Hepatitis C is a contagious liver disease that results from infection with the Hepatitis C virus. It can range in severity from a mild illness lasting a few weeks to a serious, lifelong illness. Hepatitis C is usually spread when blood from a person infected with the hepatitis C virus enters the body of someone who is not infected.
Many people have become infected with the hepatitis C mainly by coming in contact inadvertently with this virus. This could have occurred by sharing needles, or other equipment potentially contaminated with this virus, such as drug paraphernalia, instruments in tattoo parlors, sharp household contaminated instruments (razors) and from contaminated blood products such as in blood transfusions and organ transplants. Healthcare workers, such as nurses and accident first responders, are also at risk.
In 1992, a widespread screening of the blood supply began in the United States. Today, blood banks go through great length to test their blood supplies and to make sure their blood products are safe which has helped tremendously to reduce the transmission of this infection. Although much less frequent, sexual exposures can also result in transmission of hepatitis C virus.
ACUTE VERSUS CHRONIC HEPATITIS C
Hepatitis C can be either “acute” or “chronic.” Acute Hepatitis C virus infection is a short-term illness that occurs within the first 6 months after someone is exposed to the hepatitis C virus. In about 20% of the infected people the body’s immune systems clears the infection spontaneously. These are “lucky” individuals, although their hepatitis C screen test is always positive, they do not have active infection, nor can they pass the infection or need treatment.
For the remaining 80% of the infected people, the acute hepatitis C leads to chronic infection. People with chronic hepatitis C progress very slowly, and it can take decades from the time of the original infection to the development of some liver problems. During all that time, the person may be completely asymptomatic and unaware of the infection. However, chronic hepatitis C is a serious disease than can potentially result in long-term health problems such as liver cirrhosis, liver cancer and even death if left untreated.
TYPES OF GENOTYPES OF HEPATITIS C
There are different genotypes (GT) of hepatitis C with different geographic distributions. In the United States genotypes 1a and 1b are the most common (about 75% of cases) with genotypes 2 and 3 present in only 10 to 20% of patients. Other GTs are rarely seen in the US. Knowing the GT of hepatitis C is helpful in making recommendations and counseling regarding therapy. Once the GT is identified, it needs not be tested again; genotypes do not change during the course of infection.
TREATMENT OF HEPATITIS C
Hepatitis C infection is a curable disease in the majority of cases. The goal of hepatitis C treatment is to prevent worsening of liver disease by permanently eradicating the virus from the body.
Hepatitis C treatment has changed dramatically in the last few years. Cure rates are much higher, approaching 95% – 100%. The side effect profile of treatments available has significantly improved allowing most people to continue activities of daily living, including full-time employment, while receiving anti-HCV treatment.
There are still sites on the internet with information regarding HCV that have not yet been updated, including hepatitis C experience blogs, written by patients that received old treatments in the past that included interferon-based treatment. This therapy was associated with significant and sometimes debilitating side effects. A person treated with current new anti-HCV drugs (commonly described as DAAs, or direct-acting antivirals) should not anticipate experiencing these side effects.
Most people treated today for HCV can be cured in a short period of time, from 8 to 12 weeks. Cure for HCV does not revert the commonly used HCV antibody-test to negative. A person with a past HCV infection that is now cured will remain with a positive HCV antibody-test despite the lack of virus. Cure for HCV does not confer immunity (or future protection against re-infection), so a person initially infected, treated and cured, can still become re-infected if that person again gets exposed to a new HCV. The best way to determine if a person previously cured has been re-infected with HCV is by obtaining a HCV-RNA PCR (or a HCV viral load). There is no vaccine for hepatitis C. The best way to prevent it is by avoiding behaviors that can spread the disease.
Yes, your HCV antibody test could be a false positive test, which means the test looks as if it is positive, but it is really negative. This happens more often in people who have a low risk for the disease for which they are being tested. Sometimes there could be some blood reactants that can turn a screening test positive.
It is very important that a case of a false positive test is confirmed with a more sophisticated test and repeat at least twice over a period of time. Only a qualified physician in the evaluation and management of Hepatitis C should be able to determine if your test is a false positive or not. By far, most positive HCV antibody tests are indeed truly positive, even in a person with unknown risk factors.
Treatment should be considered for patients who wish to cure the infection and have evidence of active Hepatitis C without any contraindication to current available therapies.
At your first evaluation your doctor might order extensive blood work that includes Hepatitis C viral load, Hepatitis C Genotype, liver function tests, complete cell blood count and, it is often required, blood work to rule out concomitant infections or some other illnesses that might change the treatment approach.
