Hepatitis

What is Hepatitis?

Hepatitis C is a liver infection caused by the hepatitis C virus. More than four million Americans are infected with the hepatitis C virus. Your infection can be mild, perhaps not even causing any symptoms, or it can be a moderate or even severe infection. If you have a severe hepatitis C infection you can experience cirrhosis (liver scarring), liver failure, and even liver cancer. Hepatitis C is responsible for 10,000-12,000 deaths each year in the United States.

The hepatitis C virus targets your liver. One of your liver’s primary jobs is to break down waste products in your blood. The inflammation triggered by the hepatitis C virus interferes with the ability of your liver to clear out waste products. One blood waste product, called bilirubin, can then build up in your blood and body tissues; the bilirubin build-up causes a yellow coloring of your skin and eyes, called jaundice.

Other hepatitis infections, such as hepatitis A and hepatitis B, are caused by different viruses than the virus that causes hepatitis C.

How will I feel with hepatitis C?

You will probably not have any symptoms during the early stages of hepatitis C infection. Initial symptoms, if present, are generally mild and mimic the flu, such as:

• Fatigue

• Muscle and joint pain

• Nausea

• Poor appetite

• Fever

• Abdominal tenderness (near the liver)

In you have a more severe or advanced hepatitis C infection, especially if cirrhosis has developed, you may experience the symptoms listed above, as well as:

• Muscle weakness

• Weight loss

• Itching

• Dark urine

• Fluid retention

• Abdominal swelling

• Jaundice (yellowing of the skin and eyes)

• Skin rash

Even if you do not experience any symptoms from being infected with the hepatitis C virus,

you can still spread the virus to other people.

Can I prevent hepatitis C infection?

There is no vaccine to prevent infection with the hepatitis C virus. For this reason, preventing infection with this virus means avoiding contact with any infected blood or blood products. Minimizing your risk of being exposed to the hepatitis C virus includes not using illicit injected drugs, ensuring that sterile equipment is used if getting a tattoo or body piercing, and not engaging in unprotected sex with multiple partners or with a partner whose health status is unknown.

There are vaccines for two other types of hepatitis (hepatitis A and hepatitis B) and if you are infected with hepatitis C it’s a good idea to get these two vaccines to prevent further damage to your liver.

How did I get hepatitis C?

This liver disease is caused by the hepatitis C virus. You can get infected with this virus by coming into contact with blood or blood products from a person who already has this disease. You might have caught hepatitis C virus in one the following ways:

• Sharing needles, syringes, or other equipment related to injection drug use (even if you only did this once many years ago)

• Blood transfusions and organ transplants prior to 1992 (when routine screening for the hepatitis C virus was introduced)

• Accidental needle-stick in a health care setting

• Being born to a mother infected with hepatitis C

• Being on long-term dialysis for kidney failure

• Using cocaine (intranasally) with shared equipment

• Getting a tattoo or body piercing with improperly sterilized needles

• Sharing a razor or toothbrush with an infected person

• Sexual contact

Up to 30 percent of the time, you will not know the exact way or time that you became infected with hepatitis C, although you may have been inadvertently exposed to the hepatitis C virus from a cut, wound, or medical injection or procedure many years in the past.

You cannot get hepatitis C from food or beverages. In addition, you cannot catch it from casual contact, such as sharing eating utensils, shaking hands, hugging, kissing, swimming in a pool, using public toilets, sneezing, or coughing.

How will I know I have hepatitis C?

It is very common for a diagnosis of hepatitis C to come as a surprise during a routine physical. This is especially true if you do not have any symptoms of hepatitis C infection, even for many years after you’ve been exposed to the hepatitis C virus. Although symptoms may be absent or minimal for many years, your liver can be progressively and permanently damaged by the hepatitis C virus. This is why it is important to get a diagnosis as early as possible.

The following tests may be used during your diagnosis and treatment of hepatitis C:

Liver function blood tests

Blood tests of liver enzymes are often the first indication that you have an infection in your liver. Although these tests cannot tell if you have hepatitis C, they do indicate that there is a problem with your liver that merits further investigation. Blood tests can check for bilirubin, albumin, and prothrombin time (a measure of blood clotting). The liver enzymes alanine aminotransferase (ALT) and aspartate aminotransferase (AST) are checked to see if your liver is inflamed or damaged. Levels of alkaline phospatase (AP) show whether a bile duct in your liver is blocked.

Your liver enzyme levels will probably be abnormal. However, your enzyme levels can go up and down over time. If your liver enzyme levels are normal, but there are other reasons to believe that you might have a liver problem, then the test will probably be re-done after a few months.

Hepatitis C virus test

A blood test can be used to discover if you have antibodies to the hepatitis C virus (HCV). This test is sometimes called the anti-HCV test and is used as an initial screening test for hepatitis C. It shows if you have ever been exposed to the hepatitis C virus.

