Hepatitis C

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Hepatitis C

Alternative names

Non-A or non-B hepatitis
Definition

Hepatitis C is an inflammation of the liver caused by infection with the hepatitis C virus.

Causes, incidence, and risk factors

Hepatitis C infection is caused by hepatitis C virus (HCV). Persons who may be at risk for hepatitis C are those who:

Received a blood transfusion prior to July 1992
Received blood, blood products, or solid organs from a donor who has hepatitis C
Inject street drugs or share a needle with someone who has hepatitis C
Have been on long-term kidney dialysis
Have frequent workplace contact with blood (for instance, as a healthcare worker)
Have or have had sex with multiple partners
Have or have had sex with a person who has hepatitis C
Share personal items, such as toothbrushes and razors, with someone who has hepatitis C
Were born to hepatitis C infected mother
There are approximately 4 million people in the United States who are infected with hepatitis C (about 1 in 70 to 100 people). Other hepatitis virus infections include hepatitis A and hepatitis B. Each viral hepatitis infection is caused by a different virus.

Symptoms

Many people who are infected with the hepatitis C do not have symptoms. Hepatitis C is often detected during blood tests for a routine physical or other medical procedure. If the infection has been present for many years, the liver may be permanently scarred -- a condition called cirrhosis. In many cases, there may be no symptoms of the disease until cirrhosis has developed.

The following symptoms could occur with hepatitis C infection:

Jaundice
Abdominal pain (right upper abdomen)
Fatigue
Loss of appetite
Nausea
Vomiting
Low-grade fever
Pale or clay-colored stools
Dark urine
Generalized itching
Ascites
Bleeding varices (dilated veins in the esophagus)
Signs and tests Return to top

Hepatitis virus serology
ELISA assay to detect hepatitis C antibody
Hepatitis C PCR test
Elevated liver enzymes
Liver biopsy shows chronic inflammation
Hepatitis C genotype. Six genotypes are present around the world. Most Americans have genotype 1 infection, which is the most difficult to treat.
Treatment Return to top

There is no cure for hepatitis C.

Some patients with hepatitis C benefit from treatment with interferon alpha or a combination of interferon alpha and ribavirin.

Interferon alpha is given by injection just under the skin and has a number of side effects, including flu-like symptoms, headaches, fever, fatigue, loss of appetite, nausea, vomiting, depression, and thinning of hair. Treatment with interferon alpha may also interfere with the production of white blood cells and platelets.

Ribavirin is a capsule taken twice daily, and the major side effect is severe anemia (low red blood cells). Ribavirin also causes birth defects. Women should therefore avoid pregnancy during and for 6 months following treatment.

Recently, a version of interferon alpha with a longer half-life (pegylated interferon alpha) was introduced, and the longer half-life means the injections are taken weekly instead of the three times a week with standard interferon alpha. Pegylated interferon alpha and ribavirin lead to a sustained response in approximately 50% of patients.

A sustained response means that the patient remains free of hepatitis C virus 6 months after stopping therapy. Approximately 40% of patients with genotype 1 infection will respond.

Rest may be recommended during the acute phase of the disease when the symptoms are most severe. All patients with hepatitis C should be immunized against hepatitis A and B.

People with hepatitis C should also be careful not to take vitamins, nutritional supplements, or new over-the-counter medications without first discussing it with a doctor. People with hepatitis C should avoid any substances toxic to the liver (hepatotoxic), including alcohol. Even moderate amounts of alcohol speed up the progression of hepatitis C, and alcohol reduces the effectiveness of treatment.

Support Groups

The stress of illness can often be eased by joining a support group of persons who share common experiences and problems. See liver disease - resources.

Expectations (prognosis)

Hepatitis C is one of the most common causes of chronic liver disease in the U.S. today. At least 80% of patients with acute hepatitis C ultimately develop chronic liver infection, and 20% to 30% develop cirrhosis. Between 1% and 5% of patients may develop liver cancer. Hepatitis C is now the number 1 cause for liver transplantation in the U.S.

Complications

Chronic hepatitis
Cirrhosis
Calling your health care provider Return to top

Call your provider if symptoms of hepatitis develop, or if you believe you have been exposed to the hepatitis C virus.

Prevention

Avoid contact with blood or blood products whenever possible. Health care workers should practice universal precautions when handling blood and bodily fluids.

