Hepatitis C is a contagious liver disease caused by a virus. It is the most common blood-borne disease in the United States, and most people who have it do not know it.
Hepatitis C is spread by blood-to-blood contact, primarily through injectable drug use. There are immunizations against hepatitis A and B, but not for C. In order to prevent becoming infected with the hepatitis C virus it is necessary to prevent exposure.
If after being infected a person did not naturally clear the virus in six months, the infection would become chronic and only curable with medication. There are medications in all pill form to cure chronic hepatitis C infection.
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You will also see introductions at the end of some sections to any recent developments that have been covered by MNT's news stories. Also look out for links to information about related conditions.
Here are some key points about hepatitis C. More detail and supporting information is in the main article.
- Hepatitis C attacks the liver - the largest internal organ.
- Found worldwide, hepatitis C is the most common blood-borne disease in the United States, and the leading reason for liver transplant in the western world.1
- The most common method of transmitting hepatitis C virus is through injectable drug use (IDU) and sharing needles.
- The hepatitis C virus can survive outside the body at room temperature, on environmental surfaces, for up to three weeks.2
- The infection starts with an acute phase and can progress to a chronic phase in 80% of those infected.
- It is called a silent epidemic because most people do not feel sick when they initially get infected.
- Those with chronic infection can unknowingly pass the infection on to others.
- Baby boomers have a 5-fold risk of having hepatitis C as opposed to the rest of the population.3
- Early diagnosis can prevent health problems that may result from chronic infection.
- It is not uncommon for individuals to remain undiagnosed with hepatitis C until they show signs of end-stage liver disease.
- Chronic hepatitis C infection progresses to cirrhosis over a 20-year period in approximately 16% of those infected.4
What is hepatitis C?
Hepatitis is defined as inflammation of the liver. There are several strains of hepatitis with the most common being type A, type B, and type C.
Originally identified as non-A non-B, in 1989 the strain was subsequently named type C.
Hepatitis C virus (HCV), is the most widespread blood carried disease in the US, with an estimated 3.2 million persons chronically infected.5 Globally, 130-150 million have chronic infection.6 Unfortunately, 50% of those infected are unaware.7
What causes hepatitis C?
HCV is caused by a virus transmitted through blood-to-blood contact.8
A virus is a microscopic, infectious particle that contains nucleic acid (genetic instruction DNA or RNA). HCV is an RNA virus. Viruses lie in a dormant state until entering the living cell of a host, where it will then hijack the cell's hardware to replicate itself.
Hepatitis C is an RNA virus - a virus that has RNA (ribonucleic acid) as its genetic material.
Research suggests that chronic HCV infection consists of millions, or billions of actual viruses circulating within the body. At least six distinct HCV genotypes (named 1-6) and 70 subtypes have been identified.9
HCV is not transmitted through casual contact, respiratory droplets, sharing food, kissing, or through mosquito bites.10
For a blood-to-blood infection to occur, blood from an infected person must enter the body of someone who is not infected. By far, the biggest risk factor for becoming infected with HCV is injectable drug use; specifically sharing needles or equipment used to inject drugs.11
A speck of blood so small that it is not viewable to the naked eye can carry hundreds of hepatitis C virus particles. Cleaning with alcohol or rinsing with soap and water, even letting the needle and syringe air-dry for several days will not kill the virus.
Once it is injected into the body, even if on only one occasion, exposure has occurred and infection is quite possible. Around 30% of persons who inject drugs are infected with HCV within the first two years of using. After five years of IDU, 90% of users will be infected.12
Signs and symptoms of hepatitis C
Acute HCV infection is rarely diagnosed due to the lack of definitive symptoms. It is often referred to as a silent epidemic.13 The average time from exposure to symptom onset is 4-15 weeks.14
During this "acute infection period" - if symptoms are present - they are not considerably different to any other viral syndrome. Usually experienced is abdominal discomfort, nausea, fever, joint pain, fatigue, and infrequently jaundice (yellow tinge to skin and eyes) or clay colored stools.
HCV becomes chronic when the virus remains in the blood a year after the acute infection period. Unless treated with medication, the infection is lifelong.
Most people have no physical complaints with chronic infection, while some may have ongoing episodes of abdominal pain, persistent fatigue, and aching joints.
After a 25-30 year period, this chronic infection may result in significant scarring (fibrosis) of the liver, which can progress to cirrhosis (complete fibrosis), liver failure, and possibly liver cancer (hepatocellular carcinoma). Frequently it is not until the liver is on the verge of collapse that the damage is apparent.15
Tests and diagnosis of hepatitis C
Because of the lack of symptoms of acute HCV infection, it is often overlooked or considered a garden-variety viral illness. Thus, it is rare for the infection to be diagnosed during the acute phase.
A simple blood test called an HCV antibody screen can test for HCV.
A person infected with HCV produces an immune response, and only 20% will clear the virus on their own. The rest will remain chronically infected, and can unknowingly infect others.
You can get tested for an HCV through a simple blood test called an HCV antibody (or anti-HCV) screen.
