Basics: Hepatitis C (HCV)
What Is Hepatitis C ?
Hepatitis C virus (HCV) causes inflammation of the liver. A national U. S. survey found that 1.8 percent of Americans – about 3.9 million – have been infected with HCV, of whom most about 2.7 million – are chronically infected with HCV, with many showing no signs or symptoms. The good news is that, in 1995, a reliable antibody test for HCV was finally implemented nationwide. About 41,000 new cases occurred in 1998 with 15-25% recovering spontaneously. Hepatitis C is a slow-progressing disease that may take 10-40 years to cause serious liver damage in some people.
Who Is At Risk?
Since about four million Americans are infected with HCV and most don't know it, you should have a blood test for hepatitis C whether you feel sick or not. About one in ten people infected with HCV have had no identifiable exposure to HCV. That said, here are several obvious risk factors:
Intravenous (IV) drug users – even IV use in the distant past.
Those with multiple sex partners or sex with partners who have other sexually transmitted diseases.
Those with tattoos or body piercing done with unsterile instruments. Anyone who has had a blood transfusion prior to 1992 or clotting factors produced before 1987.
Hemodialysis (diabetes) patients.
The potential for transmission from an HCV-infected mother to her newborn appears to be about 5%.
How Does it Spread?
Injection drug use is the primary risk for HCV infection. Injection drug use accounts for about 60% of all new cases of hepatitis C and is a major risk factor for infection with hepatitis B virus. Among frequent drug users, 50-80% are infected by HCV within the first 12 months of beginning injecting.
Straws shared in snorting drugs are also a potential source of infection of HCV. The hepatitis C virus is found mainly in blood.
HCV is not spread through kissing or casual contact.
In relationships where there is one steady partner, sexual transmission is exceedingly unusual, less than 3% over decades in sexually active couples. Transmission from HCV RNA negative individuals has never been reported. Sexual transmission may be more common among those with multiple sex partners or where there is a history of sexually transmitted disease but this remains controversial and unconfirmed.
HCV may be transmitted by using razors, needles, toothbrushes, nail files, a barber's scissors, tattooing equipment, body piercing or acupuncture needles if these items are contaminated by blood of an infected person.
Healthcare workers have a 2% risk of acquiring HCV after a needle stick contaminated with HCV-positive blood.
There is no evidence indicating that HCV is transmitted through breast milk.
The current transmission rate through blood transfusions is estimated at less than 1 per 1,000,000 units transfused.
Symptoms
Most people who are infected with the HCV do not have symptoms and are leading normal lives. If symptoms are present, they may be very mild and flu-like – nausea, fatigue, loss of appetite, fever, headaches, and abdominal pain. Most people do not have jaundice although jaundice can sometimes occur along with dark urine.
The incubation period varies from 2-26 weeks. Liver enzyme tests may range from being elevated to being normal for weeks to as long as a year. The virus is in the blood and may be causing liver cell damage, and the infected person can transmit the disease to others.
Diagnosis
Test for HCV antibodies: HCV infection can be determined by a simple and specific blood test that detects antibodies against HCV. The current enzyme immunoassay test (EIA) that detects anti-HCV has a sensitivity of about 95% in chronic HCV. HCV infection may be identified by anti-HCV testing in approximately 80% of people as early as five weeks after exposure. This test is not a part of a routine physical examination, and people must ask their doctor for a hepatitis C antibody test. (Note: The antibody itself does not provide immunity, and the test does not distinguish between acute or chronic infection.) If the initial test is positive, it test should be repeated to confirm the diagnosis (and exclude possible laboratory error). If the initial test is negative, but the infection could have occurred within the last six months and HCV is suspected, antibody levels may not be high enough yet to be detectable (antibodies may not be present in the first 4 weeks of infection in about 30% of patients) or you may lack immune response. Under these circumstances, ask you doctor about repeating the test and about alternative test methods.
Test liver enzyme levels: If you may already have chronic infection, your doctor will test the levels of two liver enzymes. These are alanine aminotransferase (ALT) and aspartate aminotrasferase (AST). Both are released when liver cells are injured or die. Elevated ALT and AST levels may appear and disappear throughout the course of the HCV infection. If the liver enzyme levels are normal with chronic HCV, they should be re-checked several times over a 6 - 12 month period. If the liver enzyme levels remain normal, your doctor may check them less frequently, such as once a year.
Treating HCV
There are three types of interferon, plus a combination of interferon and ribavirin, used to treat hepatitis C. Blood tests and liver biopsy findings may determine the need for treatment.
Interferon must be given by injection, and may have a number of side effects, including flu-like symptoms – headaches, fever, fatigue, loss of appetite, nausea, vomiting, and thinning of hair.
Ribavirin, given by mouth, can have additional side effects including depression, severe anemia and especially birth defects. Women or the male partners of women, who are pregnant or who are planning pregnancy, should not take ribavirin. Pregnancy should not be attempted until six months after treatment is ended. Ribavirin may also interfere with the production of red blood cells and platelets by depressing bone marrow. Patients should be monitored frequently.
While 50-60% of patients respond to treatment initially, sustained response occurs in up to 40%.
Treatment of children with HCV is under investigation.
Researchers are re-examining when treatment should begin, for how long it should continue, and its effectiveness.
Many pharmaceutical companies and NIH are conducting research to find more effective treatments and cures.
Currently, almost 1/2 of all liver transplants in the US are performed for end-stage hepatitis C. However, re-infection of the transplanted liver by the virus usually occurs and may require a second transplant.
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.
Disease Outcomes
Between 20- 30 percent of HCV sufferers are able to become virus-free with proper treatment. Between 70 80% of the HVC infections reported each year become classified as chronic. Chronic HCV refers to infections that do not clear up within 6 months after the acute infection. Within the chronically infected group, about 20% go on to develop cirrhosis (scarring of the liver). Of this group, 25% may develop liver failure, even though this may take 30-40 years. Cirrhosis slows the blood flow through the liver and causes increased pressure in the vein that carries blood from the stomach and the intestines to the liver. As a result, varicose veins (e.g., "varices") may develop in the stomach and esophagus. Without warning these large veins can break causing a person to vomit blood or have black, tarry stools. An estimated 8,000-10,000 deaths occur each year resulting from the complications of HCV.
Preventing HCV Infection
There is NO vaccine to prevent HCV.Vaccines for Hepatitis A and B do not provide immunity against hepatitis C. There are various genotypes of HCV and the virus undergoes mutations making it difficult to develop a vaccine.
Avoid handling anything that may have the blood of an infected person on it, such as razors, scissors, toothbrushes, nail clippers or files, tampons or sanitary napkins, etc. Detergent and a 10% solution of household bleach is believed to kill the virus.
Don' t share drug needles, cocaine straws or any drug paraphernalia.
Practice safe sex (use latex condoms).
Notify your physician and dentist that you have hepatitis .
Get vaccinated against hepatitis A and B.
Those infected with hepatitis C should not drink alcohol, as it accelerates the liver damage.
