Hepatitis C Choices© Book

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“Hepatitis C Choices is the most thoughtfully produced patient education book around. It covers every aspect of hepatitis C diagnosis, care, and health management. The book presents a fair and comprehensive review of both traditional and complementary therapies. It is a ‘must-have’ for patients and providers alike.” ~ Andi Thomas, HealthPro Solutions

The Caring Ambassadors Hepatitis C Program is pleased to present: Hepatitis C Choices, 4th Edition, created to help you become the best possible advocate for your own healthcare. We hope it provides useful information to help you make treatment and lifestyle choices that are right for you.


This book was created to provide information about a wide variety of approaches to the treatment and management of chronic hepatitis C. The Caring Ambassadors Hepatitis C Program and the authors of Hepatitis C Choices believe access to good information leads to better decisions. However, this book is not a substitute for medical advice. It is critical that you consult your healthcare provider about any matter concerning your health, particularly with regard to new or changing symptoms that may require medical attention.

Each chapter and section of the book has been authored independently. Therefore, each chapter reflects the unique approach to the treatment of hepatitis C of its author, based on his or her medical discipline and experience. For this reason, an author is responsible only for the accuracy of the information presented in his or her chapter or section. No author can confirm the accuracy of the information presented in any other chapter or section.

Most of the contributors to Hepatitis C Choices are members of the Caring Ambassadors Hepatitis C Medical Team. Others are guest authors invited by the Caring Ambassadors Hepatitis C Program. The unifying characteristic of the Hepatitis C Medical Team is a willingness to listen and evaluate the diverse viewpoints and treatment options available to people with chronic hepatitis C. Hepatitis C Choices evolved from a consensus within the Hepatitis C Medical Team that a single resource describing the various modalities of treatment available would be useful to people with hepatitis C. Cooperation and open discussion are key components of the interaction among members of the Hepatitis C Medical Team, though individual members remain aligned with their own discipline.

Be aware that the only treatment proven through controlled clinical trials to show sustained clearance of the hepatitis C virus (as detected by HCV RNA testing of the blood) is a combination of direct acting antivirals (DAA’s) with or without an interferon-based antiviral therapy some therapies have achieved a 90 – 100 % cure rate. People receiving this treatment remain virus-free and are considered cured of the hepatitis C virus,

We strongly encourage anyone who has significant fibrosis on liver biopsy to be followed closely for evidence of disease progression. This should include a medical history, physical examination, and laboratory tests. People with cirrhosis need to be monitored for clinical and biochemical deterioration, and considered for referral to a liver transplant center. If liver failure occurs, liver transplantation counseling should be sought immediately. Regular screening for the development of liver cancer (hepatocellular carcinoma) should be part of any ongoing hepatitis C management plan.

The choice of treatment for hepatitis C is a personal one. What is right for one person may not be so for another. What is right for you will depend on the status of your disease, the health of your liver, your age, lifestyle, treatment goals, and many other factors. We encourage you to carefully assess the information provided here and elsewhere, and to work with your healthcare providers to choose treatment approaches that meet your individual needs and goals.

We strongly recommend that you review the Recommendations for Testing, Managing, and Treating Hepatitis C that were developed by the American Association for the Study of Liver Diseases and the Infectious Diseases Society of America. These guidelines, which the Caring Ambassadors Program strongly endorses, can be found at www.hcvguidelines.org.


Be sure to talk with your doctor about all of your other medications prior to taking any prescription. Treatments for hepatitis C are evolving faster than ever and the Caring Ambassadors Program is actively working on updating Hepatitis C Choices to reflect all of these exciting developments. While many sections of the book are as relevant as ever, Part 2, which covers Treatment and Management Approaches, is being completely rewritten to reflect new science and current practice.

Table of Contents

Individual chapters are available in PDF format within each Part.

