Hepatitis C
What is hepatitis C?
Hepatitis is the term used to describe inflammation within the liver. There are many causes of hepatitis such as alcohol, medications, drugs, hereditary diseases, and other viruses. Hepatitis C is a virus, which affects many parts of the body, but the liver is the area that can be most seriously damaged. Hepatitis C can be acute, meaning the patient is infected and becomes ill, then completely recovers from the infection. Most cases, however, are chronic. The patient may not even know they have become infected with hepatitis C. They harbor the hepatitis C virus in their system long after initial infection and damage can be done over many years. It is estimated that about 4 million Americans are infected with the hepatitis C virus.
How do I get hepatitis C?
Hepatitis C is transmitted through blood products. The most common means of becoming infected include sharing needles for intravenous drug use or tattoo placement, nasal cocaine use, or blood transfusions prior to 1992. Prior to that year, testing of our blood supply was not accurate, and some hepatitis C was spread. We now have excellent testing to detect hepatitis C in the blood, although a very small risk of hepatitis C transmission still exists with certain diseases requiring repeated blood transfusions. Health care workers are also at risk of acquiring hepatitis C through accidental blood and needle exposure. Risk of transmission through sexual contact is controversial; although a slight risk exists, it is heightened in the setting of coexistent sexually transmitted diseases and having multiple sexual partners. The best protection from any sexually transmitted disease is barrier contraception. Patients in long-term monogamous sexual relationships are generally considered safe for unprotected sex. Spread of hepatitis C from mother to fetus is extremely low. Women wishing to become pregnant should speak with their physician. Hepatitis C cannot be passed between family members by casual contact like hugging or kissing. The smartest way to prevent transmission is to use common sense regarding any items in the home that may be exposed to the infected person's blood - avoid sharing razors, toothbrushes, and manicure items.
Symptoms and Diagnosis
The vast majority of patients with hepatitis C have no idea they are infected. Only rarely does the initial infection cause jaundice, nausea, fatigue, diarrhea and generalized illness, which are the hallmark symptoms of acute infection with hepatitis A and hepatitis B. Blood testing must be performed to look for the presence of hepatitis C. Approximately 75 percent of patients exposed to hepatitis C will develop chronic infection.
Course of disease
Cirrhosis, or scarring of the liver, is the dreaded complication of chronic hepatitis C infection. It is estimated that only 25 percent of those with chronic hepatitis C will develop advanced cirrhosis within their natural course of life. Unfortunately, predicting which patients fall into that 25 percent group is impossible. Thus therapy is considered for all who are infected. Alcohol will speed up development of cirrhosis significantly, so avoidance of alcohol is imperative for patients infected with hepatitis C.
What is the treatment?
There is no vaccine to prevent hepatitis C. Once infection has occurred, treatment is a complicated topic that your physician will approach very thoughtfully. Many tests may need to be performed prior to considering therapy, such as laboratory testing, CT or ultrasound of the liver, and liver biopsy. The medication is twofold: ribavirin is an oral medication taken daily, and peg-interferon is an intramuscular shot given once a week by the patient. These medications can be dangerous if not used properly, so routine lab work is necessary during the course of therapy. It is very important that you and your physician are in close contact, and the patient is compliant with lab testing and office visits as requested by their doctor. Alcohol should be strictly avoided during therapy. Therapy is given from 12-48 weeks, depending on which subtype of virus the patient has (called the genotype), the patient's response to therapy, and side effects, which can include many problems from lab abnormalities to depression. Anywhere from 40-80 percent of patients are cured of hepatitis C with therapy. The goal of hepatitis C therapy is to prevent cirrhosis. In some instances, hepatitis C causes advanced cirrhosis, requiring liver transplantation.