Hepatitis C

Hepatitis is a term that refers to swelling and inflammation of the liver. It can be caused by an infection from a virus, or from other organic diseases. The hepatitis C virus is one of many viruses that cause hepatitis. About 4 million people in the United States are infected with hepatitis at any one time.

The liver is an important organ of the body. It is located in the upper right part of the abdomen. The liver regulates the body’s nutrition system. After we eat food, it is digested and absorbed, then taken through large blood vessels to the liver. The liver processes absorbed substances such as fat, sugar, protein, and vitamins so the rest of the body can use them.

The liver gets rid of harmful substances called toxins before they have a chance to poison the body. The liver also makes bile; a yellowish liquid that helps absorb the food we eat. Bile is made out of a substance called bilirubin, a yellowish chemical. Viruses are extremely small germs that can multiply only after invading a host. Cold sores and the flu are caused by viruses. Viruses can be seen only with very powerful microscopes. A virus called hepatitis C can invade the human body through contaminated blood. This virus causes a liver infection called Hepatitis C.

Approximately 4 million people in the United States are infected with hepatitis C, and up to 20,000 new infections occur annually. It is a viral infection that attacks the liver, and while usually asymptomatic in early infection, may cause decreased appetite, fatigue, abdominal pain, jaundice, itching, and flu-like symptoms.

When a person becomes infected with the hepatitis C virus, he or she may not notice any symptoms at first.

Symptoms of hepatitis C are usually flu-like, including:

• fever
• chills
• stomach pain
• nausea
• fatigue

Sometimes hepatitis C symptoms may be severe right away, causing liver dysfunction. If this is the case, bilirubin may not be excreted in the bile, leading to high levels of bilirubin in the blood.

With high levels of bilirubin in the blood, the skin and the whites of the eyes become yellow, causing a condition called jaundice. High bilirubin levels in the blood can also cause severe itching.

High levels of bilirubin in the blood also cause urine to look dark yellow. Stools are chalk white because they are not colored by the bile.

Over 20 years or so, hepatitis C may lead to the destruction of the liver, a condition called cirrhosis. With cirrhosis, the liver cannot clean the blood or meet the body’s nutritional needs. This could lead to coma or death.

Hepatitis C is transmitted through blood.

The following people have a higher risk of contracting hepatitis C:

• patients who received blood transfusions or organ transplants before 1992, the year when tests were made available to check for it
• people who have more than one sexual partner
• people who share needles or razors
• babies born to women who have hepatitis C

Prevention

Since treatment for hepatitis C is not always effective, it is best to PREVENT it rather than to have to TREAT it!

Four of the BEST ways to prevent hepatitis C:

1. Practice safe sex by using condoms, and knowing your partner.

2. Do not share needles or other objects that may have come in contact with another person’s blood, such as razors or toothbrushes.

3. Use gloves if you expect to be in contact with blood or other body fluids

4. If you decide to get a tattoo or a body piercing, make sure that the instruments used are sterile.

It is often difficult to diagnose hepatitis C early because symptoms do not usually show up right away.

In order to find and treat hepatitis C early, it is important to be VERY honest with the doctor when discussing drug use and sexual practices. If the doctor feels the need, he or she may do blood tests and discover hepatitis C early enough to treat it.

Unfortunately, blood tests alone cannot show the exact extent of liver damage. A liver biopsy may be needed.

There are many different subtypes, technically known as genotypes of hepatitis C viruses. Blood tests can help find the exact genotype. This is important because the treatment, its duration and its efficacy vary from genotype to genotype.

If you have hepatitis C, there are certain precautions you should take to keep yourself and others as healthy as possible:

• Inform your sexual partners about your condition.
• Inform ALL your healthcare providers of your condition.
• Do not donate blood or blood products.
• Get Hepatitis A and B vaccinations.
• Do not drink alcohol.

Check with your doctor before taking any new medications, including over-the-counter ones such as acetaminophen (Tylenol). You may need a different dosage than indicated or not take them at all, depending on whether they could damage your liver.

Follow directions from your doctors about medications and tell them about any side effects you may experience.

Women with hepatitis C should discuss pregnancy with a doctor BEFORE getting pregnant. There is an extremely small chance of getting infected with hepatitis C from a sexual partner in a strictly monogamous relationship.

This risk is so small that condoms are not routinely advised to prevent hepatitis C infection.

A limited number of medications are used to treat hepatitis C including:

1. interferons

2. ribavirin

3. sofosbuvir

4. telaprevir

5. boceprevir

Interferons are chemicals that boost the immune system and fight off the hepatitis C virus. Ribavirin works directly against the hepatitis C virus.

Combination therapy with a weekly injection of interferon and daily oral ribavirin is the treatment of choice 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.

Treatment with interferon alone is generally reserved for patients in whom ribavirin is contraindicated. Ribavirin, when used alone, does not work. Combination therapy using interferon and ribavirin is now FDA approved for the use in children aged 3-17 years.

The combination of interferons and ribavirin has many possible side effects including:

• headaches
• fever
• loss of appetite
• fatigue
• nausea and vomiting
• increased susceptibility to infections
• bleeding problems
• birth defects
• heart or kidney failure
• worsening of liver function
• rarely death

Who should consider treatment?

Only patients with hepatitis C in their blood (chronic hepatitis C infection) are considered for therapy. In general, doctors suggest treatment if you:

• have a liver biopsy that showed damage (usually a moderate amount of fibrosis or more)
• are motivated to undergo treatment
• are willing to comply with the necessary steps and tests and visits for treatment
• were very recently (acutely) infected with hepatitis C, within the past 6 months
• are coinfected with HIV or hepatitis B
• If you want to start treatment for hepatitis C, speak with your VA doctor. It is a good idea to talk about any concerns you have before you start treatment. You and your doctor will decide if treatment is right for you and which medicines might work.

What treatments are effective?

Before your doctor can prescribe a treatment for hepatitis C, it has to be approved for that purpose by the U.S. Food and Drug Administration (FDA). Several treatments for hepatitis C already are approved by the FDA:

• pegylated interferon alfa-2a (usually used in combination with ribavirin)
• pegylated interferon alfa-2b (usually used in combination with ribavirin)
• ribavirin (to be used only in combination with an interferon) standard interferon alfa

New drugs which are anticipated to have FDA approval are called protease inhibitors which would be used only in combination with pegylated interferon and ribavirin.