KENNETH B. GOODRICH, M.D.
HEPATITIS C
Hepatitis C is a blood-borne infection. Most cases occur in people who share needles contaminated with traces of blood to inject 'street drugs'. Some people acquire the infection from exposure to blood or body fluids of someone infected as with sexual contact, via openings in the skin (skin cuts, tears of mucous membranes, etc.) Some people clear the infection naturally. Some people with persistent infection remain free of symptoms, but some have symptoms. After many years of infection some develop cirrhosis, and a few develop liver cancer. Treatment can clear the infection in up to half of cases. |
- Storing glycogen (fuel for the body) which is made from sugars. When required, glycogen is broken down into glucose which is released into the bloodstream.
- Helping to process fats and proteins from digested food.
- Making proteins that are essential for blood to clot (clotting factors).
- Processing many medicines which you may take.
- Helping to remove or process alcohol, poisons and toxins from the body.
- Making bile which passes from the liver to the gut and helps to digest fats.
Hepatitis means inflammation of the liver. There are many causes of hepatitis. For example, alcohol excess and various infections. Several different viruses can infect the liver and cause hepatitis. One type of virus which causes hepatitis is called the hepatitis C virus.. Hepatitis A and B which are different viral infections of the liver.
How can you get hepatitis C?
Hepatitis C is a blood-borne disease. The main source of infection is from blood from an infected person.
- Most cases of hepatitis C are caused by using contaminated needles to inject drugs ('sharing needles'). Even a tiny amount of blood left on a needle from an infected person is enough to cause spread to others. Using other used injecting items such as syringes, etc, is sometimes a cause of infection.
- Some people who received blood transfusions and blood products several years ago were infected with hepatitis C from some donor blood. In recent years, all blood donated in the UK is checked for the hepatitis C virus (and for certain other blood-borne infections). So, the risk of contracting hepatitis C from a blood transfusion is now very small.
- There is also a risk of contracting hepatitis C from needlestick accidents, or other injuries involving blood spillage from infected people.
- There is thought to be a small risk of contracting the virus from sharing toothbrushes, razors, and other such items which may be contaminated with blood. Also, from using equipment which is not sterile for tattooing, body piercing, etc.
- There is a small risk that an infected mother can pass on the infection to her baby.
- There is a small risk that an infected person can pass on the virus whilst having sex.
You cannot pass on the virus during normal social contact such as holding hands, hugging, sharing cups or crockery, etc.
How common is hepatitis C ?
Over 170 million people worldwide have Hepatitis C infection. About 4 million Americans have a Hepatitis C infection.
It is helpful to think of two phases of infection with hepatitis C virus. An acute phase when you first become infected, and a chronic (persistent) phase in people where the virus remains long-term.
Acute phase
When first infected with the virus, most people have no symptoms, or only very mild symptoms. If symptoms do occur they develop about 7-8 weeks after being exposed to the virus and may include: feeling sick, vomiting, and feeling generally unwell. Some people become jaundiced (yellow). It is unusual to get severe symptoms. So, most people who become infected are not aware of it at first. Following the initial infection:
- In about 1 in 5 cases the virus is cleared from the body by the immune system within 2-6 months.
- In about 4 in 5 cases, the virus remains active in the liver and bloodstream long-term. This is called chronic infection with hepatitis C.
Chronic phase
Of those people who develop chronic infection
- Some people remain well throughout life. They develop no damage or problems to the liver. However, even if you have no symptoms, if you have chronic infection you can still pass on the virus to others who may develop problems. For example, you may pass on the virus if you share needles for injecting drugs.
- Some people develop some symptoms due to persistent inflammation of the liver such as: muscle aches, tiredness, feeling sick, lack of appetite, intolerance of alcohol, pains over the liver, jaundice, depression. Symptoms vary in severity and some people have liver inflammation without feeling any symptoms.
- About 1 in 5 people with chronic hepatitis C infection develop cirrhosis over a period of about 20-30 years. Cirrhosis is like a 'scarring' of the liver which can cause serious problems, and 'liver failure' when it is severe. (See separate leaflet called 'Cirrhosis'.) Some people with chronic hepatitis C have no symptoms for many years until they develop cirrhosis. Only when the liver starts to fail with cirrhosis do symptoms appear.
