Hepatitis C

Expected Duration

Prevention

What Is It?

Hepatitis C is a viral infection that can inflame and damage the liver. The hepatitis C virus usually is transmitted through contact with infected blood, most commonly by sharing needles during intravenous drug use. The disease also can be spread:

• On shared straws or other devices used to snort cocaine
• Through unprotected sexual intercourse, but this is uncommon
• To a health care worker through an accidental stick with a contaminated needle
• Through blood transfusion — Before 1992, people who received blood transfusions were at significant risk of developing hepatitis C, but because blood screening techniques have improved, the chance of catching the infection through contaminated blood transfusion has decreased to about one in 100,000.
• On infected tattoo or body piercing equipment

Once someone has been exposed to the hepatitis C virus, it usually takes one to three weeks before the virus can be detected in his or her blood.

Up to 80% of people who develop short-term (acute) hepatitis C develop long-term (chronic) hepatitis C. Most of these people, however, don't know that they have this infection because hepatitis C usually does not cause symptoms. After having this silent infection for 20 to 30 years, about 30% of people develop cirrhosis, a serious liver disease that can lead to death. A smaller percentage of people with long-term hepatitis C develop liver cancer. About 10,000 people in the United States die from complications of hepatitis C each year.

Symptoms

Many people with hepatitis C do not have any symptoms. However, about 30% of infected people develop symptoms, including:

• A general sick feeling (malaise)
• A yellowish discoloration of the skin (jaundice)
• Weakness
• Poor appetite
• Fatigue

Less than 20% of people who become infected with hepatitis C are able to rid their bodies of the virus completely. These people rarely suffer any long-term consequences of the disease.

About 30% of people with long-term hepatitis C will develop general symptoms, such as weight loss, a poor appetite, fatigue and aching joints. Most people, however, do not have any symptoms for 20 to 30 years after they contract the infection, even though the virus slowly damages their livers. Unless they are tested for hepatitis C, many of these people do not know that they are infected until they develop the symptoms of advanced liver disease.

Diagnosis

Your doctor will ask you about symptoms related to acute or chronic hepatitis C or advanced liver disease. He or she will ask if you have any risk factors for hepatitis C, such as a history of intravenous drug use, nasal cocaine use or blood transfusions, especially before 1992. Your doctor will ask about your sexual history, because people with more than one sexual partner are more likely to develop hepatitis C. If you have ever worked in the health care field, your doctor will ask if you could have been stuck with a needle accidentally. In rare cases, people on long-term hemodialysis become infected with hepatitis C through contaminated equipment.

Your doctor will examine you, looking for evidence of liver disease, such as an enlarged liver or spleen, a swollen abdomen, ankle swelling or muscle wasting.

Hepatitis C infection is confirmed by certain tests that work in one of two ways. Either they test for the presence of the virus in your blood or they detect infection-fighting proteins (antibodies) that your body has made to fight the hepatitis C virus. These antibodies indicate that you have been exposed to the virus in the past. The virus itself can be detected with a test called a polymerase chain reaction. Antibody tests include enzyme immunoassays and recombinant immunoblot assays.

If you have hepatitis C infection, your doctor will order blood tests to determine if you have liver disease. Results of these tests are abnormal in about two-thirds of people with hepatitis C. Special blood testing will also be done to determine which subtype of the virus you have, as different subtypes have different response rates with treatment. A liver biopsy may be needed and, in most cases, is done before medical treatment is started. In a biopsy, a small piece of tissue from your liver is removed and examined in a laboratory.

Less than 20% of people with hepatitis C are able to rid their bodies of the virus within six months. Most people have the infection for life. Some eventually develop cirrhosis or other forms of severe liver disease.

There is no vaccine to protect against hepatitis C, so the only way to prevent this disease is to avoid the risk factors.

The risk of contracting hepatitis C through sexual activity appears to be low, except for people with HIV or other sexually transmitted diseases. Someone in a long-term relationship with one person can become infected if the partner has hepatitis C, but this rarely occurs. For this reason, people with hepatitis C in these types of relationships generally do not need to take special precautions to protect their partners from infection. You should discuss your need for precautions with your doctor.

Right now, these are the most effective ways to prevent hepatitis C:

• Don't inject illegal drugs.
• Don't snort cocaine.
• If you are considering body piercing or tattooing, make sure the procedure is done using equipment that has been cleaned properly.
• If you are a health care worker, follow standard infection control precautions (gowns, gloves, hand washing, etc.) to prevent contact with a patient's blood.
• Do not have unprotected sexual intercourse unless you are in a long-term relationship with one person.

Because drinking alcohol makes hepatitis C worse, people who have the disease should significantly reduce the amount of alcohol they drink or avoid using alcohol entirely.

Treatment

Not everyone infected with hepatitis C needs treatment. If you are infected, your doctor will discuss the benefits and side effects of treatment and the likelihood that treatment will improve your condition. Your doctor will recommend that you receive vaccinations against hepatitis A and B, unless you already have been infected with these viruses, to reduce the chance that you will have further liver damage.

In the past, a medication called alpha interferon commonly was used to treat hepatitis C. However, although nearly 50% of people initially improved with this therapy, the benefits of treatment rarely lasted longer than six months. For this reason, alpha interferon now usually is given with an antiviral drug called ribavirin (Virazole). About sixty percent of patients who take this combination therapy will clear the virus from their blood. The prognosis varies with the subtype of the virus. Patients infected with genotype 2 or 3 have a higher rate of response, while those infected with genotype 1 are less likely to response to treatment.

Some people are unable to tolerate the side effects of this treatment, and it is not recommended for people with certain medical problems. Alpha interferon causes a wide variety of side effects, including a general sick feeling (malaise), depression, difficulties with concentration, anemia, thyroid disease and, less commonly, autoimmune conditions. That's why this medication is not recommended for people who have a history of depression, autoimmune diseases, certain blood diseases and a variety of other chronic medical conditions. Ribavirin is tolerated more easily. Its main side effect is anemia.

Antiviral therapy also is not recommended for people who have advanced liver disease or for people who are active users of alcohol or illegal drugs.

When To Call A Professional

Call your doctor if you have symptoms of hepatitis or if you believe that you have been exposed to someone who has hepatitis.

The U.S. National Institutes of Health (NIH) recommends that certain high-risk groups of people be tested for hepatitis C, including:

• Those who received transfusions of blood or blood products before 1992
• Drug users who inject drugs or snort cocaine
• People on long-term hemodialysis
• People with a history of sex with multiple partners
• Spouses of those with hepatitis C
• Those who live in the same household as someone with hepatitis C

If you are among these high-risk people, call your doctor and ask about hepatitis C testing.

Prognosis

Up to 80% of people infected with hepatitis C virus eventually develop chronic hepatitis. After approximately 20 years of chronic hepatitis C infection, about 20% of people develop cirrhosis, and about 1% to 5% develop a form of liver cancer called hepatocellular carcinoma. Effective treatment with anti-viral therapy will decrease the risk of developing cirrhosis and liver cancer.

Additional Info

American Liver Foundation

75 Maiden Lane

Suite 603

New York, NY 10038

Phone: (212) 668-1000

Toll-Free: (800) 465-4837

Fax: (212) 483-8179

E-Mail: info@liverfoundation.org

http://www.liverfoundation.org/