General Information About Hepatitis C

This information is for your general knowledge and is not a substitute for medical advice. You should contact our physicians with any questions about your healthcare.

If you have recently discovered that you or someone you know has hepatitis C, there are reasons to be optimistic:

• Hepatitis C progresses slowly, and many people who harbor the virus will never get sick.
• You are not alone since about 2.7 million people in the United States have the virus in their blood. Treatment is already available, and researchers are at work developing new treatments.

HEPATITIS C  The term "hepatitis" is used to describe a common form of liver injury. Hepatitis simply means "inflammation of the liver" , There are many causes of hepatitis; examples include:

• alcohol
• certain drugs
• poisonous mushrooms
• viruses. Hepatitis C is a virus that had been referred to as "non-A non-B" hepatitis for decades before it was finally identified in 1989. Since then, a tremendous amount has been learned about the virus.

Hepatitis C usually causes no symptoms when people become infected.  However, in approximately 80 percent of people, the virus makes itself at home in the liver, where it has the potential to cause liver damage ranging in severity from mild to severe. The hepatitis C virus causes damage to the liver, but the amount of damage is variable, and is combated by the liver's ability to repair itself.

Most infected patients, even those with progressing disease, may have no specific symptoms for many years. However, many patients are fatigued, although the fatigue's relationship to the infection is not always clear. Joint pains can occur in some patients. The absence of symptoms does not necessarily mean that the infection is under control.

An important fact to know, because it influences decisions about treatment, is that hepatitis C produces ongoing inflammation in the liver over many years. In some patients scar tissue accumulates in the liver, which can eventually become extensive, leading to cirrhosis. Patients who have developed cirrhosis are at increased risk for developing a number of complications since the liver may not be capable of performing all of its many functions to the same degree as when it was healthy.

CONTAGION The hepatitis C virus is spread by contact with blood. Thus, you should avoid activities that risk exposing another person's blood to your blood. Examples include:

•  sharing a toothbrush
•  nail clippers
•  razors
•  needles

Sexual transmission  The virus can also be spread sexually, but the risk is much lower than for other types of viruses. The risk of transmission between stable monogamous sexual partners is estimated to be approximately one in a thousand per year. Although use of a condom in this setting may decrease this risk, the United States Public Health Service and a consensus panel of experts from the National Institutes of Health have not recommended barrier precautions. On the other hand, if you do not have a stable monogamous sexual partner, you should practice safe sex. This is as much to protect you from getting a new infection as your partner from acquiring hepatitis C. There is no evidence that kissing, hugging, sneezing, coughing, sharing food, water, eating utensils or drinking glasses, casual contact, or other contact without blood exposure is associated with transmission of the hepatitis C virus.

The risk of transmitting the virus is higher in people who are infected with hepatitis C and with the human immunodeficiency virus (HIV). You should tell your doctor if you know that you are infected with HIV or think you may be at risk for infection.

Transmission during pregnancy The risk of transmitting hepatitis C during pregnancy may depend upon the level of virus in your blood stream. In general, the risk is about 5 to 6 percent (about 1 in 20) but is increased in people who are also infected with HIV (about 12 percent or 1 in 8). Speak to your doctor if you are pregnant or contemplating pregnancy.

RISK FACTORS  Researchers have tried to identify factors that increase the risk of developing cirrhosis once patients have become infected with hepatitis C. Several potential risk factors have been studied of which the most important are:

• Consumption of alcohol.  People with hepatitis C who drink alcohol are at much greater risk for developing cirrhosis.
• The amount of liver inflammation and scarring. As expected, increasing amounts of inflammation make it more likely that the liver will become scarred.
• Daily use of marijuana has been associated with worsening liver disease. Therefore, people with HCV should avoid it.

DIAGNOSING  Your doctor has many tools for helping to find out how much damage the hepatitis C virus has already caused. Your physician will order blood tests, and may be schedule an ultrasound examination of your liver.  The best way to see what is happening in the liver is to do a liver biopsy, which involves obtaining a tiny sample of the liver tissue and looking at it under a microscope. A liver biopsy is commonly performed and is most often done as an outpatient procedure. You should discuss with your doctor whether it is required in your case.

Your doctor may obtain two other special tests that are helpful for determining the best treatment and monitoring treatment:

• Hepatitis C virus (HCV) RNA, which is a measure of the amount of virus circulating in your blood

• HCV genotype, which determines the specific type of virus that you have (most people in the United States have type I)

Because many drugs require metabolism by the liver, it is always best to check with your doctor or pharmacist before starting a new prescription.  As a general rule, unless your liver is already scarred, most drugs are as safe as for people without hepatitis C. An important possible exception is acetaminophen (Tylenol), the maximum dose of which should not be more than 2 grams per a 24 hour period.

The rationale for treating people with hepatitis C is to prevent the progression of the liver disease. About 20 percent of people will develop cirrhosis 20 years after becoming initially infected. Since many people with hepatitis C are young, the lifetime chance of developing cirrhosis and complications of cirrhosis is greater.  Unfortunately, it is not always possible to predict accurately in whom the disease will progress.

The first drug successfully used to treat hepatitis C was interferon, which was initially tried in 1986. Since then, a great deal has been learned about using interferon for hepatitis C. The bottom line is that when given alone, the chance of permanently curing the infection was only about 10 percent.

A major breakthrough was the addition of a second drug, ribavirin, to interferon therapy, which quadrupled the chance of curing the infection both in patients who have never been treated with interferon, and those in whom the virus returned after treatment with interferon alone. The next major breakthrough was a modification of interferon, which further improved the chance of cure and reduced the number of injections that had to be given.

Currently, most patients are treated with a combination of these drugs.. This treatment is not easy since both drugs can cause side effects, although many less common but potentially serious side effects can also occur. Most people manage to undergo treatment while going to work and functioning normally. Your doctor will explain the risks of treatment, which are important for you to understand.

During therapy, your doctor will monitor the level of the virus in your blood, with the goal of completely eliminating it. Therapy may be stopped early if you do not respond; otherwise treatment is continued for six to 12 months. However, you will have to wait for six months after therapy to determine if you have been cured, since the virus can come back after therapy has been discontinued. This happens about 25 to 30 percent of the time. The absence of the virus for more than six months after stopping therapy amounts to a cure since in such people there has been no trace of the virus in the blood or liver for over 10 years.

Even though combination therapy with interferon plus ribavirin cures about 50 percent of people, many are not cured. Thus, new treatments for hepatitis C are actively being developed. At the present time most are in early stages of testing. Your doctor may be able to help you locate a clinical study of experimental treatments should this become an option for you.