conclusively, i.e. was hypersplenism excluded?  I ask because people with HCV will obviously have a higher rate of cirrhosis, which is impossible to exclude without a biopsy (I'll bet they did not biopsy all of these people).  At a minimum, I hope they looked for a surrogate of cirrhosis, e.g. esophageal varices, to confirm that they did not have significant confounding from HCV-related liver disease.  If this were in a better journal, or at least a liver-disease journal, I'd be more confident that it got an expert review prior to publication.  I will try to take a look, but I would not edit the HCV article based on a single publication in a journal that's not exactly top-tier.  --Scray (talk) 18:08, 1 March 2009 (UTC)

Attacking this
persuaded me to have a look at this article. I've been doing little edits on it over the last few years, but to bring it up to GA or FA some pretty heavy editing would be needed.
 * It needs to be organised according to WP:MEDMOS
 * We need to pick some recent high-quality sources that meet the requirements of WP:MEDRS

Some sources that might be useful:
 * (Clin Infect Dis 2009, review on novel therapies)
 * (J Hepatol 2008, review on acute hepatitis C)
 * (Lancet 2008, review on acute hepatitis C)
 * (Lancet 2003, slightly too old, review on hepatitis C in general)
 * (National guidelines, Netherlands, probably more for background reading)
 * (Ann Hepatol 2008, review on natural history)
 * (BMJ 2006, general review)

To be perfectly frank I'm a bit surprised that the major journals have not carried a general review on the disease for the last few years, unless you count the acute article in the Lancet. The UK guidelines are from 2001 (URL). The AASLD ones are from 2004 (URL). Clearly, we need to accept that there is about to be a major sea change in the treatment of hepatitis C, but that guidelines and review articles may lag behind a bit. I would therefore suggest that we rely on the 2003 Lancet article with support from more recent reviews if there have been major changes. JFW | T@lk  15:48, 10 March 2009 (UTC)


 * Further useful guideline documents:
 * 2003, French consensus
 * 2002, NIH consensus conference
 * JFW | T@lk  06:19, 11 March 2009 (UTC)


 * I notice that a lot of content is currently out of place: the "acute hepatitis C" section contains a whole piece on the diagnosis and treatment of acute hepatitis C, which belong in completely different sections if we want to remain true to the MEDMOS guideline. JFW | T@lk  06:32, 11 March 2009 (UTC)


 * And this: JFW |  T@lk  07:23, 11 March 2009 (UTC)


 * I switched the pie chart to an SVG one, but the source is now a redirect, and is US (CDC data) only. I tried to take a look around the WHO site real quick for any updated info but didn't see anything. Sorry if that was covered in one of the journal links you posted, but if you point me to an updated source I'll update the graphic. -Optigan13 (talk) 00:01, 12 March 2009 (UTC)

New expert
hello--I am a practicing board certified hepatologist. I made some edits today. Overall, this article contains some out of date data (viramidine and amantidine are both abandoned). I agree it seems to be influenced perhaps by those with some sort of agenda at times, but overall it is useful. I have changed a few things as I am a newbie to Wiki. (for example, we cure over half the patients overall, and the first paragraph said the minority). The discussion of the symptoms was no doubt written by a former or ongoing addict with a plethora of symptoms (some related to HCV, some not) who wanted everyone to know their symptoms. Some of the references are over 10 years old and contain out-of-date thoughts about the disease. I will check back in time and might edit it some more if there are no objections. Thanks, Dfdies (talk) 04:14, 29 March 2009 (UTC)


 * Thanks for your input! There's a lot you can do here. The most important task from my perspective is indeed revising the current content and ensuring it is based on reliable sources. I've left a list above, but I'm sure you might want to quote from textbooks if you think those are more accurate.
 * As I said, I was a bit surprised to find that this common disease has not really been formally reviewed in the core journals for quite a bit. JFW | T@lk  09:58, 29 March 2009 (UTC)

Surely this is a typo?
I was just starting to read through this page and found: Up to 50% of persons infected with HCV clear the virus from their bodies during the acute phase... ...The remaining 60-85% of patients infected with HCV develop chronic hepatitis C, i.e., infection lasting more than 6 months.

I was entirely unaware that up to 135% of people infected by Hep C could react in any manner.

Confused and slightly discouraged, can someone please help?


 * I have tried to make this clearer. It was not a typo, the problem arises when dealing with ranges— you can't add the up. Graham Colm  Talk

More than just five
The opening paragraph lists there being only 5 known hepatitis viruses. It would be more accurate to say that there are only five known clinically relevant hepatitis viruses. I don't have my books with me at the moment, but there is at the very least a known hepatitis G virus (mentioned briefly in both Robbin's Pathology and Goljan pathology) that can exist in a carrier state, is parenterally transmissible, but does NOT cause chronic hepatitis. glacialfury —Preceding unsigned comment added by 173.79.71.13 (talk) 09:28, 29 January 2010 (UTC)

Telaprevir
http://content.nejm.org/cgi/content/short/362/14/1292 - in relapsed/nonresponding to pegIFN and ribavirin. Given together with same leading to better virologic response rates. Mostly cutaneous toxicity. JFW | T@lk  18:15, 8 April 2010 (UTC)

The Picture
The picture has no reliable source. It was posted by PhD_Dre, who has apparently left Wikipedia. It's scattered around the Internet, also without a source. The Hepatitis A pix is from the CDC, and I don't see why we can't have a Hep C pix with an equally reliable pedigree. Since it has no particular visual value without a reliable source, I move it be deleted. Bruce Swanson 20:16, 8 April 2010 (UTC) —Preceding unsigned comment added by BruceSwanson (talk • contribs)
 * I agree, but I doubt that an electron micrograph of HCV from a reliable source is available. Flaviruses are probably indistinguishable by electron microscopy but this is no excuse for this image's retention. It's not a good image in any case. Graham Colm (talk) 21:05, 8 April 2010 (UTC)