Hepatitis C

Hepatitis is an inflammation of the liver. Hepatitis C (a specific type of hepatitis) is a viral infection of the liver. For 75 to 85 percent of people who develop hepatitis C, the condition becomes a chronic liver infection that causes progressive liver disease.


Anatomy
Your liver is found behind your lower ribs on the right side of your abdomen. It's normally the size of a football. The liver fights infection and controls bleeding. It also produces bile, which assists with food digestion, stores energy, and removes drugs and other harmful products from your blood. The liver is essential for life.

Causes/associated factors
Generally, hepatitis can be caused or aggravated by variety of factors, including medications, alcohol, toxins, parasites, bacteria and viruses. Specifically, hepatitis C is caused by the hepatitis C virus (HCV), which is spread through contact with blood from an infected person.
Infants born to mothers who are infected with hepatitis C are at risk for the infection. You are also at risk for hepatitis C if you:

have ever injected illegal drugs
have ever received long-term hemodialysis (an external method of removing unwanted material from your blood, which is normally a function of the kidneys)
received a blood transfusion or a solid organ (heart, lung, liver or kidney) transplant before July 1992
received blood from a donor who was later found to have hepatitis C
were treated for a blood clotting problem with a blood product manufactured before 1987
are a health care worker who has ever been exposed to blood (through a needle stick or eye splash, for example)
have had sex with an infected person
have had multiple sexual partners
are a homosexual or bisexual male
have ever lived with an infected person, especially if personal items such as toothbrushes or razors were shared

Transmission
Hepatitis C spreads mainly through contact with infected blood or blood products. In fact, it's the most common chronic disease transmitted by blood in the United States. Most new cases of hepatitis C develop in people who inject illegal drugs. The virus can also be transmitted through sexual activity, hemodialysis and occupational exposure. If you live in the same household as someone infected with hepatitis C but have no sexual contact with that person, the risk of contracting the disease is low. However, it is possible from an unnoticed exposure to the infected person's blood or sharing items such as toothbrushes or razors. The use of contaminated instruments for tattooing, body piercing and acupuncture can also transmit the virus. In about 10 percent of cases, the source of exposure to the virus cannot be identified.
In the United States, most medical and dental procedures (with the exception of long-term hemodialysis) don't pose a risk for the spread of HCV. Since 1992, four years after HCV was identified, blood used for transfusions has been routinely screened for the virus. Screening has significantly reduced the incidence of hepatitis C. Rarely, however, donated blood may still be contaminated with a very early stage virus that can't be detected through screening.

The incubation period (the time from exposure until symptoms appear, if they appear at all) is usually from six to seven weeks, but can range anywhere from two weeks to six months. Most people who contract hepatitis C are considered indefinitely contagious to others beginning one to two weeks before symptoms appear, if they appear at all.


Signs/symptoms
About two-thirds of all people who have acute (abrupt or sudden) hepatitis C infection do not develop symptoms, including most children who have hepatitis C. If acute symptoms develop, they are often mild and may include:
jaundice (yellowing of the skin and whites of the eyes)
fatigue
loss of appetite
abdominal discomfort
nausea

Diagnosis
The doctor will review your medical history, including potential exposure to hepatitis, blood transfusions and sexual practices. The doctor will also do a physical exam. Blood tests can be done to screen for antibodies (compounds that help to neutralize or destroy foreign substances in the blood), which usually appear in the blood eight to nine weeks after exposure to the virus. However, they may not be detectable in some people for six months or more after exposure. These antibody tests cannot distinguish between active, healed or chronic infections. Depending on the circumstances, you may also need other blood tests, a liver biopsy (taking a tissue sample for further examination) or abdominal ultrasound (using sound waves to create images of internal body parts).
If you're diagnosed with hepatitis C, your doctor may consider also testing you for hepatitis B and HIV (the virus that causes AIDS), since these diseases have many risk factors in common.


