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Hepatitis C
 
 

Hepatitis C is a liver disease caused by the hepatitis C virus (HCV). HCV is spread by contact with the blood of an infected person.

Transmission
HCV is spread primarily by direct contact with human blood. For example, you might have been infected with HCV if:

  • you ever injected street drugs, as the needles and/or other drug "works" used to prepare or inject the drug(s) may have had someone else's blood that contained HCV on them.
  • you received blood, blood products, or solid organs from a donor whose blood contained HCV.
  • you were ever on long-term kidney dialysis as you may have unknowingly shared supplies/equipment that had someone else's blood on them.
  • you were ever a healthcare worker and had frequent contact with blood on the job, especially accidental needlesticks.
  • your mother had hepatitis C at the time she gave birth to you. During the birth her blood may have gotten into your body.
  • you ever had sex with a person infected with HCV (see more information below)
  • you lived with someone who was infected with HCV and shared items such as razors or toothbrushes that might have had his/her blood on them (see more information below)

Household contacts
If HCV is spread within a household, it is most likely due to direct exposure to the blood of the infected person.

  • HCV is not spread by sneezing, hugging, coughing, food or water, sharing eating utensils or drinking glasses, or casual contact.
  • Persons should not be excluded from work, school, play, child care or other settings on the basis of their HCV infection status.
  • Involvement with a support group may help patients cope with hepatitis C.

Sexual activity
HCV can be spread by sex, but this does not occur very often. Patients with hepatitis C who have only one long-term steady sex partner have a very low chance of spreading HCV to that partner through sexual activity. If you want to lower the small chance of spreading HCV to your sex partner, you may decide to use barrier precautions such as latex condoms. The efficacy of latex condoms in preventing infection with HCV is unknown, but their proper use may reduce transmission. Ask your doctor about having your sex partner tested.

If you are having sex, but not with one steady partner, you and your partners can get other diseases spread by having sex, including AIDS, hepatitis B, gonorrhea or chlamydia. You should use latex condoms correctly and every time. The efficacy of latex condoms in preventing infection with HCV is unknown, but their proper use may reduce transmission. You should also get vaccinated against hepatitis B.

Transmission at birth
About 5 out of every 100 infants born to HCV-infected women become infected. This occurs at the time of birth, and there is no treatment that can prevent this from happening. Most infants infected with HCV at the time of birth have no symptoms and do well during childhood. More studies are needed to find out if these children will have problems from the infection as they grow older. There are no licensed treatments or guidelines for the treatment of infants or children infected with HCV; they should be referred for evaluation to a specialist familiar with the management of children with HCV-related disease.

What about donating or receiving blood?
Since more advanced tests have been developed for use in blood banks, there is less than 1 chance per million units that that a person can get HCV infection from the blood or blood products they receive during a transfusion. And of course there is effectively no risk to donors – every needle used during blood donation is brand-new and sterile, and is disposed of after a single use.

Protecting yourself from blood-borne diseases
By following just a few guidelines you can significantly reduce your chances of acquiring hepatitis C and other blood-borne diseases.

  • Don't ever shoot drugs. If you shoot drugs, stop and get into a treatment program. If you can't stop, never reuse or share syringes, water, or drug works, and get vaccinated against hepatitis A and hepatitis B.
  • Do not share toothbrushes, razors, or other personal care articles. They might have blood on them.
  • If you are a healthcare worker, always follow routine barrier precautions and safely handle needles and other sharps. Get vaccinated against hepatitis B
  • Consider the health risks if you are thinking about getting a tattoo or body piercing. You can get infected if the tools that are used have someone else's blood on them, or if the artist or piercer doesn't follow good health practices, such as washing hands and using disposable gloves.

Diagnosing Hepatitis C
There are several blood tests that can be done to determine if you have been infected with HCV. Your doctor may order just one or a combination of these tests. Since it is possible to receive a “false positive” result, it’s important to confirm a positive test with a supplemental test. Some people with early infection may not yet have developed antibody levels high enough for some tests to measure. With certain types of testing (called PCR testing), it is possible to find HCV within 1 to 2 weeks after being infected with the virus. Who should be tested for hepatitis C:

  • people who ever injected illegal drugs, including those who injected once or a few times many years ago
  • people who were treated for clotting problems with a blood product made before 1987 when more advanced methods for manufacturing the products were developed
  • people who were notified that they received blood from a donor who later tested positive for hepatitis C
  • people who received a blood transfusion or solid organ transplant before July 1992 when better testing of blood donors became available
  • long-term hemodialysis patients
  • people who have signs or symptoms of liver disease (e.g., abnormal liver enzyme tests)
  • healthcare workers after exposures (e.g., needle sticks or splashes to the eye ) to HCV-positive blood on the job
  • children born to HCV-positive women

How can people infected with HCV prevent spreading it to others?

  • Do not donate blood, body organs, other tissue, or semen.
  • Do not share personal items that might have your blood on them, such as toothbrushes, dental appliances, nail-grooming equipment or razors.
  • Cover your cuts and skin sores to keep from spreading HCV.

Long-Term Consequences
It’s estimated that of every 100 persons infected with HCV:

  • 75 to 85 people might develop long-term infection
  • 70 people might develop chronic liver disease
  • 15 people might develop cirrhosis over a period of 20 to 30 years
  • Less than 3% might die from the consequences of long term infection (liver cancer or cirrhosis).
  • Hepatitis C is a leading reason for liver transplants.

How can people with HCV infection protect their liver?

  • Stop using alcohol.
  • See your doctor or other health care provider regularly.
  • Don't start any new medicines or use over-the-counter, herbal, and other medicines without a physician's knowledge.
  • Get vaccinated against hepatitis A if liver damage is present.
  • If persons are in risk groups for whom hepatitis B vaccine is recommended, they should also be vaccinated against hepatitis B

Treatment for chronic hepatitis C
Combination drug therapy with pegylated interferon and ribavirin is currently the treatment of choice to treat hepatitis C. Unfortunately, because these are strong drugs there is a good chance that those undergoing therapy will experience side effects.

Side effects of interferon therapy
Most people on interferon therapy have flu-like symptoms (fever, chills, headache, muscle and joint aches, fast heart rate) early in treatment, 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 persons). 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 persons with cirrhosis. An important side effect of interferon is worsening of liver disease with treatment, which can be severe and even fatal. Interferon dosage must be reduced in up to 40 out of 100 persons because of severity of side effects, and treatment must be stopped in up to 15 out of 100 persons. Pregnant women should not be treated with interferon.

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 persons with conditions that cause anemia, such as kidney failure. In these persons, combination therapy should be avoided or attempts should be made to correct the anemia. Anemia caused by ribavirin can be life-threatening for persons 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.

Antiviral drugs are not licensed for persons less than 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 ongoing for children.

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