HCV2
What is HCV?



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.


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