Hepatitis C

Hepatitis means inflammation of the liver. It can be caused by many things, including viruses, alcohol, drugs and certain genetic conditions. It can be acute, lasting less than six months, or chronic. Chronic hepatitis can lead to long term liver damage resulting in cirrhosis.

Hepatitis C is a virus that attacks and invades liver cells. As a result of being infected by the virus, the liver cells may be injured and die. The damaged areas are replaced by scar tissue (fibrosis). Cirrhosis is a result of extensive scarring of the liver.

Hepatitis C accounts for 60 to 70 percent of the cases of chronic hepatitis in the United States. Most patients have no symptoms and may not be aware they are infected. It is the leading cause of cirrhosis and liver cancer, and the most common reason for liver transplantation in the US.

Transmission

Hepatitis C is acquired by blood-to-blood contact. Common modes of transmission include:

  • Injection or intranasal drug use
  • Blood transfusion or organ transplantation before 1992
  • Kidney dialysis
  • Needlestick
  • Tattoos, body piercing or acupuncture
  • High-risk sexual activity (multiple partners)
  • Maternal to fetal transmission
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Symptoms

Symptoms develop in only 25 to 35 percent of the patients who acquire acute hepatitis C and are often very nonspecific. Therefore, the disease is only rarely diagnosed at this phase. Seventy-five to 85 percent of patients infected with acute hepatitis C will develop a persistent infection called chronic hepatitis C.

Chronic hepatitis C is referred to as a "silent epidemic," as many times those affected are asymptomatic or may present with very nonspecific symptoms such as fatigue. Some patients may be discovered to have hepatitis C when they are found to have abnormalities of routine liver laboratory tests (AST/ALT). However, others may have chronic hepatitis C with normal liver enzymes. It is important to be screened for hepatitis C if you have any risk factors, regardless of the liver enzymes.

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Diagnosis

Screening involves a blood test which evaluates for antibodies to hepatitis C. If the screening test is positive for antibody, indicating you may have been exposed to the virus in the past, a viral load (HCV-RNA) test will be performed to determine if virus is still present in the blood stream (viremia).

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Treatments

Hepatitis C is curable in more than 50 percent of patients. There are many factors which may influence the likelihood of responding to treatment. Some of these include genotype (strain) of the virus, the viral load, body weight, extent of scarring of the liver, gender and age.

There are six different "strains" or genotypes of the virus. The length of treatment is determined by genotype and response to therapy. Genotype 1 is the most common in the United States. It is also one of the most difficult to treat.

The standard of care for treatment of chronic hepatitis C is Pegylated Interferon injections once a week combined with daily Ribavirin pills. Interferon boosts the immune system to attack liver cells infected with hepatitis C virus and inhibits viral replication. Ribavirin has a broad-spectrum of antiviral activity and inhibits replication and infectivity of the virus.

There can be many side effects associated with interferon, some of which include flu-like symptoms, nausea, depression, injection site reactions and lowering of certain blood counts. Ribavirin can cause anemia, fatigue, headache and skin rash. Despite a multitude of possible side effects, most patients are able to tolerate and complete the treatment. Expert treatment centers are skilled in strategies to minimize these side effects to allow patients to continue therapy.

There are many new and exciting therapies being developed for hepatitis C. This is a rapidly evolving field. There are now options for those who have failed standard therapies.

Prevention

Currently there is no vaccine available for hepatitis C. However, there are precautions you can take to reduce the risk of becoming infected.

  • If you inject drugs, never share needles or other instruments. Find out if your community has a needle exchange program.
  • Reduce the number of sex partners you have and practice safe sex by using a latex condom correctly and with every sexual encounter
  • Wear protective gloves and clothing if you are a healthcare worker and work with blood, needles or other potentially contaminated objects
  • Get vaccinated against hepatitis B
  • Check to make sure that practitioners who do your ear piercing, body piercing or tattoos use sterilized instruments
  • Razors and toiletry items should not be shared with infected individuals