Looking for information about hepatitis C

[Guest]

Do any of you know anything about hepatitis C? I have just started to research it after finding out that one of my brothers was diagnosed with it today. I know there has been a lot written about it in the popular press recently, but it is one of those things I read and didn't think twice about it.

[SusanT]

Here's something from the Mayo Clinic website:

What Is Hepatitis C?

An estimated 3 percent of the world’s population — more than 170 million people — carry a mysterious virus that silently attacks their livers, often without their knowledge. That’s because up to 90 percent of those infected with the hepatitis C virus (HCV) have no symptoms at all. In fact, most people don’t know they have the disease until decades later when liver damage shows up during routine medical tests. Sometimes people may learn they have hepatitis C when they try to donate blood, because blood banks now routinely screen for the virus.


The liver — which weighs between 3 and 4 pounds — is the largest and most complex internal organ in your body. It sits behind your lower ribs on the right side of your abdomen and performs a variety of crucial functions — including detoxifying harmful substances, purifying your blood and manufacturing vital nutrients.

Hepatitis C is one of six currently identified hepatitis viruses — the others are A, B, D, E and G. All cause the liver to become inflamed, which interferes with its ability to function. Hepatitis C is generally considered to be among the most serious of these viruses.


In many cases, HCV leads to chronic liver diseases such as cirrhosis — irreversible and potentially fatal scarring of the liver — liver cancer or liver failure. It ranks second only to alcoholism as a cause of liver disease and is the leading reason for liver transplants in the United States.

Although vaccines are used for hepatitis A and B, there is currently no vaccine for hepatitis C. In addition, standard treatments for HCV are not universally effective, so the search for new treatments is ongoing.

Signs and Symptoms


Normally, HCV produces no symptoms in its earliest stages. If you do have symptoms, they'll generally be mild and flulike. They include:

Slight fatigue
Nausea or poor appetite
Muscle and joint pains
Tenderness in the area of the liver
Even if you develop chronic hepatitis from the hepatitis C virus, you may have few, if any, symptoms. In many cases, symptoms may not appear for up to 30 years. Sometimes, though, you may experience one or more of the following:

Fatigue
Lack of appetite
Nausea and vomiting
Persistent or recurring yellowing of your skin and eyes (jaundice)
Low-grade fever
Hepatitis C can cause damage to your liver even if you don't have symptoms. You're also able to pass the virus to others without having any symptoms yourself. That's why it's important to be tested if you think you've been exposed to hepatitis C or you engage in behavior that puts you at risk.


Causes


In general, you contract hepatitis C by coming in contact with blood contaminated with the virus. Most people with HCV became infected through blood transfusions received before 1992, the year improved blood-screening tests became available. You can also contract the virus by injecting drugs with contaminated needles or by inhaling cocaine through contaminated straws or, less commonly, from needles used in tattooing or body piercing. In rare cases, HCV may be transmitted sexually.

Risk Factors


Effective blood-screening procedures have greatly reduced the chances of HCV infection from transfusions. But if you received a blood transfusion before 1992, you're at risk of hepatitis C.

You are also at risk if you:

Used illegal intravenous (IV) or intranasal (such as cocaine) drugs even once
Received an organ transplant before 1992
Are a health care worker who was exposed to infected blood
Received clotting factor concentrates before 1987 or have the clotting disease hemophilia and received blood before 1992


When to Seek Medical Advice


See your doctor if you think you may have been exposed to the hepatitis C virus, if you notice your skin or eyes turning yellow or if you have any other symptoms of hepatitis. Don't let concern about what others may think keep you from getting medical care.

If you’re being treated for hepatitis, see your doctor right away if you develop any of the following symptoms:

Increased drowsiness, confusion or irritability
Vomiting, diarrhea or abdominal pain
Increased jaundice
Skin rash
Fever
Loss of appetite

Screening and Diagnosis


Ask your doctor to screen you for HCV if you think you've been exposed to the virus or are at risk of the disease. If you received a blood transfusion before 1992 from a donor who later tested positive for HCV, you may have received a letter from your hospital or blood bank recommending that you be screened.

