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Hepatitis C

Definition

Hepatitis C is a viral disease that leads to swelling (inflammation) of the liver.

Alternative Names

Non-A hepatitis; Non-B hepatitis

Causes, incidence, and risk factors

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

• Have been on long-term kidney dialysis
• Have regular contact with blood at work (for instance, as a health care worker)
• Have unprotected sexual contact with a person who has hepatitis C (this is much less common, but the risk is higher for those who have many sex partners, already have a sexually transmitted disease, or are infected with HIV)
• Inject street drugs or share a needle with someone who has hepatitis C
• Received a blood transfusion before July 1992
• Received a tattoo or acupuncture with contaminated instruments (the risk is very low with licensed, commercial tattoo facilities)
• Received blood, blood products, or solid organs from a donor who has hepatitis C
• Share personal items such as toothbrushes and razors with someone who has hepatitis C (less common)
• Were born to a hepatitis C-infected mother (this occurs in about 1 out of 20 babies born to mothers with HCV, which is much less common than with hepatitis B)

Hepatitis C has an acute and chronic form. Most people who are infected with the virus develop chronic hepatitis C.

About 1.5% of the U.S. population is infected with HCV.

Symptoms

Most people who were recently infected with hepatitis C do not have symptoms. About 10% have jaundice that gets better.

Of people who get infected with HCV, most develop chronic HCV infection. Usually there are no symptoms.

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:

• Abdominal pain (right upper abdomen)
• Abdominal swelling (due to fluid calledascites)
• Bleeding from the esophagus or stomach (due to dilated veins in the esophagus or stomach called varices
• Dark urine
• Fatigue
• Fever
• Itching
• Jaundice
• Loss of appetite
• Nausea
• Pale or clay-colored stools
• Vomiting

Signs and tests

The following tests are done to help diagnose hepatitis C:

• EIA assay to detect hepatitis C antibody
• Hepatitis C RNA assays to measure virus levels (viral load)
• Hepatitis C genotype. Six genotypes exist. Most Americans have genotype 1 infection, which is the hardest to treat.

The following tests are done to identify and monitor liver damage from hepatitis C:

• Albumin level
• Liver function tests
• Prothrombin time

Liver biopsy can show how much damage has been done to the liver.

Treatment

The goals of HCV treatment are to remove the virus from the blood and reduce the risk of cirrhosis and liver cancer that can result from long-term HCV infection.

Many patients with hepatitis C benefit from treatment with medications. The most common medications are a combination of pegylated interferon alfa and ribavirin, an antiviral medication.

• Most patients receive weekly injections of pegylated interferon alfa.
• Ribavirin is a capsule taken twice daily. Ribavirin can cause birth defects. Women should avoid getting pregnant during, and for 6 months after treatment.
• Treatment is given for 24 - 48 weeks.

These medications have a number of side effects, and patients must be watched closely. Symptoms include:

• Anemia
• Depression
• Fatigue
• Fever
• Flu-like symptoms
• Headache
• Irritability
• Loss of appetite
• Low white blood cell counts and platelets
• Nausea
• Thinning of hair
• Vomiting

See: Cirrhosis for information about treating more severe liver damage caused by hepatitis C.

Patients who develop cirrhosis or liver cancer may be candidates for a liver transplant.

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 their health care provider.
• Avoid any substances that are 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.
• Get vaccinated against hepatitis A and B.

Support Groups

You can often ease the stress of illness by joining a support group of people who share common experiences and problems. See liver disease - resources.

Expectations (prognosis)

Most people with hepatitis C infection have the chronic form.

Patients with genotypes 2 or 3 are more likely to respond to treatment than patients with genotype 1.

The chance of removing the hepatitis C virus from the blood with treatment is over 90% for some people. Even if treatment does not remove the virus, it can reduce the chance of severe liver disease.

Many doctors use the term "sustained virologic response" rather than "cure" when the virus is removed from the blood, because it is not known whether this will last a person's entire life.

Hepatitis C is one of the most common causes of chronic liver disease in the United States today. People with this condition may have:

• Cirrhosis of the liver
• Liver cancer (also called hepatocellular cancer) -- may develop in a small number of people with liver cirrhosis

Hepatitis C usually comes back after a liver transplant, which can lead to cirrhosis of the new liver.

Calling your health care provider

Call your health care provider if:

• You develop symptoms of hepatitis
• 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 follow precautions when handling blood and bodily fluids.

Do not inject illicit drugs, and especially do not share needles with anyone. Be careful when getting tattoos and body piercings.

Sexual transmission is very 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.

People who have 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.

References

Ghany MG, Strader DB, Thomas DL, Seeff LB. American Association for the Study of Liver Diseases. Diagnosis, management, and treatment of hepatitis C: an update. Hepatology. 2009;49:1335-1374.

Jou JH, Muir AJ. In the clinic. Hepatitis C. Ann Intern Med. 2008;148:ITC6-1-ITC6-16.

O'Leary JG, Davis GL. Hepatitis C. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2010:chap 79.

Review Date: Nov 23, 2010
Reviewed By: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, Unviersity of Washington School of Medicine; and George F. Longstreth, MD, Department of Gastroenterology, Kaiser Permanente Medical Care Program, San Diego, California. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.