There is an FDA-approved rapid test that provides results in 20 minutes. Otherwise, the blood is drawn through a venipuncture and processed at a lab. A negative test means no hepatitis exposure and no infection. A positive test means exposure; it does not prove HCV infection.
All persons who have a positive HCV antibody need a second blood test called HCV RNA (PCR). This test will tell whether the virus is present.
If the test is negative, there is no virus present and, therefore, no chronic infection.16 If positive; it will measure the amount of virus in the blood (viral load). A person with a positive PCR should see a liver specialist or other provider who is trained to evaluate and treat chronic HCV infection.
It is important to understand that the positive antibody test will always remain positive, whether or not the virus is still present.
Antibodies to HCV exposure do not mean long-term protective immunity such as a person would receive through a measles vaccine or with chicken pox infection. There is no permanent immune memory with HCV antibody; a person can certainly get re-infected with a different strain of the virus.
The Center for Disease Control (CDC) has recommended a one-time HCV antibody blood test for these individuals below as they are at the greatest risk of having been exposed to the virus.16
HCV is transmitted through blood-to-blood contact.
- Baby boomers (born during 1945-1965)
- People who had transfusions or organ transplants prior to 1992
- Past/present injectable drug users
- Long-term hemodialysis patients
- Health care workers after a needle stick exposure
- People with a positive HIV infection
- Individuals that get a tattoo in an unregulated setting
- Those partaking in risky sexual behaviors or sex with a drug user note: the risk of HCV transmission between long-term heterosexual, monogamous partners is .07%17
- Children born to an HCV-infected mother (the risk of transmission is low, under 5%)18
- Those who have been incarcerated
- Individuals with a history of long-term daily alcohol use
- People with unexplained liver disease
- Intranasal (snorting through the nostrils) drug users.
Each individual's primary care provider determines repeat testing.
Once the chronic infection is confirmed the genotype needs to be designated (through a blood test), as it will determine the percentile cure rate, the length of treatment and the treatment protocol.
In terms of infectiousness or aggressiveness, it is not the genotype but rather the overall health of the infected individual and liver that determines if or how quickly damage and possible progression to cirrhosis will occur.
In some instances, a liver biopsy may be recommended, not to confirm the diagnosis, but rather for grading the severity of the disease, staging the degree of fibrosis and evaluating the extent of liver damage.
Treatment and prevention of hepatitis C
Because HCV can only be transmitted through blood to infected blood exposure, the number one way to prevent spreading hepatitis C is by not sharing needles, and avoiding all contact with anyone else's blood.
Liver scarring can be accelerated by obesity, smoking, diabetes and alcohol consumption.
Once identified, those infected with HCV should receive both the hepatitis A and B vaccines, and make lifestyle changes to promote optimum liver health.
Obesity, smoking, diabetes and alcohol consumption can accelerate the rate of liver scarring (fibrosis).19 It is important that all individuals who are infected with HCV maintain good health. That means:
- No smoking
- Maintaining ideal weight
- Managing co-existing health problems
- Abstaining from all alcohol
- Acetaminophen can be taken under the guidance of the managing provider. Ibuprofen should be avoided.20
The current treatment for chronic hepatitis C is a combination of medications. The choice of medication and duration of treatment depends on the genotype of the virus. Genotype 1a is the most prevalent in the US, and presently there are three recommended treatment options using a certain combination of the medications listed below:21
Direct-acting antivirals (DAAs) are the newest agents available to treat HCV. These medications work by targeting specific steps in the HCV life cycle and disrupting the virus from replicating.
Before the availability of DAAs, the treatment for chronic HCV was lengthy and grueling, with less than ideal cure rates. Now the cure rates are over 90%. The average duration of treatment is 8-12 weeks. The medications are well-tolerated with the most common side effect being headache and fatigue.
New medications for HCV are costly with a price tag nearing $100,000 or more. However, the average cost of a liver transplant is $578,000 - add additional medical expenses for the first year and the cost approaches one million dollars.22
Treating chronic HCV early in the disease course before the patient develops complications or progresses to life-threatening circumstances seems unequivocally the most logical choice.
In hepatitis C virus infection, treatment is prevention. Yet, two million persons in the US do not know they are chronically infected.
As we continue with education, risk-based screening, exposure prevention, and the arrival of well-tolerated treatments, the outlook for preventing serious liver complications and curing those who have chronic hepatitis C infection has never been better.
Researchers who examined the effect of treating hepatitis C patients with the newer generation of oral drugs suggest while these medications may cost tens of thousands of dollars for a 12-week course, they could avert billions in lost productivity.
A course of new antiviral drugs in a clinical trial has resulted in almost all the patients with chronic hepatitis C infection becoming virus-free, even those whose disease meant they had scarring of the liver and so were at transplant or cancer risk.
Around 3.2 million Americans have chronic Hepatitis C, making it the most common long-term bloodborne illness in the US. But could a vaccine for the disease be in sight? Researchers reveal how a vaccine has shown promise against hepatitis C infection a phase 1 clinical trial.
Scientists have discovered how a molecule with broad-spectrum antiviral activity found inside the hepatitis C virus kills viruses but does not harm host cells - it discriminates between the molecular make-up and size of their membranes.