Many people find out they have been exposed to hepatitis when routine blood work is drawn for a life insurance policy, other physical exam or when they donate blood. Still others may have one or more of the risk factors and want to be tested to see if the virus is present. The best place to start is with your family physician. He or she can discuss your risk factors with you and send you to a lab for testing.

The public health department and the Veteran's Administration can also refer you for testing. Unless you believe you are at risk, one of the easiest ways to be tested is to donate blood. If you are positive, they will notify you. If you are not, you will have done a great service to your community by donating blood. Remember, if you believe you may be at risk, see your physician and be tested, prior to donating blood.

What Test Should I Expect? (Part 1)
Testing for hepatitis B usually involves a test that measures the surface antigen (HbsAg). This is a test that measures to see if the virus' outer coat is present in the blood. If this test is positive and you are feeling ill, you may have an acute infection. However, if this test is positive and you are feeling normal, chronic disease may me suspected. Tests such as the hepatitis B e antigen (HbeAg), the hepatitis B core antibody- IgM (anti-HBc-IgM), the hepatitis B core antibody-IgG (anti-HBc-IgG), the hepatitis B e antibody test (anti-HbeAg), and the HBV-DNA test may be requested. The results of these tests will be used to determine if the disease is acute or chronic.

Genotyping may also be done to determine the genetic make-up of the virus. This may help predict how well a person will respond to treatment. Seventy percent of those infected in the US are genotype I. Other blood testing for both hepatitis B and C may include a variety of liver function tests that will help your physician see how well your liver is working. It is important to note, however, that a person's liver function tests may be completely normal and still have the virus present in their body. A liver biopsy may also be recommended if you test positive. This test takes a tiny piece of liver to be examined under a microscope. This will give your doctor information regarding the amount of damage to your liver

You may not remember how you were exposed to the virus. Many people do not know how or when they may have been infected. In fact, many people do not fit in any of the high-risk categories. However, not knowing how or when you were exposed will not effect the outcome of the disease. If you do indeed test positive, you must educate yourself about your disease and learn how not to transmit it to anyone else. This is important to you, your family, friends, and the general community. It is important for you to remember you are not alone and there are treatments and people that can help.

Once your physician tells you that you have hepatitis there will be many questions in your mind. You are probably frightened, overwhelmed and wondering what to expect now. Your physician will discuss with your options for treatment and the importance of taking care of yourself. Take the time to sit and think and talk to your physician. Start writing down all your questions. You will never remember them all when it comes time to see your doctor. You may feel too shocked, shy, sad, angry or depressed to talk about it, even though beginning may be difficult, and this is a good time to start gaining the information you need to take control of your illness.

Many people wonder if they are contagious. Casual transmission of hepatitis has not been reported. You cannot get it by touching a door handle, drinking from the same glass, kissing on the cheek, hugging or shaking hands with someone who is infected. It cannot be spread through food or water. Common sense must be used. If you cut yourself, clean up the blood thoroughly with a disinfectant and avoid exposing others to your blood by covering open wounds. Not sharing razors, nail brushes toothbrushes, manicure tools or anything else that may have blood on it is also important. Dispose of sanitary items carefully. Sharing drug needles and cocaine straws will definitely put the other person at risk. With hepatitis C, multiple sex partners is considered a risk, however, transmission betweenmonogamous partners is rare. This differs considerably from hepatitis B, which is easily transmitted through sex. Using condoms and practicing safe sex is advised. Inform your healthcare provider including your dentist and physicians about your illness and treatment choices.

With hepatitis C once the status of disease is determined, treatment recommendations will be made. Depending on what has already been determined, your physician may recommend an interferon-based treatment. Many physicians are now recommending early treatment to bring down the viral load (PCR) as quickly as possible. Much research is still being done on when the ideal time is to begin treatment and there are still many different medical opinions regarding this.

