Hepatitis
C
(HCV
- Hepatitis C Virus)
What are the signs or symptoms of hepatitis C?
What is the treatment for hepatitis C?
Do I need to talk to my partner about hepatitis C?
What
is hepatitis C?
Hepatitis C is a liver disease caused by the hepatitis
C virus (HCV). It is sometimes called non-A and non-B hepatitis. Hepatitis
C is the most common chronic blood-borne infection in the United States.
- 15 to 25% of those infected with HCV are able to clear the virus from their blood within about 6 months from the time of infection.
- However, 75 to 85% of people with acute hepatitis C are unable to rid themselves of the virus within 6 months and therefore have chronic (long-term) hepatitis C.
- 70% of infected persons will have chronic liver disease.
- Less than 3% will die from chronic liver disease.
- HCV is the leading cause for liver transplants.
How
common is hepatitis C?
It is estimated that around 4 million Americans have been infected with
hepatitis C, of who 2.7 million have chronic infections. Each year it
is estimated that there are 25,000 new infections in the United States,
according to the Centers for Disease Control and Prevention (CDC). Of
those new infections, only 20% of those infected will have symptoms. That
means many people will become infected with hepatitis C and not know it
right away.
Hepatitis C is primarily transmitted through blood or blood products.
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.
- Hepatitis C has
been found in semen and vaginal secretions and may be transmitted during
vaginal or anal intercourse. Sexual transmission occurs in about 20%
of HCV cases, and transmission is more efficient when blood is present.
Factors found to be associated with sexual transmission of HCV are:
- Sex with multiple partners
- Presence of other STDs
- Sex with trauma (for example, rough sex, rape or sexual abuse
-
Transmission through oral sex has not been documented.
-
Neonatal transmission. 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. 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 signs or symptoms of hepatitis C?
Most individuals with hepatitis C do not have 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) and a chronic (persistent) infection are different.
ACUTE INFECTION (newly acquired):
- Often, people with an acute HCV infection are asymptomatic (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
- 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 can I find out if I have hepatitis C?
There are several blood tests that can be done to determine if a person has HCV. If you think you've been exposed or infected with HCV, talk to your health care provider. They may order one test or a combination of tests. You and your health care 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 within 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 HCV 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: tests to see if enzymes are higher than normal levels, which indicates damage to liver cells.
-
Ultrasound: tests for signs of liver damage and cancer.
-
Liver biopsy: detects 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 HCV in the blood for many months.
Testing is recommended for:
- People who have ever injected illegal drugs (including those who may have injected only once many years ago).
- People who were notified that they received blood from a donor who later tested positive for the HCV infection.
- People who received blood transfusions or organ transplants before July 1992.
- Health care professionals 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).
Routine screening for hepatitis C is not necessarily recommended for:
- Health care providers
- Pregnant women
- Household contacts of HCV carriers
- The general population
NON-SEXUAL
- If you routinely inject drugs, avoid sharing needles, syringes, cotton, water, spoons, pots (cookers)--or any other drug paraphernalia. If you choose to share, 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 B.
- Avoid sharing personal objects, such as toothbrushes, razors or any other items that might have blood on them.
- Health care 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.
SEXUAL
- Abstinence and mutual monogamy between two uninfected partners are effective prevention methods.
- Latex condoms reduce the risk of transmitting HCV during vaginal and anal sex.
- A non-lubricated latex condom can be used for mouth-to-penis contact. Household plastic wrap, dams, or a latex condom cut lengthwise and opened flat can reduce the risk of transmission during mouth-to-vulva or mouth-to-anus contact.
- Get vaccinated against hepatitis A and B.
IMMUNE GLOBULIN (IG) OR INTERFERON AFTER EXPOSURE TO HCV
Available data indicate that immune globulin injections are not effective after exposure to someone infected with HCV. However, 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 health care provider for more information.
What
is the treatment for hepatitis C?
Treatment may differ depending on the stage of the 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 defined, short course) and go on to recover completely.
- Relatively few people seek medical care for acute HCV, since most individuals are asymptomatic (have no symptoms) or have only mild, flu-like symptoms.
- There is no accepted therapy or 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 health care provider for more information
- Consult your health care 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
- 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 health care professional may know of emerging therapies in the clinical trial stage for which you may be a candidate. Discuss these possibilities with your health care provider and let them help you make the best healthcare choices for you.
- Drugs used to treat HCV are not licensed for persons less than 18 years of age. Children with hepatitis C should contact a children's specialist in liver diseases.
Why worry about hepatitis C?
- 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, and 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.
Do
I need to talk to my partner about hepatitis C?
Yes. Good partner communication is important in a relationship. While HCV is more likely to be spread through sharing drug needles and such with others, it can be transmitted through sexual contact. If you or your partner use street drugs or any illegal drug requiring a needle, you could be a risk of getting hepatitis C.
Should
I talk to my health care provider about hepatitis C?
Yes. Speak to your health care provider if you have:
- Shared an injection drug needle in the past, even once.
- Received a blood product or transfusion prior to 1992.
- Had unprotected sex with someone with HCV.
- Had kidney dialysis.
- Received notice that you received blood from a donor who later tested positive for HCV infection.
- Not drinking alcohol, because it may cause further damage to the liver.
- Seeing your health care provider regularly
- Not beginning to take any new medicines, including over-the-counter or herbal ones, without talking to your health care provider.
- Getting vaccinated against hepatitis A and B.
More
Information on hepatitis and other STD's
For additional questions about this or any other STD's and other diseases,
CDC (Centers for Disease Control) provides several toll-free hotlines for public
use. The hotlines provide referrals and more answers to your questions. Be
sure to request free printed information when you call the hotlines.
-
CDC National STD and AIDS Hotlines:
1-800-342-2437 or 1-800-227-8922. The hotlines are open 24 hours a day, seven days a week. For Spanish call 1-800-344-7432, 8:00 a.m. to 2:00 a.m. eastern standard time, seven days a week. For the deaf and hard-of-hearing call 1-800-243-7889, 10:00 a.m. to 10:00 p.m. eastern standard time, Monday through Friday. -
CDC National Immunization Information Hotline:
English 1-800-232-2522 Spanish 1-800-232-0233 8 a.m. to 11 p.m. eastern standard time. For the deaf and hard-of-hearing call 1-800-243-7889. Monday through Friday 10 a.m. to 10 p.m. eastern standard time. -
CDC Public Response Hotline (CPR):
English 1-888-246-2675 span 1-888-246-2857 Monday through Friday 8 a.m. to 11 p.m. eastern standard time 10 a.m. to 8 p.m. Saturday and Sunday. For the deaf and hard-of-hearing 1-866-874-2646 10 a.m. to 1 p.m. eastern standard time Monday through Friday.