Hepatitis C

What is hepatitis C?

Hepatitis C is a viral infection. It can inflame and damage the liver.

Hepatitis C is usually transmitted through contact with infected blood. It can be spread through:

shared needles during intravenous drug use
shared devices used to snort cocaine
unprotected sexual intercourse (this is uncommon)
accidental stick with a contaminated needle
blood transfusions (rare because of improved screening techniques since 1992)
renal dialysis
childbirth, from mother to child during delivery
contaminated tattoo or body piercing equipment.

The hepatitis C virus can cause short-term (acute) or long-term (chronic) hepatitis C. Most people with acute hepatitis C eventually develop chronic hepatitis C.

Most people with hepatitis C don't know that they are infected. That's because hepatitis C usually does not cause symptoms.

After having this silent infection for 20 to 30 years, about one-third of people develop cirrhosis. Cirrhosis is a serious liver disease that can lead to death. A smaller group of people with chronic hepatitis C develop liver cancer.

The United States Preventive Services Task Force and Centers for Disease Control and Prevention recommend screening for hepatitis C virus (HCV) infection in people at higher than average risk. Also there is a high prevalence of infection in adults born between 1945 and 1965. If you were born during that time, you should get a one-time simple blood test to make sure you are not infected.

Symptoms of hepatitis C

Many people with hepatitis C do not have any symptoms.

Some people develop symptoms that last for up to three months. These symptoms include:

a general sick feeling
a yellowish discoloration of the skin
weakness
poor appetite
fatigue
nausea
abdominal pain.

Some people with acute hepatitis C completely eliminate the virus from their bodies. They don't suffer any long-term consequences.

But the majority of people with acute hepatitis C remain infected. They develop chronic hepatitis C.

Only some people with long-term hepatitis C develop symptoms. These symptoms include:

weight loss
poor appetite
fatigue
aching joints.

Most people with chronic hepatitis C do not have any symptoms for 20 to 30 years. All the while, however, the virus slowly damages their livers. Unless they are tested for hepatitis C, many of these people do not know that they are infected. That is, until they develop the symptoms of advanced liver disease.

Diagnosing hepatitis C

To make a diagnosis, your doctor will ask about symptoms of hepatitis C or advanced liver disease.

He or she will ask about your exposure to risk factors for hepatitis C. These include:

a history of intravenous drug use
a history of nasal cocaine use
blood transfusions, especially before 1992
multiple sexual partners
previous or current work in the health care field
history of hemodialysis.

Your doctor will examine you. He or she will look for evidence of liver disease, such as:

enlarged liver or spleen
swollen abdomen
ankle swelling
muscle wasting.

Hepatitis C infection is confirmed by certain tests. One test looks for hepatitis C virus in your blood. Another test detects infection-fighting proteins (antibodies). Antibodies to hepatitis C indicate that you have been exposed to the virus.

If you have hepatitis C, blood tests can determine the subtype of virus. Different subtypes respond differently to treatment.

You may need a liver biopsy. In a biopsy, a small piece of liver tissue is removed and examined in a laboratory. The biopsy helps predict whether you will develop complications from liver disease.

Expected duration of hepatitis C

Most people with hepatitis C have the infection for life. Some eventually develop cirrhosis or other forms of severe liver disease.

Preventing hepatitis C

There is no vaccine to protect against hepatitis C. The only way to prevent this disease is to avoid the risk factors.

The most effective ways to prevent hepatitis C:

Don't use illegal drugs.
Make sure body piercing or tattooing is done using clean equipment.
If you are a health care worker, follow standard infection control precautions.
Avoid unprotected sexual intercourse unless you are in a long-term relationship with one person.

It is rare for someone in a monogamous, long-term relationship with an infected partner to become infected. Discuss your need for precautions with your doctor.

Drinking alcohol makes hepatitis C worse. If you have hepatitis C, avoid alcohol.

Treating hepatitis C

Not everyone infected with hepatitis C needs treatment. Discuss the potential benefits and side effects of treatment with your doctor.

The first treatment used for hepatitis C was a combination of alpha interferon and ribavirin (Virazole). Side effects from these drugs are very common. And many people don't tolerate the therapy, especially the interferon.

Treatment today has changed dramatically. Antiviral drugs are much more effective at clearing the hepatitis C virus from the body and allowing the liver to heal. They also have fewer and less severe side effects compared to interferon.

The treatment goal is to totally clear your blood of any detectable virus using a blood test called HCV RNA. If you have no detectable HCV RNA 12 weeks or more after you have completed antiviral therapy, the cure rate is close to 100%.

Your doctor will recommend hepatitis A and B vaccinations. He or she will also advise against drinking any alcohol. These actions will reduce the chance that you will have further liver damage.

When to call a professional

Call your doctor if you have symptoms of hepatitis C. Also call if you may have been exposed to the virus.

The Centers for Disease Control and Prevention recommends that everyone ages 18 to 79 have one-time screening for hepatitis C.

High-risk individuals often need periodic testing for hepatitis C. High-risk individuals include anyone who:

received transfusions of blood or blood products before 1992
received an organ transplant before 1992
has been on long-term hemodialysis
has had multiple sexual partners
has a long-term sexual partner with hepatitis C
lives in the same household as someone with hepatitis C
has evidence of liver disease.

Prognosis

Most people infected with hepatitis C virus eventually develop chronic hepatitis C.

Long-term complications often do not develop until after decades of infection. At that time, some people develop cirrhosis. A smaller group of people develop liver cancer.

Anti-viral therapy can cure the condition and substantially decrease the risk of long-term complications.