- A small number of people who develop cirrhosis develop liver cancer after a further period of time.
How is hepatitis C diagnosed?
A blood test can detect antibodies in your blood to hepatitis C. (Antibodies are proteins made by the immune system to attack viruses, bacteria, etc. The specific antibody against hepatitis C can be detected by a simple routine blood test.) A positive test means that you have at some stage been infected with hepatitis C.
However, this test remains positive even in people who have cleared the virus from their body. (The antibodies remain even if the virus has gone.) Also, it can take up to six months for the antibody test to become positive after first being being infected. (As the body may take a while to make these antibodies.) So, a negative test does not necessarily rule out a recently acquired infection. A repeat test in a few weeks may be advised in some people who have recently been at risk of catching hepatitis C.
If the antibody test is positive, then a further blood test is needed to see if the virus is still present (chronic infection). This is a more specialized test which detects particles of the virus. Also, there are several different strains (types) of the hepatitis C virus. Tests may be done to find exactly which strain you are infected with. Some strains are more resistant to treatment than others.
Assessing the severity of the infection
If you are found to have virus present, then other tests may be advised to check on the extent of inflammation or damage to the liver. For example:
- Blood tests called liver function tests are commonly done. These measure the activity of enzymes (chemicals), proteins and other substances made in the liver. A biopsy (small sample) of the liver may be taken to look at under the microscope. This can show the extent of any inflammation, scarring, cirrhosis, etc, in the liver. Other tests may be done if cirrhosis or other complications develop.
How can I prevent passing on the virus to others?
If you have a current hepatitis C infection you should:
- not share any injecting equipment such as needles, syringes, etc.
- not donate blood or carry a donor card.
- not share razors, toothbrushes or anything else that may possibly be contaminated with blood.
- use condoms when having sex. The risk of passing on the hepatitis C virus during sex is small, but is reduced even further by using condoms. However, your partner in a regular faithful relationship may accept the small risk of having sex without condoms.
What is the treatment of hepatitis C?
The main aim of treatment is to prevent severe liver damage leading to cirrhosis. If you have chronic hepatitis C but have little or no damage to the liver, you are at low risk of developing cirrhosis. No treatment may then be needed.
If you have persistent inflammation of the liver then you are at risk of developing cirrhosis and so treatment is often advised.
The usual treatment is a combination of medicines. This treatment can clear the virus ('cure') in up to half of cases. A course of treatment lasts 6-12 months. The treatment period can be a difficult time as side-effects may develop from these powerful medicines. For example, tiredness, feeling sick, headaches, depression and other problems.
Even if the treatment does not clear the virus, it may still slow down the progression of inflammation and liver damage.
Treatment is not usually offered if you:
- are likely to continue to inject drugs as there is a risk of reactions with injected drugs, and a risk of re-infection.
- you have certain other medical conditions.
- are pregnant.
- drink a lot of alcohol.
Newer medicines are being developed and are undergoing trials. They may prove to be better than the current treatments.
Some other points about hepatitis C
- If you have a current hepatitis C infection you should not drink alcohol (or only drink small amounts). Regular drinking of alcohol can greatly increase the risk of developing cirrhosis.
- There is no vaccine against the hepatitis C virus (unlike hepatitis A and B).
- If the virus is cleared with treatment, you are not immune to future infection. You can still be re-infected, for example, if you use a contaminated needle.
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KENNETH GOODRICH, M.D. - OBSTETRICIAN- GYNECOLOGIST
Certified by the American Board of Obstetrics and Gynecology
Specializing in General Obstetrics and Gynecology, Minimally Invasive Gynecological Surgery- Hysterectomies
and Uterine Fibroids, HPV treatment for Women and Men, Surgery on Obese Women, Chronic Vaginal
Discharges, Sexually Transmiited Diseases, Menopause, Abnormal Bleeding ,Cellulite Reduction and
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