Treatment
Sometimes a hepatitis C infection clears up quickly. Typically, however, it develops into a chronic infection that progresses slowly over the years. If this is the case, you'll carry the virus the rest of your life. Thanks to ongoing research, treatment for hepatitis C has evolved in recent years.
Two medications, alpha interferon and the antiviral medication ribavirin, are currently used to treat chronic hepatitis C. The optimal treatment is a combination of the two medications, taken over a period of 24 to 48 weeks.

Alpha interferon boosts your body's immune response to the virus. A newer, more effective form of the drug, peginterferon, is given weekly in a shot. When combined with twice-daily doses of the oral antiviral ribavirin, the hepatitis C virus is eliminated for a sustained period of time (at least six months after therapy ends) in about 55 percent of those treated. When alpha interferon is used alone, only 35 percent of those treated have a similar sustained response. Recent studies also show that treatment may help protect against severe liver disease and liver cancer.

Alpha interferon often has side effects, which may include fever, chills, muscle and joint pain, headaches, nausea, vomiting, weight loss, mood changes, fatigue, irritability and depression. Your doctor may suggest taking acetaminophen before your injection to combat some of these symptoms. Side effects often decrease with continued treatment, and sometimes they can be eased by reducing interferon dosage. Rarely, severe side effects such as thyroid disease, seizures, heart or lung problems, or worsening liver disease can occur.

Ribavirin may cause nasal stuffiness, cough, rash, itching or anemia (a condition marked by a decreased number of red blood cells or hemoglobin, a protein in red blood cells that contains iron). Some people stop treatment because of the side effects.

A liver transplant may be recommended for severe cases of liver disease that don't respond to treatment. In the United States, hepatitis C is the leading reason for liver transplants.

It's essential to avoid alcohol when you have hepatitis. Don't take any new prescription or over-the-counter medications or herbal remedies without checking with your doctor. Eating a well-balanced, nutritious diet may help you feel better. Side effects of hepatitis C or the medications used to treat it may make it difficult to get all the vitamins and minerals you need, however. Talk with your doctor or dietitian if you have concerns about your diet. Again, never take vitamin or mineral supplements without checking with your doctor -- they may be toxic to your liver and cause more damage. If you have scarring in your liver, you may need to drink less fluids and eat less protein, salt and iron.

It's also important to discuss any activity restrictions with your doctor. To monitor your liver function, you may need periodic blood tests. To protect your liver from further injury, hepatitis A and B immunizations are also recommended.


Complications
Chronic hepatitis C may slowly lead to cirrhosis (a chronic liver disease that may result in liver failure), liver failure or liver cancer. Drinking alcohol often speeds the progression of liver damage.

Pregnancy-specific information
A small number of pregnant women pass hepatitis C to their babies. This is more likely to occur if the mother is also HIV-positive. Interferon is not recommended during pregnancy because it affects fetal growth. Ribavirin should be avoided because it can cause birth defects.

Senior-specific information
Adults age 60 and older are less likely to respond to hepatitis C medication.

Prevention
Prevention is crucial because most people infected with hepatitis C develop a chronic infection. If you're at high risk for hepatitis C, ask your doctor about having your blood screened periodically. Early identification of the disease is important in preventing its spread to others. Also, learn how hepatitis C spreads and modify any high-risk behaviors.
To protect yourself from hepatitis C, as well as other infections that spread through body fluids (such as HIV and hepatitis B), it's important to:

Avoid using illegal drugs. If you inject drugs, stop. Try to get into a substance abuse treatment program. If you cannot stop injecting drugs, never reuse or share injection equipment.

Avoid sharing personal care items, such as toothbrushes and razors, that could have blood on them.

Avoid touching anyone else's blood. If this is unavoidable, wear protective gloves.

Only have body piercing and tatooing done under sterile conditions.

Use a condom every time you have sex. Avoid having sex with an infected person.

To avoid the risk of occupational exposure, always follow universal precautions if you work in health care or public safety.
If you have hepatitis C, inform any sexual partners of your hepatitis C status. Don't donate blood, body organs, tissue or semen. Also, cover any cuts or sores to prevent possible spread of the disease.