Hepatitis C can be diagnosed with a blood test. In addition to the blood test, your doctor will take a complete medical history and perform a physical exam. He or she may also recommend a liver biopsy, a relatively painless procedure in which a small sample of liver tissue is removed for microscopic analysis.

Before the biopsy, you'll receive a local anesthetic to keep you comfortable. Your doctor then inserts a thin needle into your liver to remove the tissue sample. Liver biopsy is safe and unlikely to have any complications, although you may have some pain or bleeding afterward.

Although a biopsy isn’t necessary to confirm the diagnosis, it can help determine the severity of the disease. It may also help rule out other causes for your liver problem, such as alcoholic or drug-induced hepatitis, autoimmune hepatitis or excess iron (hereditary hemochromatosis).


Complications

Fifteen percent to 20 percent of people infected with hepatitis C fight off the virus on their own without liver damage. For the rest, the disease settles in and slowly attacks the liver.

About 85 percent of people infected with HCV develop chronic hepatitis. Twenty percent develop cirrhosis, usually within the first 2 decades after infection. Of those who develop cirrhosis, fully half progress to end-stage liver disease or liver cancer.

Health experts predict that hepatitis C-related deaths may soon overtake the number of AIDS-related deaths in the United States. Currently, about 10,000 people die each year of HCV, but that number is expected to triple by the year 2010. Even so, your chances of survival are high. Right now, more than 99 percent of people with HCV survive.

Treatment

A diagnosis of HCV doesn’t necessarily mean you’ll need treatment. The National Institutes of Health (NIH) recommends treatment for HCV if you have:

A positive HCV ribonucleic acid (RNA) test, which indicates circulating virus in your bloodstream
A biopsy that indicates significant liver damage
Elevated levels of a liver enzyme called alanine aminotransferase (ALT) in your blood
Even so, doctors continue to debate who needs treatment. If you have only slight liver abnormalities, your doctor may decide against medical treatment because your long-term risk of developing a serious disease is slight, and the side effects of treatment can be severe.

On the other hand, because there is no foolproof way to know whether you’ll develop liver disease later on, your doctor may choose to fight the virus. Improved treatment methods and a higher success rate in fighting hepatitis sometimes tip the argument in favor of more aggressive approaches.

Until recently, the best weapon against hepatitis C was interferon, a drug that inhibits viral replication. Interferon medications used to treat hepatitis include interferon alfa-2b (Intron A), interferon alfa-2a (Roferon-A) and interferon alfacon-1 (Infergen). But interferon worked in only about 20 percent of cases. Now, injections of interferon are usually combined with oral doses of ribavirin (Virazole) — a broad-spectrum antiviral agent. Treatment usually takes from 6 months to 1 year and is successful in about 40 percent of people with HCV.

Recent studies have shown that another drug, pegylated (PEG) interferon, may be twice as effective as regular interferon. In January 2001, the Food and Drug Administration (FDA) approved the use of PEG interferon — peginterferon alfa-2B (PEG-Intron) — for treatment of hepatitis C.

Side effects from drug therapy include severe flulike symptoms from the interferon and a temporary drop in hemoglobin (anemia), white cell or platelet counts in your blood. Chronic side effects — which affect about half of those receiving treatment with interferon-ribavirin — include extreme fatigue, anxiety, irritability and depression. A small percentage of people may experience psychosis or suicidal behavior.

For this reason, treatment with interferon isn't recommended if you have a history of major depression. You're also not a good candidate for this treatment if you have untreated thyroid disease, low blood cell counts or autoimmune disease, or if you drink alcohol or use drugs.

