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HCV is spread primarily by contact with blood and blood products. Blood transfusions and the use of shared, unsterilized or poorly sterilized needles and syringes have been the main causes of the spread of HCV in the United States. With the introduction in 1991 of routine blood screening for HCV antibody and improvements in the test in the mid-1992, transfusion-related Hepatitis C has virtually disappeared. At present, injection-drug use is the most common risk factor for contracting the disease. However, many patients acquire Hepatitis C without any known exposure to drug use or blood.
Causes
Symptoms
Exams and Tests
Diagnosis
Treatment
Managing Hepatitis C
Self-Care for Hepatitis C Patients
Caring for those with Hepatitis C
Who is at risk for Hepatitis C?
- Injection drug users, including those who used drugs briefly many years ago.
- People who had blood transfusions before June 1992, when sensitive tests for anti-HCV were introduced for blood screening.
- People who have frequent exposure to blood products. These include patients with hemophilia, solid-organ transplants, chronic renal failure, or cancer requiring chemotherapy.
- Infants born to HCV-infected mothers.
- Healthcare workers who suffer needle-stick accidents.
Other groups at slightly higher risk for Hepatitis C:
- People with high-risk sexual behavior, multiple partners and sexually transmitted diseases.
- Those who use cocaine, particularly with intranasal administration, using shared equipment.
Causes of Hepatitis C
Maternal-Infant Hepatitis C Transmission
Maternal-infant transmission of Hepatitis C is not common. In most studies, only 5 percent of infants born to infected women become infected. The disease in newborns is usually mild and free of symptoms. The risk of maternal-infant spread rises with the amount of virus in the mother's blood and with complications of delivery such as early rupture of membranes and fetal monitoring. Breast-feeding has not been linked to spread of HCV.
Sexual Transmission
Sexual transmission of Hepatitis C between monogamous partners appears to be uncommon. Surveys of spouses and monogamous sexual partners of patients with Hepatitis C show that less than 5 percent are infected with HCV, and many of these have other risk factors for this infection. Spread of Hepatitis C to a spouse or partner in stable, monogamous relationships occurs in less than 1 percent of partners per year. For these reasons, changes in sexual practices are not recommended for monogamous patients. Testing sexual partners for anti-HCV can help with patient counseling. People with multiple sex partners should be advised to follow safe sex practices, which should protect against Hepatitis C as well as Hepatitis B and HIV.
Sporadic Transmission
Sporadic transmission, when the source of infection is unknown, occurs in about 10 percent of acute Hepatitis C cases and in 30 percent of chronic Hepatitis C cases. These cases are usually referred to as sporadic or community-acquired infections. These infections may have come from exposure to the virus from cuts, wounds or medical injections or procedures.
Unsafe Injection Practices
In many areas of the world, unsafe injection practices are an important and common cause of Hepatitis C (and Hepatitis B). Use of inadequately sterilized equipment, lack of disposable needles and syringes and inadvertent contamination of medical infusions are unfortunately well-documented causes of transmission of Hepatitis C. Careful attention to universal precautions and injection techniques should prevent this type of spread. In the United States, multiple-use vials are a frequent culprit in leading to nosocomial spread of Hepatitis C. For information on how to inject prescribed medications safely, see our self-injection guide. (link to self-injection guide)
Source: National Digestive Diseases Information Clearinghouse
Symptoms of Hepatitis C
Although 80% of people have no signs or symptoms of a Hepatitis C infection, there are some signs to watch for. Early detection of the Hepatitis C virus is key to successfully treating your condition. Many people do not even realize they have the condition unless they are specifically tested.
Infection occurs when blood or body fluids from an infected person enters the body of a person who is not infected with Hepatitis C. In addition, HCV is spread through sharing needles or "works" when "shooting" drugs, through needlesticks or sharps exposures on the job, or from an infected mother to her baby during birth. If you, or someone you know, believe they may have been infected with HCV, here are some of the possible symptoms:
- Jaundice
- Fatigue
- Dark urine
- Abdominal pain
- Loss of appetite
- Nausea
Adapted from: National Institute of Health
Exams and Tests For Hepatitis C
There are several blood tests that can be done to determine if you have been infected with the Hepatitis C virus. Your doctor may order just one or a combination of these tests. The following are the types of tests your doctor may order and the purpose for each: Anti-HCV (antibody to HCV)
- EIA (enzyme immunoassay) or CIA (enhanced chemiluminescence immunoassay) - Test is usually done first. If positive, it should be confirmed.
- RIBA (recombinant immunoblot assay) - A supplemental test used to confirm a positive EIA test.
Anti-HCV does not tell whether the infection is new (acute), chronic (long-term) or no longer present.