Do not inject drugs of abuse, and especially do not share needles with anyone. Be cautious when getting tattoos and body piercings.

Sexual transmission is low among stable, monogamous couples. A partner should be screened for hepatitis C. If the partner is negative, the current recommendations are to make no changes in sexual practices. Individuals having sex outside of a monogamous relationship should practice safer sex behaviors to avoid hepatitis C as well as sexually transmitted diseases, including HIV and hepatitis B.

Currently there is no vaccine for hepatitis C.



Hepatitis C

The liver is a large reddish-brown glandular organ located in the upper right portion of the abdominal cavity. It secretes bile and performs several important functions.

The Hepatitis C virus is a blood-borne pathogen that primarily affects the liver.

Hepatitis C virus contains RNA (Ribo Nucleic Acid) as the genetic material in its core which is surrounded by a fatty envelope.

In an infected person, the virus enters the body, circulates in the blood stream, and attaches to liver cells. Once attached, the virus releases the RNA into the healthy cells.

The viral RNA then replicates itself hundreds or thousands of times, making genetic material required to produce new viruses.

These new viruses in turn infect other liver cells.


What is hepatitis C?
Hepatitis C is a liver disease caused by the hepatitis C virus (HCV), which is found in the blood of persons who have this disease. The infection is spread by contact with the blood of an infected person.

How serious is hepatitis C?
Hepatitis C is serious for some persons, but not for others. Most persons who get hepatitis C carry the virus for the rest of their lives. Most of these persons have some liver damage but many do not feel sick from the disease. Some persons with liver damage due to hepatitis C may develop cirrhosis (scarring) of the liver and liver failure which may take many years to develop.

How can I protect myself from getting hepatitis C and other diseases spread by contact with human blood?

Don't ever shoot drugs. If you shoot drugs, stop and get into a treatment program. If you can't stop, never reuse or share syringes, water, or drug works, and get vaccinated against hepatitis A and hepatitis B.
Do not share toothbrushes, razors, or other personal care articles. They might have blood on them.
If you are a health care worker, always follow routine barrier precautions and safely handle needles and other sharps. Get vaccinated against hepatitis B.
Consider the health risks if you are thinking about getting a tattoo or body piercing: You can get infected if:
the tools that are used have someone else's blood on them.
the artist or piercer doesn't follow good health practices, such as washing hands and using disposable gloves.
HCV can be spread by sex, but this does not occur very often. If you are having sex, but not with one steady partner:

You and your partners can get other diseases spread by having sex (e.g., AIDS, hepatitis B, gonorrhea or chlamydia).
Use latex condoms correctly and every time. The efficacy of latex condoms in preventing HCV is unknown, but their proper use may reduce transmission.
Get vaccinated against hepatitis B.
The surest way to prevent the spread of any disease by sex is not to have sex at all.



There is no vaccine available to prevent hepatitis C.






Hepatitis C virus is NOT spread by:

breast feeding
sneezing
hugging or kissing
coughing
sharing eating utensils or drinking glasses
food or water
casual contact

Many people who are at risk for hepatitis C are at risk for hepatitis A and hepatitis B. Check with your doctor to see if you should get hepatitis A and hepatitis B vaccines.






Could I already have hepatitis C?
Ask your doctor for a blood test for hepatitis C if:

you ever injected street drugs, even if you experimented a few times many years ago.
you were treated for clotting problems with a blood product made before 1987.
you received a blood transfusion or solid organ transplant (e.g., kidney, liver, heart) before July 1992, or you were notified that you received blood that possibly contained HCV.
you were ever on long-term kidney dialysis.
Why should I be tested for hepatitis C?
Early diagnosis is important so you can be:

checked for liver disease
get treatment, if indicated. Drugs are licensed for the treatment of persons with long-term hepatitis C.
learn how you can protect your liver from further harm.
learn how you can prevent spreading HCV to others.

Eventually this process shuts down most of the normal functions of the liver cell and damages it.

Symptoms of Hepatitis

* Jaundice
* Mild fever
* Muscle and joint aches
* Nausea
* Vomiting
* Loss of appetite
* Abdominal pain

Hepatitis infection may continue for years, eventually resulting in scarring of the liver tissue called cirrhosis.

Hepatitis infection can also result in liver cancer in the later stages.