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Hepatitis C

Background


Hepatitis C is a contagious liver disease that results from infection with the hepatitis C virus and can range in severity from a mild illness that lasts a few weeks to a serious, lifelong illness that attacks the liver.

 

Acute hepatitis C is a short-term illness that occurs within the first six months after someone is exposed to the hepatitis C virus. For reasons that are unknown, 15% to 25% of people “clear” the virus without treatment, however, approximately 75% to 85% of people who become infected with the hepatitis C virus develop “chronic” or life-long infection.

 

Hepatitis C is chronic when the body can’t get rid of the hepatitis C virus. Some people can clear the virus from their bodies in a few months, but most hepatitis C infections become chronic. Over time, approximately 60% to 70% of people with chronic hepatitis C develop liver disease and 1% to 5% of people get liver cancer or cirrhosis.

 

An estimated 3.2 million people in the United States have chronic hepatitis C and each year about 17,000 Americans become infected with hepatitis C. Most people do not know they are infected because they often don’t look or feel sick.

 

Causes


Hepatitis C is usually spread when blood from a person infected with the hepatitis C virus enters the body of someone who is not infected. Most people become infected by sharing needles or other equipment to inject drugs. Before widespread screening of blood supplies began in 1992, hepatitis C was also commonly spread through blood transfusions and organ transplants.

 

People can become infected with the hepatitis C virus during activities such as:

 

  • Sharing drug needles, syringes or other equipment to inject drugs with an infected person.

 

  • Getting an accidental needle stick with a needle that was used on an infected person.

 

  • Being born to a mother with hepatitis C.

 

  • Being tattooed or pierced with unsterilized tools that were used on an infected person.

 

  • Sharing personal care items such as razors or toothbrushes that may have come in contact with an infected person’s blood.

 

  • Having sex with an infected person.

 

Symptoms


There are many people with hepatitis C who do not have symptoms and do not know that they are infected. If symptoms do occur with acute infection, they can develop anytime from two weeks to six months after exposure. Symptoms of chronic hepatitis C can take up to 30 years to develop and damage to the liver can silently occur during this time. When symptoms develop they are often a sign of advanced liver disease. Symptoms can include:

 

  • Fever
  • Tiredness
  • Upset stomach
  • Loss of appetite
  • Vomiting
  • Light-colored stools
  • Dark yellow urine
  • Joint pain
  • Jaundice (yellowish eyes and skin)

 

Diagnosis


Doctors can diagnose hepatitis C using specific blood tests that are not part of the normal blood work commonly done during regular physical exams:

 

EIA (enzyme immunoassay) test - Typically a person will first get an initial screening test that looks for “antibodies” to the hepatitis C virus. One of the most common names for this test is EIA (enzyme immunoassay). Antibodies are chemicals that are released into the bloodstream when a person becomes infected with the virus. If the screening test is positive for hepatitis C antibodies, it means the person is or has been infected with the hepatitis C virus. There are some people who get infected and are able to fight the virus and clear it from their bodies. However, for most people the virus remains and becomes a chronic infection. When people have become infected they will always have antibodies in their blood regardless of whether they have cleared the virus or become chronically infected.

 

Confirmatory test – A person who has a positive antibody test for hepatitis C should then have a confirmatory test. This test looks for the actual presence of the hepatitis C virus. If the confirmatory test is positive this means that a person currently has the virus in their blood. This test detects the RNA, or genetic material, in the hepatitis C virus. There are different ways of detecting viral RNA but the most common test used is called PCR (polymerase chain reaction).

 

People who have a positive antibody test but a negative RNA test have had an infection that has been cleared and they are not currently infected. Those people that have a positive antibody test along with a positive RNA test have an ongoing hepatitis C infection.

 

Treatment

 

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Hepatitis C is not treated unless it becomes chronic. Medications, called antivirals, can be used to treat many people with chronic hepatitis C. However, not everyone needs or can benefit from treatment and a doctor must determine the most appropriate medical care. Many factors should be considered before starting antiviral therapy, such as the condition of the liver and if the person has any other health conditions.

 

Treatment often involves taking combinations of different antiviral medications that help fight the hepatitis C virus. For many people, medical treatment can be successful and can result in the hepatitis C virus no longer being detected in the blood.

 

Side effects


Treatment can cause side effects such as flu-like symptoms, depression, weight loss, rash, anemia and insomnia. Sometimes side effects can disrupt a person’s life and day-to-day activities but it is important that a person never changes their dosage or stops taking the medication without talking to their doctor or pharmacist.

 

Resources


There are many resources and organizations available to help, providing support, advocacy and information:

 

American Liver Foundation
www.liverfoundation.org

 

Hepatitis Foundation International
www.hepfi.org

 

Hepatitis C Association
www.hepcassoc.org

 

References


Centers for Disease Control and Prevention. http://www.cdc.gov/hepatitis. Accessed November 29, 2011.

 

National Institutes of Health. NIDDK. Handout on What I need to know about Hepatitis C. NIH Publication No. 09-4229. April 2009.

 

National Institutes of Health. NIAID. http://www.niaid.nih.gov/topics/hepatitis/hepatitisC/Pages/Default.aspx.  Accessed November 29, 2011.

 

 

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