Unfortunately, if treatment isn't effective for you or you're not able to tolerate the side effects, you may have few other options. But researchers are investigating the use of protease inhibitors in people with HCV. These are the same medications that have helped some people with the AIDS virus. In the future, it may also be possible to treat HCV with gene therapy.

Liver transplantation

The best treatment for people with end-stage liver disease is liver transplantation. Unfortunately, the number of people awaiting transplants far exceeds the number of donated organs. But several new developments in transplantation may make it possible for more people to receive the organs they desperately need.

These developments include the donation of liver segments from living relatives, splitting one donated liver between two recipients, new organ allocation policies and, especially, new approaches to liver transplants for people with HCV.

In fact until recently, HCV-infected livers were routinely discarded. But studies show that people already infected with HCV who receive livers from HCV-positive donors do as well as if they'd received a liver not infected with the virus. This may mean that many more livers will become available for people with hepatitis C.

Prevention


Because no effective vaccine for hepatitis C exists, the only way to protect yourself is to avoid becoming infected. That means taking the following precautions:

Avoid unprotected sex with multiple partners or with one partner whose health status is uncertain.
Don’t share needles or other drug paraphernalia. Contaminated drug paraphernalia is responsible for about half of all new hepatitis C cases.
Avoid nasal use of cocaine.
Avoid body piercing and tattooing unless you're absolutely certain the equipment is sterile.

Self-Care


If you receive a diagnosis of hepatitis C, your doctor will likely recommend certain lifestyle changes. These simple measures will help keep you healthy longer and protect the health of others as well:

Eliminate alcohol consumption. Alcohol speeds the progression of liver disease.
Avoid medications that may cause liver damage. Your doctor can advise you about these medications, which may include over-the-counter (OTC) medications as well as prescription drugs.
Maintain a healthy lifestyle. Be sure you eat a healthy diet that emphasizes fresh fruits, vegetables and whole grains, exercise regularly, and get plenty of rest.
Help prevent others from coming in contact with your blood. Cover any wounds you may have and don't share razors or toothbrushes. Don't donate blood, body organs or semen, and advise health care workers that you have the virus.

Complementary And Alternative Medicine


In Europe, the herb milk thistle (Silybum marianum) has been used for centuries to treat jaundice and other liver disorders. Today, scientific studies have confirmed that the chief constituent of milk thistle, silymarin, may aid in healing and rebuilding the liver. Silymarin seems to stimulate the production of antioxidant enzymes that help the liver neutralize toxins. It also seems to increase the production of new liver cells and may even improve the severe scarring of cirrhosis. These benefits have not been proved in people with hepatitis C, however. Furthermore, although milk thistle may help the liver, it will not cure hepatitis C nor will it prevent the disease from recurring.

Milk thistle is available in capsule or alcohol-free extracts. Check with your doctor before trying this or any other herb to make sure it won't interact with other medications you’re taking.


Additional Resources
National Center for Complementary and Alternative Medicine
HepNet: Hepatitis Information Network
American Liver Foundation
Centers for Disease Control and Prevention


DS00097

January 04, 2002

[Ralph]

Good job, Susan! Here's more information, this a patient handout from a subscription only medical site (MDConsult).

Hepatitis C

What is hepatitis?

Hepatitis is an inflammation of the liver. Inflammation causes soreness and swelling. Hepatitis can be caused by many things. Drinking too much alcohol, abusing drugs and taking some medicines can cause hepatitis. Many viruses can cause hepatitis, too.

There are 2 main kinds of hepatitis, acute hepatitis and chronic hepatitis. When a person has hepatitis, the liver may become inflamed very suddenly. This is called acute hepatitis. If you have acute hepatitis, you might have nausea, vomiting, fever and body aches. Or you may not have 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, 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 right. The bilirubin makes the skin of a person with 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?

