Hepatitis C
Definition of Hepatitis C
Hepatitis C is a specific type of virus that may cause the clinical disease called hepatitis. It is referred to as the hepatitis C virus (HCV). Hepatitis (literally, inflammation of the liver) can be caused by many drugs, toxic agents, numerous viruses, autoimmune disease, and genetic disorders.
Description of Hepatitis C
Hepatitis (literally, inflammation of the liver) can be caused by many drugs, toxic agents, numerous viruses, autoimmune disease, and genetic disorders. Infection with the hepatitis C virus (HCV) poses a significant public health problem, the magnitude of which may match or eventually exceed that of hepatitis B virus (HBV) in the United States. In the United States, more than 36,000 people a year are infected with HCV. Hepatitis C accounts for more than 90 percent of non-A, non-B hepatitis cases attributable to intravenous drug use, transfusion, and other percutaneous (through the skin) exposures.
More than 80 percent of community-acquired non-A, non-B hepatitis can be traced to HCV infection. Up to one-fifth of people with chronic hepatitis C may go on to develop scarring of the liver (cirrhosis).
Hepatitis C has been implicated as a cause of cancers originating in the liver.
Hepatitis C has several different forms, called genotypes. The genotypes can be important, since each often responds differently to therapy. In Western Europe and the United States, the most common genotypes are 1a, 1b, 2b, and 3a. In Japan and Taiwan, genotypes 1b, 2a, and 2b are seen most frequently; in other parts of Asia, type 3 is the most common. Type 4 is often found in the Middle East.
Causes and Risk Factors of Hepatitis C
IV drug use appears to be the most common mode of HCV transmission, accounting for 50 percent or more of infections. Sharing drug needles or having received a tattoo from an unclean needle are also risk factors. Sexual transmission is less common than with hepatitis B. Maternal transmission of HCV infection has been demonstrated, but the incidence appears to be low (about 2-5 percent). Co-infection with HIV may increase the risk of maternal and perhaps sexual HCV transmission. The risk of HCV infection from a blood transfusion is now less than 1 in 100,000 units transfused in the U.S. HCV has been responsible for over 90 percent of cases of post-transfusion hepatitis, but only 4 percent of cases of hepatitis C are attributable to blood transfusions.
You do not get hepatitis C by hugging, kissing, shaking hands or other casual contacts with an infected person.
Symptoms of Hepatitis C
Eighty percent of those infected do not have symptoms. Some people feel like they have the flu. Symptoms of hepatitis C can include fatigue, decreased appetite, nausea, jaundice, fever, and an enlarged liver. Following acute infection with HCV, approximately 80 percent of patients will develop chronic infection. Chronic liver disease develops in 50-60 percent of those with chronic infection. The patients with cirrhosis, the most severe type of chronic liver disease, are also at risk (about 3 percent per year) of all liver cancer (hepatocellular carcinoma).
Diagnosis of Hepatitis C
An accurate diagnosis of hepatitis C hinges on a thorough history, with careful attention paid to percutaneous (through the skin) exposures. Blood tests will be performed, including liver enzymes and antibody to HCV (anti-HCV). Liver enzymes may be an unreliable marker, as alanine aminotransferase levels can fluctuate for months or years and can be normal. However, they may be markedly elevated early in the course of the disease. A liver biopsy is rarely indicated.
Treatment of Hepatitis C
The decision to treat chronic hepatitis C remains problematic. Since a liver biopsy can show how diseased the liver has become, it is often used to guide the decision to treat or to carefully watch a patient. In patients who have very mild disease or are poor candidates for treatment, many physicians prefer a wait-and-see approach given the low risk of mortality and the considerable cost and side-effects of treatment. Others believe the strong association between HCV and cirrhosis justifies treatment much of the time. Interferon alfa and ribavirin are two drugs approved for the treatment of persons with chronic hepatitis C, and are sometimes used in persons with acute hepatitic C, also.
Interferon is an injection. A new, big interferon molecule is being used, called pegylated interferon. This means that the injection is usually only needed once a week. Interferon can be taken alone or in combination with ribavirin. Combination therapy, using pegylated interferon and ribavirin, is currently the treatment of choice. Combination therapy can get rid of the virus in up to 5 out of 10 persons for genotype 1 and in up to 8 out of 10 persons for genotype 2 and 3. However, treatment often lasts 6-12 months, or longer. Treatment is also associated with complications such as flu-like symptoms, and blood tests are necessary very frequently. Treatment with combination therapy appears to decrease the risk of chronic hepatitis.
Prevention of Hepatitis C
Although there is little evidence that HCV is spread by sexual contact, HCV-infected persons should practice safe sex. Additionally, remember to: - (if carrier) Cover open wounds, don't share razors or manicure tools.
- Don't share needles, razors, toothbrushes, manicure tools or other items that could bear contaminated blood.
- Don't allow yourself to be pierced or tattooed with non-sterile equipment.
- Limit alcohol intake.
- Never share IV drug needles or other drug equipment.
Questions To Ask Your Doctor About Hepatitis C
What medications will you prescribe?
For how long?
Is it contagious?
How communicable is the disease?
What precautions can be taken to minimize the exposure to hepatitis?
How frequently do you recommend testing for a hepatitis relapse?
Are there any lasting effects after treatment?
Can a regular exercise program be resumed?
If so, when?
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