What
is hepatitis C?
Hepatitis C (HCV)
causes inflammation of the liver. First called non-A non-B hepatitis, hepatitis
C was discovered in the mid-1970’s. It wasn’t until 1989, however, that
the test for specific antibodies to the virus became available, thus permitting
routine testing. Each year, about 35,000 Americans contract hepatitis C,
which is a more frequent cause of chronic liver disease than hepatitis
B. While it was believed originally that at least half the cases of acute
hepatitis C became chronic, it is now estimated that the rate may exceed
80% and some may develop cirrhosis. Some individuals with cirrhosis may
also develop cancer of the liver. Long term studies are being conducted
to identify those who will receive benefit from treatment.
Who
is at risk?
People who are
at risk of acquiring hepatitis C include anyone who has had a blood transfusion
or blood products prior to July, 1994, IV drug users, Military vaccines
with the jet injector, patients on hemodialysis, and hemophilia patients.
Such individuals should be tested for hepatitis C. Body-piercing, tattooing,
and cocaine snorting also are risk factors. However, an estimated 10% have
no identifiable history of exposure to the virus.
How
is HCV transmitted?
The virus is
found in blood. It is rarely sexually transmitted. However, those who have
other sexually transmitted diseases with rashes or sores may be at increased
risk and the use of latex condoms is recommended. It is not clear whether
semen or saliva can actually transmit the virus. There is also no evidence
indicating that HCV is transmitted through breast milk. It can be transmitted
by using razors, needles, toothbrushes, nail files, or even a barber’s
scissors, tattooing, body piercing or acupuncture needles used by an infected
person. All people with HCV are potentially infectious. As many as 4.9
million people are believed to be carriers which means that they have the
virus in their system, and whether they have symptoms or not, they can
infect others. Unlike hepatitis A and B, previous infection does not produce
immunity. HCV accounts for 90% of transfusion-related cases of hepatitis,
but transfusions nowadays hardly ever transmit the infection because donor
blood is tested. The potential for transmission from an infected mother
to her newborn baby appears to be less than 5%. However, transmission may
depend on the presence of high levels of the virus in the mother’s blood.
Babies born to infected mothers should be tested at one year of age.
Is
there a vaccine for hepatitis C?
There is NO vaccine
for HCV and vaccines for hepatitis A and B do not provide immunity against
hepatitis C. There are various genotypes of HCV and the virus undergoes
mutations. As a result it will be difficult to develop a vaccine. Also,
there is no effective immune globulin preparation.
What
are the symptoms?
Most people who
are infected with the HCV do not have symptoms and are leading normal lives.
The incubation period varies but averages about 7 to 8 weeks. Liver tests
may range from being elevated to being normal for various lengths of time
(from weeks to as long as a year). Even if infected persons have normal
liver tests, they may carry the virus and can transmit the disease to others.
The virus is in their blood and can cause liver cell damage. If symptoms
are present, they may be very mild and flu-like: nausea, fatigue, loss
of appetite, mental confusion, fever, headaches, and abdominal pain. Most
people do not have jaundice (yellowing of the skin and eyes); however,
it can sometimes occur along with dark urine.
How
will I know if I have HCV?
Infection by
the hepatitis C virus can be determined by a simple and specific blood
test that detects antibody against HCV; however, it does not distinguish
between acute or chronic infection. This test is not a part of a routine
physical, and people must ask their doctors for a hepatitis C test. If
the initial test is positive, a second test should be done to confirm the
diagnosis and liver enzymes (a blood test) should be measured. The current
enzyme immunoassay test (EIA) that detects anti-HCV has a sensitivity of
about 95% in chronic hepatitis C. Antibody may not be present in the first
four weeks of infection in about 30% of patients. HCV infection may be
identified by anti-HCV testing in approximately 60% of people as early
as 5 - 8 weeks after exposure.
Will
I get well?
