Hepatitis C (HCV)

Hepatitis C (HCV)

What is hepatitis C (HCV)?

Hepatitis is a disease that affects the liver. There are 5 types, with A & B the most common & E rarely found in the US. Hepatitis C is the liver disease caused by hepatitis C virus (HCV), found only in the blood of persons with this disease. Hepatitis C (also called non-A & non-B hepatitis) is the most common chronic (persistent/long-term) bloodborne infection in the US. Bloodborne means it can only be transmitted by blood, not through the air or from an object like a toilet seat.

Between 15 & 25% of those newly infected with HCV (called acute HCV) are able to clear the virus from their blood within about 6 months from the time of infection. But 75 to 85% of people with acute HCV don’t get rid of the virus in 6 months & therefore have what’s called chronic (long-term) hepatitis C. According to the US Centers for Disease Control & Prevention (CDC), only 20% of people with new HCV infections will have symptoms. That means that about 80% of those infected with hepatitis C will not know it right away.

In fact, liver disease progresses so slowly that a person can have HCV for years without symptoms. Many with chronic/long-term HCV have mild to moderate liver damage but do not feel sick.


Likely symptoms for acute/new infection versus chronic infection:
Acute
Many people with an acute HCV infection have no symptoms (asymptomatic), although some will have jaundice (yellowing of the skin & eyes) or mild flu-like symptoms.
Chronic
Most people with chronic HCV will have only mild to moderate liver disease, with symptoms such as:
• Jaundice
• Fatigue
• Loss of appetite
• Nausea (the urge to vomit or squeamishness of the stomach)
• Malaise (a vague feeling of discomfort that can’t be pinned down but is sensed as just not right)
• Abnormalities in liver enzyme levels that can change a lot
• If cirrhosis (scarring) of the liver develops, symptoms may be more obvious, including muscle weakness, itching, dark urine, fluid retention & abdominal swelling.

How is Hepatitis C transmitted?

HCV is spread by contact with the blood or blood products from an infected person. At present, injection drug use is the most common way to get HCV. Although less likely, certain jobs, mother to newborn & sex can also transmit HCV. There are no recommendations to avoid pregnancy or breast-feeding if infected with HCV, but if nipples are cracked or bleeding, hepatitis C-infected mothers may not want to breastfeed because of increased risk. Mothers infected with both HCV & HIV (Human Immunodeficiency Virus, which leads to AIDS) have an increased risk of transmitting HCV to their newborn before, during or after birth.

Overall, sex accounts for up to 20% of HCV infections. High amounts of HCV in the body (usually when a person is very ill) or also being infected with HIV may increase the risk of sexual transmission. HCV can be transmitted during vaginal or anal intercourse, with transmission more likely if blood is present. Factors that increase the possibility of sexually transmitting HCV are sex with many partners, already being infected with other sexually transmitted diseases (STD) & sex with trauma (for example, rough sex, rape or sexual abuse).

CDC says that you may be at risk for hepatitis C & should contact your medical care provider for a blood test if you:
• have ever injected illegal drugs, even if you only experimented 1 or 2 times many years ago
• were notified that you received blood from a donor who later tested positive for HCV
• have ever been on long-term kidney dialysis
• received a blood transfusion or solid organ transplant before July, 1992
• were a recipient of clotting factor(s) made before 1987
• have medical evidence of liver disease like persistently high ALT (alanine aminotransferase, a liver enzyme)

How is Hepatitis C diagnosed?

You must talk with your medical care provider to decide if you or your sex partner(s) need to be tested. If so, there are blood tests that can find if you are infected with HCV. The only tests approved by the US Federal Drug Administration (FDA) look for antibodies to HCV – that is, what your body produces to fight this virus. Because the test is looking for antibodies, you must be sure your body has had time to produce them to get an accurate test. Most people develop HCV antibodies 8 weeks to 6 months after infection. People who clear HCV from their bodies may still have antibodies in the blood for many months.

RT-PCR (reverse transcriptase polymerase chain reaction) test can find the actual virus in your blood, but are not FDA-approved & only used in research or where specialized services for liver disease are provided. RT-PCR can find HVC within a week or 2 after infection. Neither antibody nor viral tests can tell the difference between acute (new) or chronic (long term) infections.

Please note that routine testing for HCV is not recommended by CDC just because someone is a health care provider, pregnant, had normal household contact with an HCV-infected person, nor for the general public.

Babies born to mothers with hepatitis C cannot be accurately tested for HCV antibodies before 12 months of age because antibodies found may be from the mother. If for some reason testing is needed before 12 months of age, RT-PCR could be done when the infant is 1 to 2 months old.

What is the treatment for Hepatitis C?

If you have HCV, the presence of chronic liver disease should be checked out, including the degree of liver damage, in order to determine treatment. Liver function tests see if enzymes are higher than normal. Ultrasound checks for both damage & cancer. Liver biopsy, in which a tiny part is removed for examination, also shows whether there is liver damage or cancer.