Qualitative tests to detect presence or absence of virus (HCV RNA)
This is a reliable way of demonstrating that Hepatitis C infection is present. And it is the most specific test for infection.
Quantitative tests to detect amount (titer) of virus in blood (HCV RNA)
These tests measure the concentration or level of Hepatitis C virus particles in your blood (also referred to as the viral load). The viral load helps predict the likelihood of responding to antiviral therapy.
Genotyping and Serotyping of HCV
There are six known genotypes and more than 50 subtypes of Hepatitis C. The genotype of infection is helpful in defining the epidemiology of Hepatitis C. More important, knowing the genotype or serotype (genotype-specific antibodies) of HCV is helpful in making recommendations and counseling regarding therapy. Patients with genotypes 2 and 3 are two to three times more likely to respond to interferon-based therapy than patients with genotype 1.
Furthermore, when using combination therapy, the recommended dose and duration of treatment depend on the genotype. Once the genotype is identified, it need not be tested again; genotypes do not change during the course of infection.
Source: Adapted from National Institutes of Health
Hepatitis C Diagnosis
It is possible to find HCV within one to two weeks after being infected with the virus. Anti-HCV can be found in 7 out of 10 people when symptoms begin and in about 9 out of 10 people within three months after symptoms begin. However, it is important to note that many people who have Hepatitis C have no symptoms. Who should get tested for Hepatitis C?
People who…
- have injected illegal drugs, including those who injected once or a few times many years ago.
- were treated for clotting problems with a blood product made before 1987 when more advanced methods for manufacturing the products were developed.
- have been notified that they received blood from a donor who later tested positive for Hepatitis C.
- received a blood transfusion or solid organ transplant before July 1992 when better testing of blood donors became available long-term hemodialysis patients.
- have signs or symptoms of liver disease (e.g., abnormal liver enzyme tests).
- are healthcare workers who have been exposed to HCV-positive blood on the job (e.g., needle sticks or splashes to the eye).
- children born to HCV-positive women
What is the next step if you have a confirmed positive anti-HCV test? Measure the level of ALT (alanine aminotransferase, a liver enzyme) in the blood. An elevated ALT indicates inflammation of the liver, and you should be checked further for chronic (long-term) liver disease and possible treatment. The evaluation should be done by a healthcare professional familiar with chronic Hepatitis C.
Source: Centers for Disease Control
Hepatitis C Treatment
Any physician who manages a person with Hepatitis C should be knowledgeable and current on all aspects of the care of Hepatitis C patients.
What is the treatment for chronic Hepatitis C?
Combination therapy with pegylated interferon and ribavirin is the treatment of choice for Hepatitis C, resulting in sustained response rates of 40%-80%. (up to 50% for patients infected with the most common genotype found in the U.S. [genotype 1] and up to 80% for patients infected with genotypes 2 or 3). Interferon monotherapy is generally reserved for patients in whom ribavirin is contraindicated. Ribavirin, when used alone, does not work.
What are the side effects of interferon therapy?
Most people have flu-like symptoms (fever, chills, headache, muscle and joint aches, fast heart rate) early in treatment for Hepatitis C, but these lessen with continued treatment. Later side effects may include tiredness, hair loss, low blood count, trouble with thinking, moodiness, and depression. Severe side effects are rare (seen in less than 2 out of 100 people). These include thyroid disease, depression with suicidal thoughts, seizures, acute heart or kidney failure, eye and lung problems, hearing loss, and blood infection.
Although rare, deaths have occurred due to liver failure or blood infection, mostly in people with cirrhosis. An important side effect of interferon is worsening of liver disease with Hepatitis C treatment, which can be severe and even fatal. Interferon dosage must be reduced in up to 40 out of 100 people because of severity of side effects, and treatment must be stopped in up to 15 out of 100 people. Pregnant women should not be treated with interferon.
What are the side effects of combination (ribavirin + interferon) treatment?
In addition to the side effects due to interferon described above, ribavirin can cause serious anemia (low red blood cell count) and can be a serious problem for people with conditions that cause anemia, such as kidney failure. In these people, combination therapy should be avoided or attempts should be made to correct the anemia.
Anemia caused by ribavirin can be life-threatening for people with certain types of heart or blood vessel disease. Ribavirin causes birth defects and pregnancy should be avoided during treatment. Patients and their healthcare providers should carefully review the product manufacturer information prior to treatment.
Can anything be done to reduce symptoms or side effects due to antiviral treatment?
You should report what you are feeling to your doctor. Some side effects may be reduced by giving interferon at night or lowering the dosage of the drug. In addition, flu-like symptoms can be reduced by taking acetaminophen before treatment.
Can children receive interferon therapy for chronic Hepatitis C?