Liver function tests (LFT’s), which include liver enzymes, are groups of clinical biochemistry laboratory blood assays designed to give information about the state of a patient’s liver. These tests can be used to (1) detect the presence of liver disease, (2) distinguish among different types of liver disorders, (3) gauge the extent of known liver damage, and (4) follow the response to treatment.ALT and AST are enzymes present in hepatocytes (liver cells). When a liver cell (hepatocyte) is damaged, it leaks these enzymes into the blood, where they can be measured. ALT and AST levels rise frequently on patients with chronic viral hepatitis, and other conditions, such as alcohol use. A normal level should be interpreted with carefulness because it does not always correlate with a healthy liver.
Your viral load is the amount of specific viruses that you have, in a given volume of your blood (usually 1 milliliter = 1 cubic centimeter). More precisely, it means that the amount of Hepatitis C genetic material found in your blood corresponds to as many Hepatitis C viruses as the given number says.
Viral load varies between infected individuals and varies from time to time in the same individual. Your viral load becomes useful for your doctor to follow and monitor the response to Hepatitis C treatment.
Knowing the genotype of hepatitis C for each patient is important information. The hepatitis C genotype (GT) is a type or “strain” of hepatitis C virus. There are 6 genotypes of hepatitis C around the world. In the United States, 3 genotypes are common: GT 1, 2, and 3. The GT of hepatitis C does not change over time. It needs to be tested only once. Approximately 75% of Americans with hepatitis C have GT 1 whereas GT 2 and 3 share the reminder 25 %.
Liver biopsies for HCV evaluation are becoming less necessary. There are other non-invasive staging methods such as laboratory fibrosis score (blood sample collection) and transient elastography (fibroscan) that can assist the provider in determining the extent of liver damage. Occasionally, a liver biopsy is still required; this biopsy is a procedure that involves obtaining a small piece of liver tissue, which is then analyzed in the laboratory. A liver biopsy may be recommended to diagnose a problem or to determine the severity of liver disease. As a general rule, a liver biopsy is recommended only when the results would affect the planned treatment or management. In certain liver diseases, such as chronic hepatitis B or C, a biopsy can provide other important information about how severe the liver is damaged.
Most liver biopsies are done in a hospital or in a specialized center. They normally place an IV line into a vein so that fluid and medicine can be administered if needed, such as medicines to minimize discomfort and anxiety. In most situations, it is important that the person undergoing a liver biopsy remain awake during the procedure because their cooperation may be needed during the procedure. The doctor will put some local anesthesia at the site of the needle to minimize discomfort. The biopsy itself only takes a few seconds as the biopsy needle is passed quickly in and out of the liver. A small bandage will be applied to the biopsy site, and stitches are not needed.
A liver biopsy is a very safe procedure when performed by an experienced doctor. The most common complications include pain, low blood pressure, and bleeding; however, most of these complications are minor and can be treated. Very rarely other complications can occur such as infection and accidental puncture to nearby organs. To further minimize the occurrence of complications the doctor may obtain the biopsy with the assistance of an ultrasound or CT Scan.
Cirrhosis is the term used to describe a diseased liver that has been severely scarred, usually due to many years of continuous injury. The most common causes of cirrhosis include longstanding alcohol abuse, hepatitis B or hepatitis C and fatty liver disease. Although cirrhosis cannot be cured, there are a number of things you can do to prevent the disease from worsening.
Many herbal products claim that they may help to detoxify the liver, and in patients with significant liver inflammation it is possible that some of these agents may be marginally effective in decreasing liver inflammation, but they do not cure the virus. Many herbal products claim to “cure” or improve hepatitis C; none of these claims have been proven true. In addition, some herbal medications can seriously injure the liver.
There are several new and highly effective treatments eliminating the need for interferon. These treatments are extremely effective also reaching 95-100% with improved tolerability. A person treated in the past with no response should look for re-treatment as soon as possible.
Your doctor should be able to determine when you need to be considered for liver transplant consultation. Patients are considered for liver transplant when there is an irreparable damage to the liver that leads to permanent impairment of its regular function jeopardizing the patient’s life.In adults, the most common reason for a liver transplant is cirrhosis. Cirrhosis is caused by many different types of liver injuries that destroy healthy liver cells and replace them with scar tissue. Cirrhosis can be caused by viruses such as hepatitis B and C, alcohol, autoimmune liver diseases, buildup of fat in the liver, and hereditary liver diseases. The transplant process is elaborate, involving an extensive screening process for eligibility. Thus, not all patients with cirrhosis are eligible, and only those with the most advanced, severe cirrhosis are placed on the transplant registry.
WHAT PATIENTS ARE SAYING
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