PART 1: Information for Everyone with Hepatitis
Chapter 1: How to Use Hepatitis C Choices

Chapter 2: Overview of Hepatitis C, Robert G. Gish, MD

Chapter 3: Alcohol and Hepatitis C, Douglas R. LaBrecque, MD and Lorren Sandt

Chapter 4: Understanding Hepatitis C Disease

 Section 1: Liver Disease Progression, Lorren Sandt

 Section 2: Promoting Liver Health, Lorren Sandt

Chapter 5: Signs and Symptoms That May Be Associated with Hepatitis C, Tina M. St. John, MD

Chapter 6: Laboratory Tests and Procedures, Tina M. St. John, MD

Chapter 7: The Immune System and Hepatitis C

 Section 1: Meet the Immune System, Tina M. St. John, MD

 Section 2: Immunology Takes on Hepatitis C, Stewart Cooper, MD

PART 2: Hepatitis C Treatment and Management Approaches

Chapter 8: Western (Allopathic) Medicine

 Section 1: Allopathic Hepatitis C Treatment Overview, Douglas R. LaBrecque, MD

 Section 2: Initial Treatment Options, Douglas R. LaBrecque, MD

 Section 3: Options When Initial Treatment Fails to Clear the Hepatitis C Virus, Gregory T. Everson, MD

 Section 4: Future of Allopathic Hepatitis C Treatment, Anthoney Martinez, MD and Robert G. Gish, MD

Chapter 9: Integrative Medicine, Randy J. Horwitz, MD, PhD and Julia Jernberg, MD

Chapter 10: Ayurvedic Medicine, Shri K. Mishra, MD, MS, Bharathi Ravi, BAMS, and Sivaramaprasad Vinjamury, MD

Chapter 11: Chinese Medicine

• Section 1: Traditional Chinese Medicine and Hepatitis C, Misha Cohen, OMD, LAc

 Section 2: Modern Chinese Medicine Therapeutics for Hepatitis C, Qing Cai Zhang, MD (China), LAc

Chapter 12: Homeopathic Medicine, Sylvia Flesner, ND

Chapter 13: Mind-Body Medicine & Spiritual Healing, Sharon D. Montes, MD

Chapter 14: Naturopathic Medicine, J. Lyn Patrick, ND,

Chapter 15: Nutrition and Hepatitis C, Lark Lands, PhD

Chapter 16: Nutritional Supplementation, Lark Lands, PhD and J. Lyn Patrick, ND

Chapter 17: Products Marketed to People with Hepatitis C, J. Lyn Patrick, ND

PART 3: Other Topics for People Living with Hepatitis C

Chapter 18: Women and Hepatitis C, Norah Terrault, MD and Jessica Irwin, PAC

Chapter 19: Hepatitis C in Children, Aparna Roy, MD, MPH and Kathleen Schwarz, MD

Chapter 20: HIV/HCV Coinfection

 Section 1: Overview of HIV/HCV Coinfection, Misha Cohen, OMD, LAc and Tina M. St. John, MD

 Section 2: Western (Allopathic) Treatment Options, Tina M. St. John, MD and Misha Cohen, OMD, LAc

 Section 3: Alternative Eastern Treatment Options, Misha Cohen, OMD, LAc

 Section 4: Naturopathic Treatment Options, J. Lyn Patrick, ND

Chapter 21: Mental Health & Hepatitis C

 Section 1: Mental Health & Neurocognitive Issues Associated with Hepatitis C Infection, Julie Nelligan, PhD, David W. Indest, PsyD, and Peter Hauser, MD

 Section 2: Mental Health Issues in the Setting of Interferon-Based Therapy, Joyce Seiko Kobayashi, MD

 Section 3: Interferon-Based Therapy in Recovery, Amy E. Smith, PAC and Diana L. Sylvestre, MD

 Section 4: Psychosocial Issues and HCV, Susan L. Zickmund, PhD

Chapter 22: Military Veterans & Hepatitis C,  Terry Baker

Chapter 23: Choosing: My Journey, My Choices, Randy Dietrich

Chapter 24: A Look to the Future, Lorren Sandt