Antiviral drugs are not licensed for people under 18 years of age. Children with Hepatitis C should be referred to a children's specialist in liver diseases. You may want to ask your doctor about clinical trials that may be on-going for children.
Source: Centers for Disease Control
Managing Hepatitis C
People infected with the Hepatitis C virus should try to maintain a healthy diet and fitness schedule. If you are being treated for Hepatitis C, it is important to maintain your strength through a combination of a healthy diet and fitness routine.
Because fatigue, nausea and loss of appetite commonly accompany HCV many people are not able to maintain adequate caloric intake. It is important to eat right during these times and attempt to stick to a balanced diet, or foods that appeal to you. With adequate nutrition, you can minimize the Hepatitis C symptoms and continue to live an active lifestyle.
If you are able to exercise during your HCV infection, stick to it. Exercise can help you feel stronger and help fight against depression that may also accompany your condition. Take fitness in moderation and slow down if you feel fatigued or cannot continue.
Because HCV effects the liver's ability to process chemicals in your body, it is important to avoid drugs and alcohol whenever possible.
If you develop itchy skin because of your Hepatitis C infection, avoid scratching these areas. Topical creams and non-prescription mediations can be effective in reducing the itching sensations. Do not continue using the products if there are side effects.
Adapted from: Centers for Disease Control
Self-Care For Hepatitis C Patients
People who have a mild case of Hepatitis C may only need to manage it by visiting their doctor regularly and following their doctor's recommendations, such as eating a nutritious diet, avoiding alcohol (because of its impact on the liver) and getting regular exercise.
For people with more severe Hepatitis C, however, drug therapy may be needed. A drug called interferon is the mainstay of conventional treatment. Interferon is often combined with an antiviral (virus-fighting) drug called ribavirin. Such combination therapies are usually taken for six months to one year.
Approximately 55 percent of patients treated with the combination of interferon and ribavirin for one year will achieve a sustained response (that is, a sustained benefit from treatment). If a patient does not achieve a sustained response, his doctor may decide whether another course of treatment (re-treatment) is appropriate.
Combination regimens benefit many patients. However, their side effects can be difficult for some patients to tolerate. These side effects can include flu-like symptoms (such as body aches, fever, chills and fatigue); nausea and other gastrointestinal problems; hair loss; emotional changes; skin reactions and, in more severe cases, depression, organ damage, blood conditions and other problems.
What should I do to take care of myself if I have Hepatitis C?
- Make sure you have received an accurate diagnosis. Hepatitis C can be diagnosed reliably only through sophisticated blood tests used in conventional medicine.
- See your health care provider regularly.
- Discuss Hepatitis C treatment options with your provider. Ask any questions you have to make sure you understand any treatment and possible side effects. Follow her recommendations for any changes to your diet or lifestyle.
- Tell your provider about any herbal supplements, other dietary supplements, or medications (whether prescription or over-the-counter) that you are using or considering. This is important for your safety during Hepatitis C treatment. Even if your provider does not know about the actions or interactions of an herbal supplement or other CAM treatment, he can access the most current medical guidance.
- Get vaccinated against Hepatitis A and B. Infection with Hepatitis C does not prevent you from becoming infected with other types of Hepatitis. If this happens, it can be serious - even life-threatening.
- Be an informed consumer. Seek high-quality, science-based information on any CAM modality that you are using or considering. There is free information from NCCAM, the National Library of Medicine and other Federal sources to help you distinguish science-based information from other types, including word-of-mouth and manufacturers' claims.
- If you decide to try herbal supplements, do so with care.
- If you would like to find out about clinical trials of treatments for Hepatitis C, go to www.clinicaltrials.gov or contact the NCCAM Clearinghouse.
Source: National Institute of Health
Caring For Those With Hepatitis C
One of the key elements of successfully caring for someone with a chronic medical condition such as Hepatitis C - is taking care of yourself first. A major mistake friends and family members make when giving care to another person is forgetting about their own well being. This can lead to conflict, depression, anxiety and a variety of other negative side-effects.
It is important for caregivers to maintain a high level of enthusiasm while around the person they are giving care to. This can give the other person the extra energy it might take to combat their illness, whether Hepatitis C or some other condition. By taking care of yourself, you are taking care of them.
Being a caregiver does not mean that your life needs to stop or even be put on hold. You should maintain a healthy balance of diet, exercise, and social activity to ensure that you find ways to step outside your role as caregiver. Set some time aside every day for yourself. You will find this method is very effective in preventing guilt, frustration, depression, stress and resentment.
In addition, it is important that you do not give too much assistance to the person you are taking care of. It is necessary to empower them with as many duties as you feel they can safely accomplish. A sense of independence on their part will go a long way towards building confidence and ultimately to their recovery.
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