Treatment choices are very individual and based on many different factors including your viral load and the amount of inflammation in your liver. Hepatitis B is less likely to become chronic and require treatment. Some people can carry the virus and are capable of spreading it to other people, but never feel sick themselves. Others cannot get rid of the virus on their own and will require further treatment to fight the disease. Interferon alpha is also used to treat hepatitis B. Prior to treatment, a hepatitis B DNA test (HBV DNA) is drawn. This may help you physician determine if you are likely to respond to treatment. Those people that have less virus respond better that those with very may high levels of the virus.

You may be wondering what your options are and where you go from here.
Determining what is right for you may take more than one opinion from physicians who are experts at treating this disease. Your family physician may be helpful in directing you to a specialist. Also, national organizations such as the Hepatitis Foundation International, American Liver Foundation, and others may be able to direct you to specialists in your area. Your local hospital directory, local medical society and your health insurance carrier may also assist you in locating a physician. If you are unsure if your physician is qualified to treat hepatitis, ask him or her how many hepatitis C patients they treat. Your physician may be comfortable treating hepatitis C or may refer you to a specialist for consideration of further treatment. Further testing, such as a liver biopsy, may be recommended.

Disease treatment is a difficult decision for many people and you must take the time to weigh your options carefully by utilizing the best information available. Medical history, physical exams and tests will be done to gather the information necessary for your physician to make the best treatment recommendations. Your physician should be a partner with you in your care decisions. Regardless of your treatment choice, your body will need some extra care from you. It is important that you get enough rest. Eating right, even if you don't feel like eating, is critical so your body has the energy it needs to heal. It is important that you drink plenty of water and eliminate caffeine and alcohol entirely. Avoid additional stresses as much as possible. Talking with a support group, friend, family member, counselor or clergy can help you deal with the stresses in your life.

You may be feeling very frightened, alone and scared and don't know where to turn for help. Your mind can get very distracted and confused, but it is important to stay focussed and deal with the facts. If your diagnosis has not been confirmed, you need to start with an accurate diagnosis. Once your diagnosis is confirmed, there are many resources available to you. You'll find a wealth of information and support at our Hepatitis Neighborhood Support Center. The Support Center can help you to locate local support groups and other resources. Depending on where you live, some communities have more resources than others do. This may not be based on the size of the community. Many smaller communities have numerous resources as well as support groups. Also, national organizations can lead you to resources in your area. Your local hospital or the closest medical school are also possible places that may be able to help.

With hepatitis B, you may be feeling ill and have hopes that the medication will quickly help make your symptoms improve. If you are too sick with hepatitis B, the treatment may do more harm than good and your physician may decide to postpone treatment. Again, this will be a decision you will make with your physician. Once you start therapy, there may be many side effects to deal with. This differs with every person. How one person responds to treatment is not necessarily an indication of how another person may respond. You may feel ill at the start of therapy, it may continue or taper off as treatment continues. However, you may not feel ill at all. Again, this will vary with each individual. With hepatitis B, which also involves the use of interferon alpha, you may initially feel worse.

One way that interferon works is by stimulating the immune system to attack the infected liver cells. It is because of this attack, there may be times when symptoms of the disease are worse than before the treatment began. This is called a flare and is actually a good sign. It will occur more often in patients that respond to the treatment than those that don't. Interferon therapy can be difficult to complete. Family, friends, and your community can be invaluable to you during this time. They may want to educate themselves about hepatitis B to better help you through treatment. You are not alone, it is the time to ask for help. Local support groups, internet chat rooms and hepatitis organizations can be useful in helping you to share your feelings with others who understand what you are going through. Healthcare providers, including the pharmacy where you are obtaining your medication, should have professionals who are able to help provide information to deal with the side effects of your treatment and help you to complete your therapy. These professionals should be available to you 24 hours a day, seven days a week.

