Hi B.,
I specialize in writing about infectious disease, especially Hepatitis. HCV can occur as either an acute or chronic disease. If you were diagnosed 40 years ago, it's clear that you have chronic HCV, which is very serious, indeed. The virus itself does not destroy the liver: instead, the damage is done by the body's immunological response in its attempt to fight the virus by killing the cells harboring the virus. Thus, it is very important that you get treatment to reduce your viral load (how much virus that can be detected in your blood) as low as possible -- preferably to the point where it's undetectable. The less Hep C virus you carry in your liver cells, the less your body attacks the liver, and the longer you live with a better quality of life (and without a liver transplant).
Standard therapy is to treat with pegylated interferon 2-alpha and ribaviron. Interferon blocks the release of viral particles from infected cells so that new cells can't be infected. It boosts the inate immune response, but not in a way that kills cells. Ribaviron keeps the virus from replicating (producing more copies of itself). Your daughter may think it's too cookie cutter, but there really isn't any other approved therapy available.
There is a move to individualize therapy, however. Before beginning therapy, it is very important the your doctor genotype the HCV that you harbor and get an accurate viral load. Genotypes 2 and 3 tend to respond much better to therapy than types 1 and 4. Knowing what genotype you have can help your doctor predict the likelihood that you will respond well to medication and how long you should stay on the treatment. Standard treatment length is 48 weeks, but new research indicates that people who respond very rapidly (called EVR -- early viral response) with at least a 2 log reduction in viral load (i.e., 100 times less than started with) after 4 weeks of therapy have a greater likelihood of achieving remission of the disease and sustaining remission of the disease. They also can be treated for a shorter amount of time -- 24 weeks, rather than 48 weeks. This is good to know, since the therapy is not pleasant for most people.
It is also very important to know what your initial viral load is -- not just so your doctor can tell if you're responding to therapy, but also because it is predictive of how well and whether you're likely to respond. Usually, people harboring less than 200,000 to 500,000 viral copies/mL blood are expected to respond better and are more likely to achieve sustained remission.
So -- make sure you're seeing a board certified hepatologist who is familiar with all of this -- a general practitioner is not experienced enough. GET THE TREATMENT, and START NOW. Also, if there is a chance that others in your family and circle of friends/acquaintances have come into contact with your blood they should get tested as well. Anyone you have had a sexual relationship with should be tested, although if you have been in a long-term monogamous relationship it is, believe it or not, not very likely that your mate has been infected. BUT, if you were diagnosed with HCV before you had children, they should be tested immediately as there is a high rate of transmission from mother to fetus.
BTW, your doctor will want to do periodic punch biopsies to determine the extent of liver damage. There are now blood tests that can be used in combination that can give just as accurate information as the biopsy and with far less pain and risk. Ask your doctor to learn about the APRI set of tests. Also, within the next couple of years, Siemens Healthcare Diagnostics should have its ELF test on the market in the US. This has been used with great success in the UK, but is only available from one lab, iQur, Ltd. (Southampton, UK). Both of these tests measure fibrotic processes and turnover of cellular products in the liver (your doctor will know what this means).
Good luck B.. This will be a tough disease to get control of, but it can be done.
R.
