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What is Hepatitis C?

The hepatitis C virus (HCV) is an organism that affects the liver. Of the people who are exposed to the virus, approximately 80% will be chronic carriers. HCV can cause chronic (long-lasting) inflammation and scarring of the liver. There generally are no symptoms of HCV or early cirrhosis so people do not know they are infected unless their blood is tested. It is estimated that more than 4 million Americans are now infected with HCV, with 9,000 to 10,000 dying from it each year.

Fortunately, most people will live normal healthy lives and not be affected by the virus.

Risk Factors:

Hepatitis C is passed from person to person by blood. Some people never know how they were exposed to the virus. Below are the most common types of exposure.
  • Blood transfusion before 1992 (when tests for HCV became available and the blood was tested)
  • Intravenous drug use (street drugs such as heroin, cocaine, etc.)
  • Snorting cocaine
  • Tattoos, body piercing
  • Sharing razors, needles, nail clippers, or toothbrushes
  • Environmental or occupational exposure to infected blood
  • Healthcare workers, paramedics, etc.
  • Infants born to HCV infected mothers
  • High-risk sexual behavior, multiple partners, and sexually transmitted diseases
Everyone with the disease is potentially infectious. If you have been diagnosed with hepatitis C, you should not share razors, toothbrushes, nail clippers or any items that may be contaminated with your blood and can mix with someone elses blood. It is recommended that you use protection during sexual intercourse but the risk of sexual transmission is low for long-term monogamous partners. Cover cuts with waterproof dressing and clean up any blood using paper towels and bleach straight from the bottle. Bloodstained items such as Band-Aids, wound dressings, tampons and pads should be placed in plastic bags before being placed into the trash.

Diagnosis of Chronic Hepatitis C

Individuals infected with HCV are often identified due to their elevated liver enzymes on a routine blood test, or because a hepatitis C antibody is found to be positive at the time of blood donation. Once the antibody is found, other tests can be done to provide more information. These include:
  1. Viral load: an actual count of how much of the virus is in the blood. This number is reported as a number that can range from 500 to 5 million per ml of blood.
  2. Genotype: identifies the strain of the virus. There are currently 6 genotypes and several subtypes of HCV known.
  3. Liver function tests: these can tell us how the liver is working and that there is inflammation but they do not tell us how much inflammation or what the cause is.
  4. Abdominal ultrasound: useful to show if there is too much fat or any tumors in the liver
  5. Liver Biopsy: a sample of liver tissue that can be examined under a microscope to determine the amount of inflammation and scarring present. An injection of local anesthetic is given, and a special needle is passed between the ribs and into the liver. A small sample is then taken for microscopic examination. The liver biopsy helps to tell whether treatment should be stared.
Functions of the Liver

The liver is the largest internal organ in the body and acts like the bodys factory. Some of its functions include processing products of digestion by storage and distribution. The liver stores fat, protein and sugar; regulates the blood sugar level, and stores vitamins and minerals. It makes proteins and substances to help the blood clot, breaks down medications and alcohol, filters waste products and stores up to 10% of your total blood supply for emergency use. If the liver becomes inflamed and scarred it cannot perform the necessary functions that keep your body working.

Who should be tested?

People should consider having the hepatitis C antibody test if they have any of the risk factors listed above and those with abnormal liver function tests should be tested. Spouses of those with HCV and anyone who has been exposed to blood or blood products should be tested. It is not always necessary to have children tested. Discuss any concerns or questions you have with your doctor. Household transmission of HCV is extremely low.

Complications of Hepatitis C

The majority of patients with chronic Hepatitis C will never develop a complication related to this disease. Hepatitis C is a slow-working virus and usually, signs of inflammation in the liver dont show up until 10-20 years after the exposure. However, if undetected/untreated, HCV can cause cirrhosis (scarring of the liver), liver failure, and liver cancer. About 20-30%% of patients develop cirrhosis within 20 to30 years after the onset of infection. Liver damage due to chronic hepatitis C is the leading cause of liver transplants in the United States. The most important risk factor for developing cirrhosis and cancer is alcohol. Regular alcohol intake can raise your risk of developing cirrhosis and cancer significantly higher that of nondrinkers with HCV. It is strongly advised to stop all alcohol intake.

Treatment of HCV:

Currently, pegylated (long-acting) interferon and ribavirin is the treatment of choice. In the past response rates were low but continue to improve with better treatment. Treatment can last 12 months or longer depending on your response. Response to treatment is affected by:
  1. the amount of virus in the blooda count of 2 million or less is favorable
  2. the genotype of the virusTypes 2 or 3 are favorable
  3. the presence or absence of scarring in the liverthe less damage the better the chance of responding

Follow-up care with your doctor

It is important to consult a doctor or pharmacist about your current medications and anything you plan to take. Some medications (prescribed or over the counter) and dietary and herbal supplements can be harmful to the liver.

Keep in mind that Hepatitis C is not transmitted by ordinary social contact such as hugging, kissing, shaking hands, sharing food and drinks, using the same utensils and plates, using the same shower and toilet facilities, and using the same towels and washing machine. Sexual transmission is not common, but can occur and appropriate precautions should be taken. Partners should be tested periodically to make certain they have not acquired the virus.

Keep regular appointments so that you can be tested and monitored. The virus was first discovered approximately 10 years ago and our knowledge is in early stages. However, much research is being done and we continue to learn new information. By checking with your doctor you can be made aware of changes and new treatments so that you can live a productive healthy life.
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