Hepatitis C

Definition

Hepatitis C is an inflammation of the liver caused by infection with the hepatitis C virus.

Alternative Names

Causes

Hepatitis C infection is caused by hepatitis C virus (HCV). Persons who may be at risk for hepatitis C are those who:

• Received a blood transfusion prior to July 1992
• Received blood, blood products, or solid organs from a donor who has hepatitis C
• Inject street drugs or share a needle with someone who has hepatitis C
• Have been on long-term kidney dialysis
• Have frequent workplace contact with blood (for instance, as a healthcare worker)
• Have or have had sex with multiple partners
• Have or have had sex with a person who has hepatitis C
• Share personal items, such as toothbrushes and razors, with someone who has hepatitis C
• Were born to hepatitis C infected mother

There are approximately 4 million people in the United States who are infected with hepatitis C (about 1 in 70 to 100 people). Other hepatitis virus infections include hepatitis A and hepatitis B

Symptoms

Many people who are infected with the hepatitis C do not have symptoms. Hepatitis C is often detected during blood tests for a routine physical or other medical procedure. If the infection has been present for many years, the liver may be permanently scarred -- a condition called cirrhosis. In many cases, there may be no symptoms of the disease until cirrhosis has developed.

The following symptoms could occur with hepatitis C infection:

• Jaundice
• Abdominal pain (right upper abdomen)
• Fatigue
• Loss of appetite
• Nausea
• Vomiting 
• Low-grade fever
• Pale or clay-colored stools
• Dark urine
• Generalized itching
• Ascites 
• Bleeding varices  (dilated veins in the esophagus)

Exams and Tests

• Hepatitis virus serology
• ELISA assay to detect hepatitis C antibody
• Hepatitis C PCR test
• Elevated liver enzymes
• Liver biopsy shows chronic inflammation
• Hepatitis C genotype. Six genotypes are present around the world. Most Americans have genotype 1 infection, which is the most difficult to treat.

Treatment

There is no cure for hepatitis C.

Some patients with hepatitis C benefit from treatment with interferon alpha or a combination of interferon alpha and ribavirin.

Interferon alpha is given by injection just under the skin and has a number of side effects, including flu-like symptoms, headaches, fever, fatigue, loss of appetite, nausea, vomiting, depression, and thinning of hair. Treatment with interferon alpha may also interfere with the production of white blood cells and platelets.

Ribavirin is a capsule taken twice daily, and the major side effect is severe anemia (low red blood cells). Ribavirin also causes birth defects. Women should therefore avoid pregnancy during and for 6 months following treatment.

Recently, a version of interferon alpha with a longer half-life (pegylated interferon alpha) was introduced, and the longer half-life means the injections are taken weekly instead of the three times a week with standard interferon alpha. Pegylated interferon alpha and ribavirin lead to a sustained response in approximately 50% of patients.

A sustained response means that the patient remains free of hepatitis C virus 6 months after stopping therapy. Approximately 40% of patients with genotype 1 infection will respond.

Rest may be recommended during the acute phase of the disease when the symptoms are most severe. All patients with hepatitis C should be immunized against hepatitis A and B.

People with hepatitis C should also be careful not to take vitamins, nutritional supplements, or new over-the-counter medications without first discussing it with a doctor. People with hepatitis C should avoid any substances toxic to the liver (hepatotoxic), including alcohol. Even moderate amounts of alcohol speed up the progression of hepatitis C, and alcohol reduces the effectiveness of treatment.

Support Groups

The stress of illness can often be eased by joining a support group of persons who share common experiences and problems. See liver disease - resources.

Outlook (Prognosis)

Hepatitis C is one of the most common causes of chronic liver disease in the U.S. today. At least 80% of patients with acute hepatitis C ultimately develop chronic liver infection, and 20% to 30% develop cirrhosis. Between 1% and 5% of patients may develop liver cancer. Hepatitis C is now the number 1 cause for liver transplantation in the U.S.

Possible Complications

• Chronic hepatitis
• Cirrhosis

When to Contact a Medical Professional

Call your provider if symptoms of hepatitis develop, or if you believe you have been exposed to the hepatitis C virus.

Prevention

Avoid contact with blood or blood products whenever possible. Health care workers should practice universal precautions when handling blood and bodily fluids.

Do not inject drugs of abuse, and especially do not share needles with anyone. Be cautious when getting tattoos and body piercings.

Sexual transmission is low among stable, monogamous couples. A partner should be screened for hepatitis C. If the partner is negative, the current recommendations are to make no changes in sexual practices. Individuals having sex outside of a monogamous relationship should practice safer sex behaviors to avoid hepatitis C as well as sexually transmitted diseases, including HIV and hepatitis B.

Currently there is no vaccine for hepatitis C.

Rocca LG. Management of patients with hepatitis C in a community setting: diagnosis, discussions and decisions to treat. Ann Fam Med. 2004; 2(2): 116-124.