False-positives sometimes occur with the anti-HCV test, which is why the diagnosis of hepatitis C is often confirmed with an additional blood test looking for the genetic material, which is called RNA, of the hepatitis C virus. This “HCV RNA” test will show if you are currently infected with the hepatitis C virus; it can be used as little as one to two weeks after your exposure to the virus. Another test, called the HCV RIBA, is sometimes done to confirm a diagnosis of hepatitis C.

Viral load

This blood test shows how much hepatitis C virus is in your blood. This is called the “viral load” and it can be helpful in choosing which antiviral therapy is more likely to be effective for you. Checking for viral load is generally done both before and during treatment with a particular medication to see how well you are responding and determine how long your treatment will be continued.

Hepatitis C genotyping

There are six types of hepatitis C viruses: genotypes 1-6. A blood test can identify which genotype is causing your hepatitis C infection. The genotype that you are infected with will influence which treatment could be most effective for you.

Liver biopsy

This test checks to see if the hepatitis C virus has damaged or scarred your liver. This test is done by removing a small sample of liver tissue with a thin needle in a procedure called a biopsy. This test can also show if your liver problem is caused by hepatitis C or a different condition (such as alcoholic liver injury, nonalcoholic fatty liver disease, or iron overload).

Additional tests

Imaging tests such as a CT scan, MRI, or ultrasound may be ordered by your doctor to determine if you have liver cancer.

Could I have something else?

If you appear to have a liver problem, your doctor will rule out these other conditions before confirming your diagnosis of hepatitis C infection:

• Autoimmune hepatitis

• Chronic hepatitis B and D

• Alcoholic hepatitis

• Nonalcoholic fatty liver disease

• Sclerosing cholangitis

• Wilson disease

• Alpha-1-antitrypsin-deficiency-related liver disease

• Drug-induced liver disease

What problems can hepatitis C cause?

Hepatitis C infection can be either acute or chronic. Acute hepatitis C refers to the first six months after you are infected. Acute hepatitis C is a short-term illness that causes jaundice, fatigue, and nausea; although you may have no symptoms at all. An estimated 15-25 percent of people infected with the hepatitis C virus will clear the virus and not develop chronic hepatitis C infection. Unfortunately, this means that for most people (75-85 percent) that an acute hepatitis C infection will lead to a chronic hepatitis C infection. Chronic hepatitis C infection is diagnosed when your liver enzymes are abnormal for more than six months.

Chronic hepatitis C can cause several long-term health problems. Hepatitis C is the leading cause of cirrhosis, which is scarring of liver tissue that compromises liver function. At least 20 percent of people with chronic hepatitis C infection will develop cirrhosis. However, this is a long process that takes 10-20 years to develop after you are infected with the virus. Hepatitis C is also the leading cause of liver cancer; but this is also a long process, with liver cancer not appearing until 20-40 years after your initial infection. The liver failure that can develop from chronic hepatitis C infection is the most common reason that you would need a liver transplant.

What side effects can I expect?

Side effects can occur during the medication treatment of hepatitis C. Doctors can’t predict who will have side effects and how severe they will be. The most common side effects include:

• Nausea

• Vomiting

• Fever

• Fatigue

• Depression

• Headache

• Low white blood cell counts

• Low red blood cell counts

These side effects are generally worse in the first few weeks of your treatment and become less severe over time. There are additional medications you can take to lessen some of these side effects.

Although these side effects can be difficult, it is very important to complete your full course of treatment to protect your liver in the long run.

What will happen in the future?

Whether or not your medication therapy will successfully treat your hepatitis C infection depends on many factors. Some of these factors are in your control, such as taking all of your medications on the correct schedule. Avoiding alcohol makes treatment more successful. Having a normal body weight, as opposed to being overweight or obese, also makes treatment more likely to be successful.

Other factors are not in your control, such as the genotype of your hepatitis C virus. If you have genotypes 2 or 3, you have a 70-80 percent likelihood of clearing the virus from your body after medication therapy. If you have genotype 1, there is a 40-45 percent treatment success after finishing your medication therapy.

Regardless of which genotype you have, women tend to have better treatment success than men, as do younger people compared to older people. For unknown reasons, medication therapy is more likely to be successful in Caucasian-Americans and Asian-Americans, compared to African-Americans. If you also have HIV, in addition to hepatitis C, your treatment outcome is poorer. In addition, having cirrhosis or a higher amount of the virus in your blood also corresponds to less treatment success.


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Where can I get more information?

Hepatitis Disease Information:

American Liver Foundation

Centers for Disease Control and Prevention

Hepatitis Foundation International

Hepatitis Central

Support Group information

Hepatitis Magazine

What is Hepatitis C

Hepatitis Medication Information:

Pegasys / Copegus

Peg Intron/Rebetol/IntronA/Rebetron

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