1. What is Hepatitis C?

Hepatitis C (HCV) causes inflammation of the liver. First called non-A non-B hepatitis, hepatitis C has been around since the early 1940's and is related to the Yellow Fever Virus. It wasn’t until 1989, however, that the test for specific antibodies to the virus became available, thus permitting routine testing. In 1992 a much more sensitive test became available and replaced the first test. Each year, about 28,000 Americans contract hepatitis C,which is a more frequent cause of chronic liver disease than hepatitis B. While it was believed originally that at least half the cases of acute hepatitis C became chronic, it is now estimated that the rate may exceed 80% and some may develop cirrhosis. Some individuals with cirrhosis may also develop cancer of the liver. Long term studies are being conducted to identify those who will receive benefit from treatment.

2. Who is at risk?

People who are at risk of acquiring hepatitis C include anyone who has had a blood transfusion prior to 1992, IV drug users, hemodialysis patients, those with tattoos and those with multiple sexual partners. Such individuals should be tested forhepatitis C. Body-piercing and cocaine snorting also are risk factors. However, an estimated 10% have no identifiable history of exposure to the virus. Veterans who were given their innoculations via the phnumatic jet injector are also at a very high risk of having hepatitis c.

3. How is HCV transmitted?

The virus is found in blood. It is not clear whether semen or saliva can actually transmit the virus, but it is not considered to be a transmission route. There is also no evidence indicating that HCV is transmitted through breast milk. It may be transmitted by using razors, needles, toothbrushes, nail files, or even a barber’s scissors, tattooing, body piercing or acupuncture needles used by an infected person. All people with HCV are potentially infectious, but it is very difficult to transmit it unless there is a blood to blood connection. As many as 2 million Veterans are hepatitis C positive, many from the jet injector used in Basic Training for innoculations. As many as 4 million people are believed to be carriers which means that they have the virus in their system, and whether they have symptoms or not, they can infect others. Unlike hepatitis A and B, previous infection does not produce immunity. HCV accounts for 90% of transfusion-related cases of hepatitis, but transfusionsnowadays hardly ever transmit the infection because donor blood is tested. With an incubation period of up to 6 months however, it is still possible to transmit HCV via transfusion. Gammagard products, such as Gamma Globulin, have been proven to have the HCV virus in them, and have transmitted the virus as well. The potential for transmission from an infected mother to her newborn baby appears to be less than 5%. However, transmission may depend on the presence of high levels of the virus in the mother’s blood. Babies born to infected mothers should be tested at one year of age.

4. Is there a vaccine for hepatitis C?

There is NO vaccine for HCV and vaccines for hepatitis A and B do not provide immunity against hepatitis C. There are various strains of HCV and the virus undergoes mutations. As a result it will be difficult to develop a vaccine. Also, there is no effective immune globulin preparation.

5. What are the symptoms?

Most people who are infected with the HCV do not have symptoms and are leading normal lives. The incubation period varies but averages about 7 to 8 weeks. Liver tests may range from being elevated to being normal for various lengths of time (from weeks to as long as a year). Even if infected persons have normal liver tests, they may carry the virus and can transmit the disease to others. The virus is in their blood and can cause liver cell damage. If symptoms are present, they may be very mild and flu-like: nausea, fatigue, loss of appetite, fever, headaches, and abdominal pain. Most people do not have jaundice (yellowing of the skin and eyes); however, it can sometimes occur along with dark urine.

6. How will I know if I have HCV?

Infection by the hepatitis C virus can be determined by a simple and specific blood test that detects antibody against HCV; however, it does not distinguish between acute or chronic infection. This test is not a part of a routine physical, and people must ask their doctors for a hepatitis C test. If the initial test is positive, a second test should be done to confirm the diagnosis and liver enzymes (a blood text) should be measured. The previous enzyme immunoassay test (EIA) that detects anti-HCV had a lower sensitivity in chronic hepatitis C. Antibody may not be present in the first four weeks of infection in about 30% of patients. HCV infection may be identified by anti-HCV testing in approximately 60% of people as early as 5 - 8 weeks and up to 6 months after exposure. Newer, even more sensitive tests have since been approved and are in use.