Treatment depends on whether HVC infection is acute or chronic.
Acute (new)
Few with new HCV seek medical care because they have either no symptoms or feel like a mild case of the flu. Acute HCV is a short illness that ends with complete recovery & while there is no accepted therapy it is recommended that you
• not drink alcohol, because it may cause further damage to the liver
• see your medical care provider regularly
• ask your doctor about new studies of treatment with interferon to reduce the risk of chronic infection & liver disease
• talk with your doctor before starting any new medications, including over-the-counter or herbal remedies
• get vaccinated against hepatitis A and B

Chronic (long term)
Current approved therapy for HCV liver disease is alpha interferon or a new, longer-lasting interferon called pegylated or interferon combined with ribavirin. Interferon alone or in combination with ribavirin should be taken for 6-12 months. Combination is often better than interferon alone. Treatment options can change due to research, so your doctor should consult with HCV specialists to see if you can try new medicines being studied. Drugs approved to treat HCV are not for those under 18 years old, so see a specialist in children’s liver diseases.

The National Institutes of Health Consensus Development Conference Panel recommends that therapy only be used for those with
• continuously high ALT levels
• HCV diagnosis by viral (not antibody) testing
• certainty of worsening liver disease from liver biopsy findings

How do I prevent Hepatitis C?

There is currently neither vaccine against hepatitis C nor any treatment to prevent infection after obvious exposure. HCV-infected people should have qualified medical HCV specialists helping reduce their possibility of liver & other chronic diseases.

CDC recommendations to prevent HCV.
Non-sexual
• Don’t inject or shoot drugs. If you already inject drugs, get into drug treatment to stop. If you continue to inject, never share needles, syringes, cotton, water, spoons, pots (cookers) or any other drug paraphernalia (“works”). If you share works, clean them with water & bleach for at least 30 seconds. Get vaccinated against hepatitis A & B.
• Don’t share personal care items that could have blood on them like razors or toothbrushes.
• Health care & public safety workers should be vaccinated against hepatitis B & follow Universal Precautions (precautions used each & every time) such as protective barriers & safe handling of needles & other sharps.
• If you get a tattoo or body piercing be sure Universal Precautions are used: tools must be specially cleaned to remove someone else’s blood before use on you & the tattoo artist or piercer must wash hands & use disposable gloves.
• If you know you have hepatitis C, you can protect others by:
A) not donating blood, body organs, tissue or semen
B) covering cuts or sores to prevent spreading HCV-infected blood or secretions
C) not sharing personal hygiene items such as razors or toothbrushes

Sexual
• Abstinence or mutual monogamy between 2 uninfected partners is effective prevention.
• HCV can be spread by sex, but it’s rare. If you are having sex with more than one partner, use safe(r) sex protective barrier methods:
1) latex condom every time you have vaginal or anal sex
2) non-lubricated latex condom every time you have mouth-to-penis sex
3) household plastic wrap, dental dam, or latex condom cut lengthwise & opened flat every time you have mouth-to-vagina or mouth-to-anus sex

What are possible complications of hepatitis C?

Most people with hepatitis C have mild or moderate liver damage. Some have so much damage that they have cirrhosis (scarring), liver failure, liver cancer or need a liver transplant. In fact, HCV is the leading cause for liver transplants. B-cell non-Hodgkin’s lymphoma, a cancer of the lymph tissue, has also been linked with chronic HCV. Complications from hepatitis C cause 8,000 to 10,000 deaths every year in the US.

People infected with HCV are at risk for chronic liver disease or other HCV-related chronic diseases for at least 20 years after infection. Several studies found that after infection, it takes 10 to 14 years for chronic hepatitis to appear, about 20 years to develop cirrhosis, and about 28 years to develop liver cancer. A 2001 study of the entire population of Sweden found that those with both chronic hepatitis & cirrhosis had a much greater increase in the development of liver cancer–118-times more. The regular use of alcohol, even in moderation, is harmful in HCV chronic liver disease.

A small percentage of people with chronic hepatitis C develop medical conditions outside the liver (called extrahepatic). These conditions are thought to occur due to the body’s immune system fighting against itself. The most common extrahepatic condition is essential mixed cryoglobulinemia. This causes joint pain & swelling/arthritis, enlargement of the spleen, skin vasculitis (inflammation of veins) with a raised, purple skin rash called palpable purpura that is usually in the lower portion of the legs, swelling of the legs & feet due to loss of protein in the urine from the kidney involvement & nerve pain called neuropathy. In addition, Raynaud’s phenomenon can develop, in which the fingers & toes turn white, then purple, then red & become painful in cold temperatures. Other extrahepatic conditions include glomerulonephritis, nerve, kidney & heart disease & porphyria cutanea tarda (PCT). The symptoms of PCT are blisters which become ulcerated in areas of the skin exposed to sunlight, especially on the face, ears & back of the hands. The affected areas of skin also tend to become fragile & show hyperpigmentation (excess pigment) & hypertrichosis (excess hair).

Who should I contact?

If you find that you are infected with hepatitis C, talk to an HCV-knowledgeable doctor about further tests to determine treatment & about sexual partner(s) being tested for HCV. If you are in a mutually monogamous relationship (meaning you only have sex with one partner who only has sex with you) you should discuss the low but possible risk of HCV transmission by sex & together decide whether to use safe(r) sex & their need for testing.

If you have multiple sex partners you should be honest about your HCV infection & use safe(r) sex to avoid giving them HCV & getting STD from them. If you or a sexual partner use injected drugs, get treatment or learn how to avoid getting/giving bloodborne diseases by not sharing works or proper cleaning of works. Such discussion & new behavior may be difficult, but concern for health demonstrates maturity & can be an important step in personal growth & relationship building.

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