Hepatitis C

Hepatitis C is a virus that often silently attacks your liver.  Hepatitis C is one of six identified hepatitis viruses — the others are A, B, D, E and G. All cause the liver to become inflamed, which interferes with its ability to function. Hepatitis C is generally considered to be among the most serious of these viruses.  Most people infected with the hepatitis C virus (HCV) have no symptoms at all. In fact, most people don’t know they have the disease until liver damage shows up, decades later, during routine medical tests.  Although vaccines exist for hepatitis A and B, no vaccine for hepatitis C has been developed.

Over time, if you have a hepatitis C infection, it can lead to liver cancer, liver failure or cirrhosis — irreversible and potentially fatal scarring of the liver. Unlike HIV, the virus that causes AIDS, the hepatitis C virus usually isn’t transmitted through sexual contact. Instead, you’re more at risk if you’re exposed to contaminated blood — through needles shared during drug use or through blood transfusions.

In general, you get hepatitis C by coming in contact with blood contaminated with the virus.  You can also get the virus by injecting drugs with contaminated needles and, less commonly, from contaminated needles used in tattooing and body piercing. Needle exchange programs, which increase the availability of sterile needles, are helping to reduce the risk of hepatitis C, HIV and other blood-borne diseases. A small number of babies born to mothers with hepatitis C acquire the infection during childbirth. Mother-to-infant transmission rates are higher among women infected with both hepatitis C and HIV. Talk with your doctor about these risks before becoming pregnant.  In rare cases, hepatitis C may be transmitted sexually. And in many people infected with hepatitis C, no risk factor can be identified.

Effective blood-screening procedures have greatly reduced the chances of hepatitis C infection from transfusions. But if you received a blood transfusion before 1992, you’re at risk of hepatitis C.

You are also at risk if you:

  • Have used illicit intravenous (IV) or intranasal drugs, such as cocaine
  • Received an organ transplant before 1992
  • Are a health care worker who has been exposed to infected blood
  • Received clotting factor concentrates before 1987 or have the clotting disease hemophilia and received blood before 1992
  • Are receiving hemodialysis for kidney failure
  • Were born to a woman with a hepatitis C infection

Most people infected with HCV develop chronic hepatitis. Some people infected witfh hepatitis C develop cirrhosis, usually within 20 to 30 years after infection. This risk is higher and the progression is faster if you also have HIV infection. Of those who develop cirrhosis, the risk of developing liver failure is about 4 percent a year. In addition, between 1 percent and 5 percent of people with HCV eventually develop liver cancer. HCV also may increase the risk of developing several types of lymphatic system cancers (lymphomas). Your risk of non-Hodgkin’s lymphoma, for example, may increase by 20 percent to 30 percent. Rarely, HCV infection can be associated with skin and kidney problems. The hepatitis C virus is linked to an increased risk of porphyria cutanea tarda, a condition that may cause a blistering rash, to cryoglobulinemia, which can cause a purplish rash (purpura) on your lower extremities, and may cause kidney damage.

Commonly, hepatitis C infection produces no signs or symptoms during its earliest stages. When it does, they’re generally mild and flu-like and may include:

  • Slight fatigue
  • Nausea or poor appetite
  • Muscle and joint pains
  • Tenderness in the area of your liver

Even if you develop chronic hepatitis from the hepatitis C virus, you may have few, if any, symptoms. In many cases, signs and symptoms may not appear for decades. Sometimes, though, you may experience one or more of the following:

  • Fatigue
  • Lack of appetite
  • Nausea and vomiting
  • Persistent or recurring yellowing of your skin and eyes (jaundice)
  • Low-grade fever

Hepatitis C can cause damage to your liver, even if you don’t have symptoms. You’re also able to pass the virus to others without having any symptoms yourself. That’s why it’s important to be tested if you think you’ve been exposed to hepatitis C or if you engage in behavior that puts you at risk.

A blood test can determine whether you have the hepatitis C virus. If test results indicate that you have HCV, your doctor may measure the quantity of the virus in your blood (viral load) and evaluate the genetic makeup of the virus (genotype). There are six known HCV genotypes. Knowing which genotype you have will help your doctor determine the best course of treatment for you and how likely you are to respond to treatment.  Your doctor may also recommend a liver biopsy, a procedure in which a small sample of liver tissue is removed for microscopic analysis. Before the biopsy, you’ll receive a local anesthetic to decrease the pain. Your doctor then inserts a thin needle into your liver to remove the tissue sample. Liver biopsy is unlikely to have any complications, although you may have some pain or bleeding afterward. One in 100 to one in 1,000 people may experience significant bleeding.  Although a biopsy isn’t necessary to confirm a diagnosis of hepatitis C, it can help determine the severity of the disease and guide treatment decisions. It may also help rule out other causes for your liver problem, such as alcoholic or drug-induced hepatitis, autoimmune hepatitis or excess iron (hereditary hemochromatosis).

