I was diagnosed with hepatitis C about one month ago and was found to have a viral load of 9.7 million. I was found negative for hepatitis A and B. What do those numbers mean? Is this a dangerous level? I have no health insurance, and I am scared.

Sheri

Hepatitis C is an infection of the liver caused by the hepatitis C virus. It is very common, with an estimated 3 million people infected in the United States alone. Between 20 and 50 percent of people with hepatitis C will develop significant liver disease after 20 years. Many factors increase the rate of progression to liver disease, including alcohol abuse, HIV infection and infection with other hepatitis viruses. The fact that you are not infected with the hepatitis B virus is one thing in your favor.

The viral load is the number of viral particles per milliliter of blood. For HIV infection, the viral load is the single best predictor of future outcome. For hepatitis C, on the other hand, studies about the predictive value of the viral load are inconclusive. Certainly, if the viral load is persistently undetectable, then the disease would be unlikely to progress. (This would be rare, however, as most patients who become chronically infected with hepatitis C have a detectable viral load.) The hepatitis C viral load is typically around 1 million copies per milliliter, but it can be much higher or significantly lower. Again, studies are conflicting regarding the significance of a higher number.

The treatment of hepatitis C usually involves a combination of two antiviral agents, interferon (Intron A) and ribavirin (Virazole). These are typically given for 12 months if the initial response is good. Although most patients have some initial response, long-term effectiveness is seen in only 10 to 40 percent of patients. Some research studies show some correlation between the level of viral load and the response to treatment. In several studies, a viral load over 1 million copies makes the patient less likely to have a good, durable response to interferon and/or ribavirin.

The last point to make is regarding your lack of health insurance. I cannot stress enough the importance of adequate health insurance. As far as I am concerned, health insurance should be the first thing on the top of everyone's monthly budget, before rent, mortgage and even food. You can always eat very inexpensively, but you can never get health care inexpensively.

Is there any way you can get health insurance through work? If not, what if you change jobs? While most private insurance carriers exclude patients with the pre-existing medical condition of hepatitis C, job-related health insurance usually does not do so. However, these carriers may have a time period (say, one to 12 months) when you cannot receive treatment for the pre-existing condition. The treatments for hepatitis C, including a necessary liver biopsy, are quite expensive -- too expensive for most people to pay out of pocket. One possibility you should look into is enrolling in a medical-research study. Studies on hepatitis C are going on at many universities, and the medical interventions are usually free of charge. I do not know where you live, but if it is near a university, I would contact them to see if there are any such research studies.