Side effects commonly associated with interferon therapy include flu-like symptoms, fatigue, loss of appetite, weight changes, (decrease), nausea and diarrhea, mental status changes, skin changes, (erythema or rash), hair loss and blood count changes. Although most of the side effects are not life threatening, they often have tremendous impact on a patient's quality of life. Physical side effects such as the flu-like syndrome, gastrointestinal effects, fatigue and mental status changes may influence quality of life due to change in the capacity to continue socializing as in the past and coping mentally and physically.

Flu-like syndrome may be defined as a group of signs and symptoms that may include fever, chills, rigors, muscle aches, headache, fatigue and upper respiratory symptoms such as cough and nasal congestion, and gastrointestinal symptoms such as anorexia and nausea, vomiting and diarrhea. Gastrointestinal symptoms effect nutritional status. Maintenance of nutritional status during Interferon therapy is very important because anorexia and associated weight loss are common. Patients often complain of taste changes, a decreased craving for food or lack of motivation to eat. Patients tend to be sensitive to food odors and may be unable to eat because of nausea. Mental status changes associated with interferon therapy such as depression, anxiety, agitation and mood changes are also commonly reported.

For many patients, fatigue may be the most challenging. It potentially influences sense of well being, daily performance, activities of daily living and relationships with family and friends and compliance with therapy. It is often difficult to recognize the symptoms of fatigue, it is important to understand the potential impact fatigue may have on you during therapy. Managing the side effects associated with interferon therapy represents one of the primary challenges to every patient. Learning as much as possible about the management of side effects will be of great assistance to you.

You may wonder if the treatment is working. During the course of your treatment your physician will monitor your disease and how well you are tolerating treatment. He or she may draw blood for PCR or HBV-DNA testing to see if the treatment is effecting your viral load. He or she may take blood to look at how well your liver is working. He or she will determine your overall well being. Once you start treatment it is essential that you remain compliant and committed to remain on it for its duration. This is essential to your overall response to the treatment. Open communication with your physician and other healthcare workers such as your pharmacist and nurse is necessary to achieve an overall positive treatment outcome. Keeping a detailed journal of physician appointments, discussions, lab results, tests and medication regimen wil save you from having to remember these details, so you can monitor your progress throughout therapy.

It may seem hard to believe, but your treatment will come to an end. Gradually you will start to feel better and symptoms will subside. You will feel your energy starting to return. It seems difficult while you are on treatment, but your life will slowly begin to become more normal. If you had a good response to treatment, your physician will recommend a follow-up schedule for you to monitor your status and disease. If you did not have an adequate response, your physician will discuss further options with you.

You may be feeling very frightened, alone and scared and don't know where to turn for help. Your mind can get very distracted and confused, but it is important to stay focussed and deal with the facts. If your diagnosis has not been confirmed, you need to start with an accurate diagnosis. Once your diagnosis is confirmed, there are many resources available to you. You'll find a wealth of information and support at our Hepatitis Neighborhood Support Center. The Support Center can help you to locate local Support Groups and other resources. Depending on where you live, some communities have more resources than others do. This may not be based on the size of the community. Many smaller communities have numerous resources as well as support groups. Also, national organizations can lead you to resources in your area. Your local hospital or the closest medical school are also possible places that may be able to help.

Once your treatment is completed, your physician will continue to monitor the status of your disease. For patients that responded as evidenced by the disappearance of the virus from your blood, your physician will continue to monitor your disease status and treatment recovery. For those that did not respond to the initial treatment, further treatment may be recommended. Patients who initially had a response then relapse, further treatment may also be recommended.

Many treatments are under clinical investigation now and new treatments will be introduced over the next few years. Your physician and other healthcare providers can keep you updated on the latest developments as well as numerous other resources such as the Internet, local and national organizations, and support groups that are available to you.

There are those who will not respond to interferon-based therapy either alone or with another drug. Taking care of yourself and communication with your physician are important tools in fighting this disease. Keeping abreast of the latest developments and keeping a positive mental outlook are also very important. Everyday we hear about a promising new drug that is being tested for either hepatitis B or C. Clinical trials take a long time and waiting for new treatment can be frustrating.