What is hepatitis C?

Hepatitis C virus (HCV) is the most common chronic bloodborne infection in the United States. Hepatitis C accounts for the great majority of what was referred to in the past as non-A, non-B hepatitis. The hepatitis C virus was identified in 1989, and in 1990, a hepatitis C antibody test (anti-HCV) became available to identify individuals exposed to HCV. There is no vaccine available to prevent hepatitis C.

What causes hepatitis C?

HCV is transmitted primarily through direct exposure to blood through an opening in the skin or mucus membrane. The hepatitis C virus infects the liver, causing inflammation that results in damage of the liver tissue.

Who is at risk for infection with hepatitis C?

Most recent data indicate that approximately 4 million Americans have been infected with HCV. It is estimated that up to 85% of the people infected with the hepatitis C virus each year will develop chronic infection. It has been estimated that roughly one in fifty Americans test positive for HCV, of which a majority are chronically infected. As many as 70% of those persons infected are unaware that they carry the virus.

Individuals who may come in contact with infected blood, instruments or needles, such as injection drug users, health care workers or public safety workers are at risk of acquiring hepatitis C. Other potential risks include intranasal cocaine use, tattooing and body piercing. Currently, there is no vaccine available to immunize individuals against this virus.

People living with HCV infected individuals should avoid sharing personal care items such as razors, toothbrushes and nail clippers to reduce the risk of exposure to infected blood.

According to the Centers for Disease Control and Prevention (CDC), there is an association between sexual exposure to someone with a history of hepatitis or exposure to multiple sex partners and contraction of HCV. However, there is a low prevalence of the infection in long-term spouses of people with chronic hepatitis C virus who have no other risk factor for infection.

Women with hepatitis C do not need to avoid pregnancy or breast-feeding according to the CDC. Potential, expectant and new parents should be advised that approximately 5 out of every 100 infants born to HCV infected females may be infected. There is no known treatment to prevent infection. HCV positive mothers should consider abstaining from breast-feeding if their nipples are cracked or bleeding.


What is the history of hepatitis C?

Chronic hepatitis C appears to be a slowly progressive disease that may gradually advance over 10-40 years. There is some evidence that the disease may progress faster when acquired in middle age or older. In one study, chronic hepatitis C confirmed by liver biopsy
was identified an average of 10 years following blood transfusions, while cirrhosis (scarring) was identified after an average of 20 years. It also appears that HCV, like the hepatitis B virus, is associated with an increased chance of developing hepatocellular carcinoma, a type of primary liver cancer. Almost all hepatitis C-related liver cancer occurs in patients with cirrhosis of the liver. The exact magnitude of this risk is unknown, but appears to be a late risk factor occurring on the average of 30 years after the time of infection.

Before 1992, HCV was transmitted through blood transfusions. However, all blood is now tested for the presence of this virus by the hepatitis C antibody test. It is estimated that the risk of post-transfusion hepatitis C has been reduced to 0.001% per unit transfused.


How is hepatitis C diagnosed?

The incubation period after exposure to HCV has a range of 15-150 days (average 50 days). Within 3 months following exposure to the virus, 90% of the infected people will have detectable antibodies. Within the average of 50 days, almost all patients develop liver cell injury which is indicated by elevated serum blood levels of alanine aminotransferase (ALT).

Individuals infected with HCV are often unaware of the illness because most of the time they do not have specific symptoms, e.g., loss of appetite, abdominal pain or malaise. They are often found to have elevated liver enzymes on a routine blood test (i.e., ALT test). Others test positive for hepatitis C antibody during a blood donation. A more specific hepatitis C antibody test with a low false positive rate has been available since 1992. In general, elevated liver enzymes and a positive HCV antibody test indicate that an individual has chronic hepatitis C. Some patients (15-25%) may recover from acute hepatitis C, but their HCV antibody test may remain positive. A hepatitis C antibody test is the best way of determining if you have been exposed to HCV. A doctor or clinic can readily provide this test. An easy to use, FDA-approved hepatitis C test kit (Hepatitis C Check) can also be purchased online or by telephone. Other testing that may be performed includes RIBA, HCV RNA and other biochemical liver tests. A liver biopsy is typically done to provide confirmation of the underlying disease, find the severity of liver damage, and determine the necessity of treatment.


Who should be tested?

Testing is advised in those individuals who:

• received a blood transfusion or organ transplantation prior to 1992
   
• used intravenous drugs, even once
   
• received long-term hemodialysis
   
• received of clotting factor made prior to 1987
   
• have persistently abnormal ALT levels
   
• are healthcare, emergency medical and public safety workers exposed to needle sticks, sharps, or mucosal exposures to HCV-positive blood
   
• were born to an HCV-infected mother
   

and should be considered in those individuals who:

• have unprotected sex with multiple partners or have a history of sexually transmitted disease
   
• received tattoos or body piercings with unsterile needles, especially in unregulated setting
   
• are intranasal cocaine users
   
• have household exposure - sharing razor or toothbrush with an HCV infected person
   

How is hepatitis C treated?

Current FDA approved treatments for HCV include monotherapy with interferon α: Infergen, Intron-A, Roferon-A, Peg-Intron, and Pegasys, and combination therapy for use in patients who have never had any interferon therapy and patients who have relapsed following interferon therapy with Ribavirin.

Side effects caused by interferon and pegylated interferon monotherapy therapy can include “flu-like” symptoms, depression, headache, and decreased appetite. The “flu-like” symptoms can be minimized by taking acetaminophen (e.g. Tylenol). In addition, interferon may depress the bone marrow leading to reduced levels of white blood cells and platelets.

Side effects with combination therapy are the same as those for monotherapy with a few additional risks. Combination therapy may decrease levels of red blood cells. Frequent blood tests are needed to monitor white blood cells, red blood cells, platelets, and liver enzymes.

What lifestyles changes should hepatitis C patients make?

General guidelines for individuals infected with HCV include maintaining a healthy lifestyle, eating a well-balanced diet, and avoiding alcohol. Adequate rest and moderate exercise can also contribute to a feeling of well-being. Since HCV infection may lead to loss of appetite, those individuals whose appetite is diminished may find frequent, small meals more easily tolerated.