Hepatitis C

What is Hepatitis C?

Hepatitis C virus is one of several known viruses that infects the liver. The hepatitis viruses have been labeled A through E. Recently, yet another virus, hepatitis G, has been discovered. There is good evidence that other hepatitis viruses exist that are not discovered yet.

Hepatitis C is found worldwide amongst individuals of all ages, both genders and all social, racial and ethnic backgrounds. It is known that hepatitis C is readily spread by needle sharing (amongst drug abusers) and by transfusion of blood or blood products before 1991 (before hepatitis C testing of the blood supply was introduced). The risk of getting hepatitis by blood transfusion was as high as 10% several decades ago. With efficient testing of the blood supply, this risk is now less than half percent.

Hepatitis C infection also occurs in patients on hemodialysis, in health care workers who have been exposed by accidental needle stick injury and among alcoholics with liver disease. Although it is probable that hepatitis C is spread sexually, and from mothers to newborn infants, the rate of infection by these means is extremely low (unless the individuals are also infected with HIV (the AIDS virus). A surprising fact, however, is that approximately half of all individuals seen with hepatitis C infection have no obvious or admitted episodes of exposure to infected persons. The high rate of this so-called "sporadic" infection has yet to be explained.

What are the symptoms of hepatitis C?

• Fatigue
• Joint and muscle and aches
• Headaches
• Nausea and loss of appetite
• Stress and depression

How do I know I have hepatitis C?

• Once you are exposed to hepatitis C your body builds antibodies to fight the virus. Your blood is tested for the antibodies to the hepatitis C virus.
• You may have a polymerase chain reaction (PCR) test that tells your doctor how much virus is in your blood.
• You may need a liver biopsy to determine the nature and severity of the disease.

How does hepatitis C advance?

At the time that you are is first infected with hepatitis C, you may develop a typical illness of acute hepatitis, that is a feeling of ill health, loss of appetite, nausea, vomiting, and jaundice. More frequently, however, you are unaware of the infection. Hepatitis C infection may only be apparent on blood testing. It is likely that only 20% of infected individuals clear the viral infection completely within a few months; the majority of patients remain infected for many decades and probably lifelong.

Almost all hepatitis C patients will have some degree of liver injury and inflammation, even if blood tests for liver enzymes are normal. The combination of liver injury and inflammation is called hepatitis.

If you have been infected for a long time, symptoms may be quite vague and non-specific. You may feel tired, minor aches and pains, or a feeling of mild ill health. Although all of these symptoms may be caused by liver disease associated with hepatitis C infection, there may be other explanations, such as depression or other illnesses.

The degree of liver inflammation and damage varies from patient to patient. This difference may be related to the length of time that you have been infected and your response to the virus and the viral strain involved. It has been estimated that cirrhosis develops in approximately 25% of individuals after 20 years of infection and approximately half of all patients with cirrhosis have evidence of significant deterioration in health. Although serious deterioration in health associated with hepatitis C infection is uncommon, you may eventually need a liver transplant.

Long term, that is to say after 20 to 30 years or more of infection, patients with cirrhosis due to hepatitis C are at risk for the development of liver cancer. The liver cancer risk appears to be related to the presence of cirrhosis, rather than to the hepatitis C virus.

In patients with chronic hepatitis C infection, with or without obvious liver disease, abnormalities may occur in other organs. This is usually due to the presence of blood vessel inflammation, which may be apparent because of skin inflammation and ulceration, arthritis or kidney damage.

How is hepatitis C transmitted?

As yet, there are no vaccines for the prevention of hepatitis C infection.

There are no strict recommendations about sexual activity, except for the use of condoms for new or infrequent sexual encounters. If you have had a close relationship for many years, it is likely that transmission of hepatitis C has already occurred or your spouse may not be susceptible. The use of condoms has not been officially recommended in this situation and this remains a matter of personal choice for the couple concerned.

The best way for you to prevent exposing someone to hepatitis C is by avoiding high risk behavior such as needle sharing and promiscuous sexual activity. You should not share toothbrushes, razors, etc. with other individuals.

It is known that alcoholics who are infected with hepatitis C have more advanced liver disease than those without hepatitis C. Alcohol may lead to increases in virus activity. Thus alcohol should be avoided by patients with hepatitis C infection.

How is hepatitis C treated?

To date, there is no vaccine or immunization available for hepatitis C. Several drugs are being investigated for the treatment of hepatitis C infection. Only one drug, interferon, is licensed for the treatment of hepatitis C infection.

Interferon is a naturally occurring protein that is made by your body during viral infection. Drug manufacturers have been able to prepare human interferon in sufficient quantities for use in various diseases. Interferon, given by injection in standard doses several times per week, may result in effective treatment of hepatitis C infection. Approximately 50% of infected individuals show normalization of elevated blood enzyme levels by the end of six months treatment. The remaining 50% either show no response or an inadequate response. Unfortunately, of the individuals responding to this treatment, approximately 50% relapse after stopping the medication.

Hepatitis C may be detected after you stop interferon treatment even if your liver enzyme levels are within normal blood enzyme levels. In this case, it is likely that your viral infection and liver inflamation continues. If you show a longterm response to interferon that continues for many years after stopping therapy, it is likely that liver inflammation will be reduced, and it is hoped (but not yet proven) that the progression of liver scarring and cirrhosis will be retarded or even stopped.

If you respond successfully to interferon once but relapse when this medication is stopped, it is possible to use this treatment again. Research is being undertaken now to determine whether longterm treatment is safe and effective, and to work out the frequency, dose and duration of injections. There is a growing trend now to extend full dose treatment to 12 months or more in responsive patients, to maximize the chances of a durable longterm response.

Approximately 60% of patients do not experience the side effects that are common with interferon treatment such as flu-like symptoms, irritability, gastrointestinal upset and minor hair loss. Blood counts are monitored regularly, in case there is a sidnificant decrease in white cells or platelet count necessitating temporary cessation of therapy or reduction in dosage. If this occurs, you may need to stop therapy or reduce your dose. If blood tests show that treatment is ineffective after three months, it is questionable whether it is worthwhile to try an increased dose.

You should let your doctor know if you have a history of psychiatric illness requiring therapy. One of the most serious side effects of interferon therapy is the development of major depression. If depression occurs, you must stop treatment.

Therapy may also be limited if you already have a low white cell or platelet count due to cirrhosis. Therapy is less likely to be successful if you have had the disease for many years. Finally, interferon may provoke the occurrence of other diseases because this drug stimulates the immune system. There have been reports of thyroid disease, diabetes and even hepatitis because of immune stimulation in susceptible individuals, and the drug may also provoke a flare-up of other inflammatory diseases such as rheumatoid arthritis.

What life changes should I make?

• Eat small well-balance meals.
• Have very little caffeine and no alcohol
• Drink 4 to 8 glasses of water a day.
• Seek out positive activities and use relaxation techniques.
• Remain as active as possible.
• Do not share a razor or a tooth brush with anyone.