7. Will I get well?

Few people are able to clear the virus from their blood, which is necessary for completely recovery. Over 80% of the cases reported each year become chronic, which means liver enzyme levels remain elevated for at least six months after the initial acute infection. The enzymes alanine aminotransferase (ALT) and aspartate aminotransferase (AST) are released when liver cells are injured or die. Elevated ALT and AST levels may appear and disappear throughout the course of the infection. Current tests can indicate that the infection is chronic. The term chronic persistent hepatitis or chronic active hepatitis are no longer used because doctors now believe that the persistent form, formerly thought to be harmless, can sometimes progress to more severe liver disease, including cirrhosis.

8. What does chronic hepatitis mean?

Chronic HCV refers to infections that do not clear up within six months after the acute infection. The disease may gradually progress over a period of 10-40 years. High ALT and AST levels reveal ongoing liver damage, but they do not reliably predict the severity of liver injury. A liver biopsy can identify the type and degree of damage and can determine the severity of the disease. It is believed that 20% of patients with chronic hepatitis C will develop cirrhosis (scarring of the liver resulting from the death of liver cells). Of these patients 25% (5% overall) may develop liver failure even though it may take 30 - 40 years after infection. Patients with chronic hepatitis C in whom cirrhosis develops appear to have increased risk for developing hepatocellular carcinoma (primary liver cancer), which may occur 10-40 years after the initial infection.

9. What is the treatment?

Currently, there are three types of interferon used to treat hepatitis C. Selection of patients for treatment may be determined by biochemical, virologic, and liver biopsy findings, rather than presence or absence of symptoms. The treatment must be given by injection, and has a number of side effects including flu-like symptoms: headaches, fever, fatigue, loss of appetite, nausea vomiting and thinning of hair. The medication may also interfere with the production of white blood cells and platelets by depressing the bone marrow. Periodic blood tests are required to monitor blood cells and platelets. The severity and type of side effects differ for each individual. Treatment of children with HCV is under investigation.

 -- Bioengineered consensus interferon alone which results in elimination of the virus in 58% of patients and is well tolerated;
-- Combined therapy with interferon and ribavirin which slows elimination of the virus in 47% with side effects from both drugs. Ribavirin can cause sudden, severe anemia and birth defects so women should avoid pregnancy while taking it and for 6 months following treatment;
-- Pegelated interferon which, when used in combination with Ribavirin shows a much higher response rate and is only given as a once a week shot. Peg was only approved by the FDA in late 2001 and is made by both Schering Plough and by Roche Labs. Roche is still waiting for FDA approval but studies have shown that the Roche product - PEGESYS has a much better response rate than the Schering PegIntronA.

Currently, almost one quarter to one third of all liver transplants in the U.S. are performed for end-stage hepatitis C. However, reinfection of the transplanted liver by the virus appears to occur at a high rate. Fortunately, this infrequently requires a second transplant.

 Anyone with hepatitis C should be vaccinated for hepatitis A and B.

 Try to maintain as normal a life as possible eating a well balanced diet, exercising and keeping a positive attitude. Avoid depressing or overwhelming tasks and learn how to pace yourself, rest when you feel tired. Plan physically exhausting tasks in the morning when your energy level is at its peak.

10. How can I protect others and prevent hepatitis C?

No vaccine is available for hepatitis C at this time. Care should be taken in handling anything that may have the blood of an infected person on it such as razors, scissors, toothbrushes, clipper, nail files, tampons or sanitary napkins, etc. Clean up blood spills with household bleach. Although it is believed that HCV is transmitted only occasionally through sexual contact, safe sex practices (use of a latex condom) are recommended for individuals with multiple sexual contacts. Notify your physician and dentist that you have HCV.