Few people are
able to clear the virus from their blood, which is necessary for completely
recovery. Over 80% of the cases reported each year become chronic, which
means liver enzyme levels remain elevated for at least six months after
the initial acute infection. The enzymes alanine aminotransferase (ALT)
and aspartate aminotransferase (AST) are released when liver cells are
injured or die. Elevated ALT and AST levels may appear and disappear throughout
the course of the infection. Current tests can indicate that the infection
is chronic. The term chronic persistent hepatitis or chronic active hepatitis
are no longer used because doctors now believe that the persistent form,
formerly thought to be harmless, can sometimes progress to more severe
liver disease, including cirrhosis.
What
does chronic hepatitis mean?
Chronic HCV refers
to infections that do not clear up within six months after the acute infection.
The disease may gradually progress over a period of 10-40 years. High ALT
and AST levels reveal ongoing liver damage, but they do not reliably predict
the severity of liver injury. A liver biopsy can identify the type and
degree of damage and can determine the severity of the disease. It is believed
that 20% of patients with chronic hepatitis C will develop cirrhosis (scarring
of the liver resulting from the death of liver cells). Of these patients
25% (5% overall) may develop liver failure even though it may take 30 -
40 years after infection. Patients with chronic hepatitis C in whom cirrhosis
develops appear to have increased risk for developing hepatocellular carcinoma
(primary liver cancer), which may occur 10-40 years after the initial
infection.
What
is the treatment?
Currently, there
are three types of interferon and a combination of interferon and ribavirin
used to treat hepatitis C. Selection of patients for treatment may be determined
by biochemical, virologic, and when necessary, liver biopsy findings, rather
than presence or absence of symptoms. Interferon must be given by injection,
and has a number of side effects including flu-like symptoms: headaches,
fever, fatigue, loss of appetite, nausea, vomiting, depression and thinning
of hair. It may also interfere with the production of white blood cells
and platelets by depressing the bone marrow. Periodic blood tests are required
to monitor blood cells and platelets. The combination therapy (Rebatron)
can cause sudden, severe anemia and birth defects so women should avoid
pregnancy while taking it and for 6 months following treatment. The severity
and type of side effects differ for each individual. Treatment of children
with HCV is under investigation.
While 20% - 50% of patients respond to treatment initially, lasting clearance of the virus occurs in about 10-20% of patients. Treatment may be prolonged and given a second time to those who relapse after initial treatment. Retreatment with bioengineered consensus interferon alone results in elimination of the virus in 58% of patients treated for one year. Side effects occur but the medication is usually well tolerated. Combined therapy (interferon and ribavirin) shows elimination of the virus in 47% after 6 months of therapy. Side effects from both drugs may be prominent.
Currently, almost one half of all liver transplants in the U.S. are performed for end-stage hepatitis C. However, reinfection of the transplanted liver by HCV occurs at a high rate. Fortunately, this infrequently requires a second transplant.
Anyone with hepatitis C should consider being vaccinated for hepatitis A and B and should not drink alcohol.
Try to maintain as normal a life as possible eating a well balanced diet, exercising and keeping a positive attitude. Avoid depressing or overwhelming tasks and learn how to pace yourself, rest when you feel tired. Plan physically exhausting tasks in the morning when your energy level is at its peak.
How
can I protect others and prevent hepatitis C?
No vaccine is
available for hepatitis C at this time. Care should be taken in handling
anything that may have the blood of an infected person on it such as razors,
scissors, toothbrushes, clipper, nail files, tampons or sanitary napkins,
etc. Clean up blood spills with household bleach. Although it is believed
that HCV is transmitted only occasionally through sexual contact, safe
sex practices (use of a latex condom) are recommended for individuals with
multiple sexual contacts. Notify your physician and dentist that you have
HCV.
Hepatitis C is NOT spread by:
Hepatitis
C is a blood pathogen and can only be transmitted through blood to blood
contact.