A diagnosis of HCV doesn’t necessarily mean you need treatment.  If you have only slight liver abnormalities, your doctor may decide against medical treatment because your long-term risk of developing a serious disease is slight, and the side effects of treatment can be severe. On the other hand, because there’s no foolproof way to know whether you’ll develop liver disease later on, your doctor may recommend fighting the virus. Improved treatment methods and a higher success rate in fighting hepatitis sometimes tip the balance in favor of more aggressive approaches.

The standard of care for hepatitis C treatment is weekly injections of a drug called pegylated interferon alfa combined with twice-daily oral doses of ribavirin (Rebetol) — a broad-spectrum antiviral agent. Two pegylated interferon medications are available, peginterferon alfa-2b (Peg-Intron) and peginterferon alfa-2a (Pegasys).

The goal of HCV treatment is to clear the virus from your bloodstream. Combined pegylated interferon and ribavirin clear HCV infection in 40 percent to 80 percent of those treated. It’s success often depends on the type of infection. For example, this treatment clears infection in up to half the people with genotype 1 — the most common genotype found in the United States — and in up to 80 percent of those with genotypes 2 and 3.

If you have genotype 1 HCV, your doctor may recommend a course of relatively high-dose medications for 48 weeks. If you have genotype 2 or genotype 3, a 24-week course of medications at a lower dose may be adequate.  If one course of combined pegylated interferon and ribavirin doesn’t clear HCV from your bloodstream, your doctor may recommend a second course of combination therapy. If your viral load declined during the first round of medications, a second round may clear the virus completely. Even if there was no change in your viral load during the first course of treatment, a second course may help reduce the damage HCV does to your liver.

The best treatment for people with end-stage liver disease is liver transplantation. However, the number of people awaiting transplants far exceeds the number of donated organs. But several new developments in transplantation may make it possible for more people to receive transplants. These developments include the donation of liver segments from living relatives, splitting one donated liver between two recipients, new organ allocation policies and, especially, new approaches to liver transplants for people with HCV.  Until recently, HCV-infected livers were routinely discarded. But studies show that people already infected with HCV who receive livers from HCV-positive donors can do as well as if they had received a liver not infected with the virus. This may mean that many more livers will become available for people with hepatitis C. Liver transplantation does not cure HCV. The majority of people with hepatitis C who receive liver transplants experience a recurrence of the virus. Those with HCV who receive liver transplants also are at accelerated risk of developing cirrhosis within five years. Treatment with HCV-fighting medications may help prevent a recurrence of infection or treat recurrent illness that develops after a liver transplant. However, the effectiveness of this type of treatment after a liver transplant is unclear.

In Europe, the herb milk thistle (Silybum marianum) has been used for centuries to treat jaundice and other liver disorders. Today, scientific studies have confirmed that the chief constituent of milk thistle, silymarin, may aid in healing and rebuilding the liver. Silymarin seems to stimulate the production of antioxidant enzymes that help the liver neutralize toxins. It also may decrease inflammation in the liver. However, more study is needed. Although milk thistle may help the liver, it won’t cure hepatitis, and it won’t protect you from contracting the virus.  Milk thistle is available in capsules or alcohol-free extracts. Check with your doctor before trying this or any other herb, to make sure it won’t interact with other medications you’re taking.

Because no effective vaccine for hepatitis C exists, the only way to protect yourself is to avoid becoming infected. That means taking the following precautions:

Avoid illegal drug use. Don’t share needles or other drug paraphernalia. Contaminated drug paraphernalia is responsible for more than half of all new hepatitis C cases. Avoid nasal use of cocaine. Blood on shared straws also can transmit the virus.
Avoid body piercing and tattooing. If you do undergo piercing or tattooing, be absolutely certain the equipment is sterile.
Avoid risky sexual behavior. Don’t engage in unprotected sex with multiple partners or with one partner whose health status is uncertain. Sexual transmission between monogamous couples may occur, but the risk is low.