Hepatitis C

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Hepatitis C is a liver disease caused by the hepatitis C virus (HCV). It is the most common chronic bloodborne infection in the United States. Some of those infected with hepatitis C are able to clear the virus from their blood within about 6 months from the time of infection. However, about 75% of people with hepatitis C infection do not get rid of the virus and therefore have chronic (long-term) hepatitis C. Chronic infection can lead to serious liver problems, including cirrhosis (scarring of the liver) or liver cancer.

According to Centers for Disease Control and Prevention (CDC), it is estimated that between 2.7–3.9 million people in the United States have chronic hepatitis C. There were an estimated 17,000 new HCV infections in the United States in 2010. This number is likely lower than the number of people actually infected, as many people who have hepatitis C never have symptoms and don't seek medical help.


How is it transmitted?

 Hepatitis C is primarily transmitted by direct contact with blood. The most common ways are:

  • Contact with HCV-infected blood through sharing of needles or other injecting equipment during intravenous drug use that have not been properly cleaned between users. At present, injection drug use is the most common risk factor for contracting the disease.
  • Organ transplants and blood transfusions prior to 1992.
  • Sexual contact. Hepatitis C can be spread by vaginal or anal sex, but this does not occur very often. Factors found to be associated with sexual transmission of HCV are: sex with multiple partners, presence of other sexually transmitted diseases, or sex with trauma (for example, rough sex, rape, or sexual abuse).Transmission through oral sex has not been documented.
  • Hepatitis C may be passed from an infected mother to her baby. Neonatal transmission may occur at birth if the mother is infected. The rate of infection is the same regardless of method of delivery (Caesarean section or vaginal). There are no recommendations to avoid pregnancy or breast-feeding if infected with HCV, because transmission of HCV infection through breast milk has not been documented. However, if nipples are cracked or bleeding, hepatitis C-infected mothers may not want to breastfeed because of increased risk.


What are the symptoms?

 Most individuals with hepatitis C (70-80%) do not have signs or symptoms. Liver disease progresses so slowly that a person can have hepatitis C for years without having symptoms. Many individuals with chronic hepatitis C have mild to moderate liver damage but do not feel sick. The possible symptoms for an acute infection (newly acquired or short-term) and a chronic (long-term or persistent) infection are different.

Acute Infection (newly acquired)

  • Often, people with an acute HCV infection have no symptoms.
  • Some people with an acute HCV infection will have jaundice (a yellowing of the skin and eyes) or mild flu-like symptoms.

Chronic Infection (persistent)

  • Most people with chronic HCV will have only mild to moderate liver disease. Symptoms of this may include: jaundice, fatigue, loss of appetite, nausea, or malaise.
  • Most people with chronic infection have abnormalities in liver enzyme levels that can fluctuate widely.
  • If a person develops cirrhosis (scarring) of the liver, symptoms and signs may be more prominent. In addition to fatigue, symptoms may include muscle weakness, poor appetite, nausea, weight loss, itching, dark urine, jaundice, fluid retention, and abdominal swelling.

How is hepatitis C diagnosed?

 

There are several blood tests that can be done to determine if a person has hepatitis C. If you think you've been exposed or infected with HCV, talk to your healthcare provider. They may order one test or a combination of tests. You and your healthcare provider can discuss whether your sex partner(s) need to be tested for hepatitis C.

  • The only FDA-approved tests are anti-HCV tests. These tests look for antibodies to HCV in the blood.
  • The average time it takes for a person infected with hepatitis C to develop antibodies to the virus is 8-9 weeks after exposure. Most people will develop the antibodies by 6 months, but it can take up to 12 months. If you believe you have been recently exposed to hepatitis C and the test comes back negative, consider retesting at a later time.
  • RNA tests are able to detect the presence or absence and amount of HCV in the blood. These tests are not FDA-approved, although they are commonly used for research purposes. With these tests, it is possible to find HCV in the blood within 1 to 2 weeks after being infected with the virus.
  • People with hepatitis C should be evaluated for the presence and severity of chronic liver disease and possible treatment. Talk to your health care providers for specific recommendations. The degree of liver damage may be determined by: Liver function tests, which tests to see if enzymes are higher than normal levels, which indicates damage to liver cells; ultrasound, which tests for signs of liver damage and cancer; or, liver biopsy, to detect signs of liver damage and cancer.
  • None of the available tests to detect hepatitis C virus or its antibody can tell the difference between acute or chronic infections.
  • People who clear the virus from their bodies may still have antibodies to hepatitis C virus in the blood for many months.

Testing is recommended for:

  • People who ever injected illegal drugs (including those who injected once many years ago).
  • People who were notified that they received blood from a donor who later tested positive for the hepatitis C infection.
  • People who received blood transfusions or organ transplants before July 1992.
  • Healthcare professionals if exposed to HCV-infected blood.
  • Children born to HCV-infected women.
  • People who used kidney dialysis (a process for people with kidney failure, in which excess water and waste from the blood are removed and purified).
  • Persons who received clotting factor concentrate produced before 1987.
  • Persons with signs or symptoms of liver disease (for example, abnormal liver enzyme tests).
  • All “baby boomers” (those born between the years 1945 and 1965). Because of the high number of infections that occurred in the 1970s and 1980s, people in this age group account for about 75% of all chronic hepatitis C cases in the U.S.

