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Hepatitis C
Overview
What is hepatitis?

Hepatitis is an inflammation of the liver. Inflammation causes soreness and swelling. Hepatitis can be caused by many things. Hepatitis is most commonly caused by one of the 5 hepatitis viruses (A, B, C, D or E). All types of hepatitis cause inflammation of the liver, which interferes with its ability to function. Lack of blood supply to the liver, poison, autoimmune disorders, excessive alcohol use, an injury to the liver and taking certain medicines can also cause hepatitis. Less commonly, viral infections such as mononucleosis or cytomegalovirus can cause hepatitis.

There are 2 main kinds of hepatitis, acute hepatitis (short-lived) and chronic hepatitis (lasting at least 6 months). If you have acute hepatitis, the liver might become inflamed very suddenly and you might have nausea, vomiting, abdominal pain, fever and body aches. Or you may not experience any symptoms. Most people get over the acute inflammation in a few days or a few weeks.

Sometimes, however, the inflammation doesn't go away. When the inflammation doesn't go away in 6 months, the person has chronic hepatitis.

How does hepatitis affect the liver?

The liver breaks down waste products in your blood. When the liver is inflamed, it doesn't do a good job of getting rid of waste products. One waste product in the blood, called bilirubin (say "billy-roo-bin"), begins to build up in the blood and tissues when the liver isn't working properly. The bilirubin makes the skin of a person who has hepatitis turn a yellow-orange color. This is called jaundice (say "john-dis"). Bilirubin and other waste products may also cause itching, nausea, fever and body aches.

What is hepatitis C?

There are 5 viruses that cause hepatitis. Each hepatitis virus is named with a letter of the alphabet: hepatitis A, hepatitis B, hepatitis C, hepatitis D and hepatitis E. Hepatitis C is usually spread through contact with blood products. People who use intravenous (IV) drugs can get hepatitis C when they share needles with someone who has the virus. Health care workers (such as nurses, lab technicians and doctors) can get these infections if they are accidentally stuck with a needle that was used on an infected patient. You are also at a higher risk if you got a blood transfusion or an organ transplant before 1992 (improvements in blood-screening technology were made in 1992).

Most people don't feel sick when they are first infected with hepatitis C. Instead, the virus stays in their liver and causes chronic liver inflammation.

Most people who are infected with hepatitis C don't experience any symptoms for years. However, hepatitis C is a chronic illness (which means it doesn't go away). If you have hepatitis C, you need to be watched carefully by a doctor because it can lead to cirrhosis (scarring of the liver) and liver cancer.

Symptoms
What are the symptoms of hepatitis C?

At first, hepatitis C does not usually produce any symptoms. When it does, symptoms are typically flu-like and can include:

  • Mild fatigue
  • Achiness in your joints and muscles
  • Nausea
  • Lack of appetite
  • Tenderness in the areas of your liver

As the disease progresses, symptoms may still not appear. When they do, they can include:

  • Fatigue
  • Nausea
  • Vomiting
  • Loss of appetite
  • Jaundice (yellowing of the skin and the whites of the eyes)
  • Low-grade fever (fever up to 102°F)
Causes & Risk Factors
I've never used IV drugs or been stuck with a dirty needle. How did I get hepatitis C?

Hepatitis C is usually spread through direct contact with the blood of a person who has the disease. It can also be transmitted by needles used for tattooing or body piercing. In rare cases, hepatitis C can be passed from a mother to her unborn baby. This virus can be transmitted through sex, sharing razors or toothbrushes, although these occurrences are also rare. Many times, the cause of hepatitis C is never found.

Hepatitis C can't be spread unless a person has direct contact with infected blood. This means a person who has hepatitis C can't pass the virus to others through casual contact such as sneezing, coughing, shaking hands, hugging, kissing, sharing eating utensils or drinking glasses, swimming in a pool, using public toilets or touching doorknobs.

Could I give hepatitis C to someone else?

Yes, once you have hepatitis C, you can always give it to someone else. If you have hepatitis C, you cannot donate blood. You should avoid sharing personal items like razors and toothbrushes, although it is very rare to pass hepatitis C in these ways. Always use a condom when you have sex. If you have hepatitis C, your sexual partners should be tested to see if they also have it.

Talk to your doctor first if you want to have children. The virus isn't spread easily from a mother to her unborn baby, but it is possible so you need to take precautions. However, if you're trying to have a baby, do not have sex during your menstrual cycle, because the hepatitis C virus spreads more easily in menstrual blood.

Treatment
How should I take care of myself if I have hepatitis C?

You should eat a healthy diet and start exercising regularly. Your family doctor can help you plan a diet that is healthy and practical.

Talk to your doctor about medicines that you are taking, including over-the-counter medicine. Many medicines, including acetaminophen (brand name: Tylenol) are broken down by the liver and may increase the speed of liver damage. You should also limit alcohol use, as it also speeds the progression of liver diseases like hepatitis C. An occasional alcoholic drink may be okay, but check with your doctor first.

Is there a treatment for hepatitis C?