Routine screening for hepatitis C is not recommended for:

  • Healthcare providers
  • Pregnant women
  • Household contacts of HCV carriers
  • The general population


How is hepatitis C treated?

Treatment may differ depending on the stage of illness at the time treatment is sought. Your health care provider can help you make the best decisions about your treatment based upon your individual health needs.

Acute (newly acquired):

  • People with acute viral hepatitis experience a self-limited illness (one that runs a short course) and go on to recover completely.
  • Relatively few people seek medical care for acute hepatitis C, since most people are have no symptoms or have only mild, flu-like symptoms.
  • There are no restrictions on diet or activity, although alcohol use may be restricted.
  • New studies indicate that treatment with interferon shortly after infection with HCV may be effective in reducing the risk of chronic infection and liver disease. Contact your healthcare provider for more information
  • Consult your healthcare provider before starting any new medications, including over-the-counter or herbal remedies.

Chronic (persistent):

Treatment options for people with chronic HCV and/or liver damage include:

  • Treatment with interferon alone:
  • alpha interferon or a new, longer-lasting interferon called pegylated interferon.
  • Combination therapy with interferon and ribavarin. In most cases, combination therapy is more effective than interferon alone.
  • Your healthcare professional may know of therapies in the clinical trial stage for which you may be a candidate. Discuss these possibilities with your healthcare provider and let him or her help you make the best healthcare choices for you.

Drugs used to treat hepatitis C are not licensed for persons under 18 years of age. Children with hepatitis C should contact a children's specialist in liver diseases



What does it mean for my health?

The majority of people with hepatitis C have some sort of mild or moderate liver damage. Some have such damage that they have cirrhosis, liver failure, liver cancer, or need a liver transplant because of hepatitis C.

People infected with Hepatitis C are at risk for chronic liver disease or other HCV-related chronic diseases for at least 2 decades after infection. Complications from hepatitis C cause 8,000 to 10,000 deaths per year.

Sexual Prevention

There are ways to protect yourself against sexual transmission of hepatitis C:

  • Abstinence and mutual monogamy between two uninfected partners are effective prevention methods.
  • If you are having sex, but not with one steady partner, you should use latex condoms correctly and every time you have sex. The efficacy of latex condoms in preventing infection with hepatitis C is unknown, but their proper use may reduce transmission, and it reduces the risk of transmitting or acquiring other infections.
  • According to the CDC, if you have hepatitis C and only have one long-term steady sex partner, there is a very low chance of spreading hepatitis C to that partner through sexual activity. If you want to lower the chance, you may decide to use barrier precautions such as latex condoms.
  • Get vaccinated against hepatitis A and hepatitis B.

Non-Sexual Prevention

Other ways to prevent hepatitis C:

  • If you inject drugs and can't stop, avoid sharing your works--needles, syringes, cotton, water, spoons, pots (cookers)--or any other drug paraphernalia. If you choose to share your works, clean them with water and bleach to reduce your risk of getting hepatitis C, filling syringes for at least 30 seconds. Also, consider getting vaccinated against hepatitis A and hepatitis B.
  • Avoid sharing personal objects, such as toothbrushes, razors or other items that might have blood on them.
  • Healthcare workers should follow standard precautions when handling sharps and body fluids. They should also be vaccinated against hepatitis B.

If you know you have hepatitis C, you can protect others by:

  • not donating blood, body organs, tissue or semen.
  • covering cuts or sores to prevent spreading infectious blood or secretions.
  • not sharing personal hygiene items such as razors or toothbrushes.

Talking to a partner

Good partner communication is important in a relationship. While hepatitis C is more likely to be spread through sharing drug needles and works with others, it can be transmitted through sexual contact. If you or your partner use street drugs or any illegal drug requiring shooting with a needle, you could be a risk of getting hepatitis C.


Talking to your healthcare provider

Speak to your health care provider if you have:


  • shared a injection drug needle in the past, even once.
  • received a blood product or transfusion prior to 1992.
  • had unprotected sex with someone with hepatitis C.
  • had kidney dialysis.
  • received notice that you received blood from a donor who later tested positive for hepatitits C infection.

If you have hepatitis C you can protect your liver by:

  • not drinking alcohol, because it may cause further damage to the liver.
  • seeing your healthcare provider regularly.
  • not beginning to take any new medicines, including over-the-counter or herbal ones, without talking to your healthcare provider.
  • getting vaccinated against hepatitis A and hepatitis B.

More information:

Centers for Disease Control (CDC):
Viral Hepatitis Division and National Immunziation Program
Hepatitis Foundation International
American Liver Foundation
Immunization Action Coalition (IAC)
Parents of Kids with Infectious Diseases (PKID)