Good health habits are essential for those who have hepatitis C, especially avoidance of alcohol and other medicines and drugs that can put stress on the liver. There is not yet a proven cure for hepatitis C, but it is noteworthy that after taking medicines for 6 months to 1 year, a significant number of people (45% to 75%) do not experience any more problems from hepatitis C. You should discuss treatment with a doctor if you have hepatitis C.

The standard method of treatment for hepatitis C is a combination of antiviral medicines. Your doctor will prescribe a full course of the medicines, then check the level of hepatitis C in your blood after you have completed the treatment. If there is still a significant amount of the virus in your system, your doctor may recommend another course of medicine.

What are the side effects of drug treatment?

Side effects of treatment for hepatitis C may include the following:

  • Nausea
  • Vomiting
  • Fever
  • Fatigue
  • Depression

Side effects are usually worst during the first few weeks of treatment and become less severe over time. If you are having trouble dealing with the side effects of your medicine, talk to your doctor. He or she can suggest ways to relieve some of the side effects. For example, if your medicine makes you feel nauseated, it may help to take it right before you go to sleep.

If taking medicine to treat hepatitis C makes you feel worse than the actual disease does, you may be tempted to stop taking your medicine before your treatment is done. However, if you don't prevent chronic inflammation from damaging your liver, you'll be much sicker in the long run. Don't stop taking your medicine until your doctor tells you to.

Do I have to have drug treatment?

The choice is up to you and your doctor. Some people who have hepatitis C don't have any symptoms. They only have slight inflammation of their liver. If you have hepatitis C but no symptoms, your doctor will want to closely monitor your condition. This is done by checking your blood at least once a year (maybe up to 3 times a year). Your doctor might decide to start drug treatment only if the hepatitis C virus reaches a certain level in your body or you start experiencing many symptoms.

The decision to use drug therapy can be hard to make because of the side effects. Your doctor will pay attention to the type of the virus and the amount of the virus in your body. Your overall health, the results of your blood tests and the liver biopsy are also important factors to consider before you and your doctor start drug treatment for your hepatitis C.

How will I know if my treatment works?

The goal of treatment is to reduce the amount of the hepatitis C virus in your blood to levels that can't be detected after 24 weeks of therapy. The amount of the virus in your blood is called your viral load. At the end of your treatment, your doctor will need to measure your viral load and find out how healthy your liver is. He or she may repeat many of the same tests that were done when you were first diagnosed with hepatitis C.

If your blood has so few copies of the virus that tests can't measure them, the virus is said to be undetectable. If it stays undetectable for at least 6 months after your treatment is finished, you have what is called a sustained virologic response (SVR). People who have an SVR have a good chance of avoiding serious liver problems in the future.

If treatment doesn't reduce your viral load, or if you don't have an SVR after treatment, your doctor will discuss other treatment options with you. For example, if 1 round of treatment did not decrease your viral load enough, your doctor may recommend a second round of treatment. Even if treatment doesn't keep you from having active liver disease, lowering your viral load and controlling chronic liver inflammation may help you feel better for a longer time.

How can I cope with my feelings about having hepatitis C?

Coping with hepatitis C isn't easy. You may feel sad, scared or angry, or you may not believe you have the disease. These feelings are normal, but they shouldn't keep you from living your daily life. If they do— or if they last a long time— you may be suffering from depression. People who are depressed have most or all of the following symptoms nearly every day, all day, for 2 weeks or longer:

  • Feeling sad, hopeless and having frequent crying spells
  • Losing interest or pleasure in things you used to enjoy (including sex)
  • Feeling guilty, helpless or worthless
  • Thinking about death or suicide
  • Sleeping too much, or having problems sleeping
  • Loss of appetite and unintended weight loss or gain
  • Feeling very tired all the time
  • Having trouble paying attention and making decisions
  • Having aches and pains that don't get better with treatment
  • Feeling restless, irritated and easily annoyed

Talk to your doctor if you notice any of these symptoms. Your doctor can help by recommending a support group or a therapist, and/or by prescribing a medicine for you to take.

Prevention
Is there a vaccine for hepatitis C?

No, not for hepatitis C. There are vaccines for hepatitis A and hepatitis B. If you have hepatitis C, your doctor may want you to take the vaccine for hepatitis B (and maybe the vaccine for hepatitis A), if you don't already have these viruses. If you have hepatitis C, you are more likely to catch hepatitis A or hepatitis B, which would cause more damage to your liver.

A note about vaccines

Sometimes the amount of a certain vaccine cannot keep up with the number of people who need it. More info...

Other Organizations
Questions to Ask Your Doctor
  • What treatment is best for me?
  • Do I need treatment?
  • What medicines should I take?
  • Are there any medicines I should avoid?
  • How can I cope with the side effects of treatment?
  • Is there a therapist I can talk to?
  • How long will my treatment last?
  • Can hepatitis C be cured?
  • Are organ transplants and blood transfusions safe?
  • Is it safe for me to get pregnant?
References
  1. Hepatitis C: Part II. Prevention Counseling and Medical Evaluation by LA Moyer, R.N., EE Mast, M.D., M.P.H., and MJ Alter, Ph.D. (01/15/99, http://www.aafp.org/afp/990115ap/349.html)