Several viruses can infect the liver. Each hepatitis virus is named with a letter of the alphabet. There are 3 main types: hepatitis A, hepatitis B and hepatitis C. Hepatitis C is usually spread through contact with blood products, like accidentally being stuck with a dirty (used) needle, using IV drugs and sharing needles, or getting a blood transfusion before 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 have any symptoms for years. However, hepatitis C is a chronic illness (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 (a liver disease) and liver cancer.


I've never used IV drugs or been stuck with a dirty needle. How did I get hepatitis C?

Many times, the cause of hepatitis C is never found. This virus may be transmitted through sex. It may also be passed from one person to another by living in the same house with someone who has hepatitis C. Sharing razors or toothbrushes may transmit the hepatitis C virus. It can be transmitted by tattoo needles. It can even be passed from a mother to her unborn baby. All of these ways of catching hepatitis C are uncommon, but they do occur.


Could I give hepatitis C to someone else?

Yes, as far as we know, once you have hepatitis C, you can always give it to someone else. If you have hepatitis C, you can't donate blood. You should avoid sharing personal items like razors and toothbrushes. Always use a condom when you have sex. If you have hepatitis C, your sex 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 by sexual contact or from a mother to her unborn baby. If you're trying to have a baby, don't have sex during the menstrual cycle, because the hepatitis C virus spreads more easily in menstrual blood.


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

You should eat a healthy diet and start exercising regularly. A dietitian can help you plan a diet that is healthy and practical. Talk to your doctor about medications that you are taking, including over-the-counter medications. Many medicines, including acetaminophen (brand name: Tylenol) are broken down by the liver and may increase the speed of liver damage. It is very important that you drink only a minimal amount of alcohol. An occasional alcoholic drink is probably O.K., but check with your doctor first.


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, and that would cause more damage to your liver.


Is there a treatment for hepatitis C?

Medicines available for hepatitis C include interferon alfa-2a (brand name: Roferon-A), interferon alfa-2b (brand name: Intron A), interferon alfacon-1 (brand name: Infergen), interferon alfa-2b plus ribavarin (brand name: Rebetron), and interferon alfa-n1 (brand name: Wellferon). These medicines are given as an injection (a "shot") every day, every other day, or 3 times a week for several months, and sometimes longer. About 14/4 of the people who take interferon for hepatitis C feel better. These medicines don't cure hepatitis C, but they do make people feel better and may prevent future liver problems.


What should I know about interferon?

Before you can start taking interferon, you will have a liver biopsy. A tiny bit of your liver will be taken out in a surgical operation. The doctor will check this sample of your liver to see how much damage there is. Younger patients with mild liver disease and fewer virus particles in the liver have a better response to interferon.

Interferon is expensive. It costs about $6,000 a year. You should check with your health insurance provider to see if your medical insurance will cover the cost.


What side effects will I have from taking interferon?

The most common side effect feels like having the flu. Some people taking interferon have fevers, body aches, headaches, fatigue, irritability, nausea, vomiting, loss of appetite, sleep disturbance or changes in their blood. If you take interferon, your doctor will want to examine you regularly to keep track of the side effects. If they get too bad, you may have to stop taking interferon.


Do I have to take interferon?

The choice is up to you and your doctor. Some people with hepatitis C don't have any symptoms. They only have a little inflammation of their liver. If you have hepatitis C but no symptoms, your doctor will want to keep a close watch on you. This is done by checking your blood at least once a year, and maybe 3 times a year. Your doctor will check the level of 2 enzymes that are made in your liver. Your doctor might decide to give you medicine for hepatitis C only if these enzymes reach a certain level.

The decision to use interferon therapy can be hard to make because of the expense and 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 and the results of your blood tests and the liver biopsy are also important to know about before your doctor gives you interferon treatment.


For more information

American Liver Foundation
75 Maiden Lane, Suite 603
New York, NY 10038-4810
Telephone: 800-GO-LIVER
Internet address: www.liverfoundation.org

You may also want to search the web site of the American Gastroenterological Association (www.gastro.org).

[Guest]

Susan and Ralph,
Thanks very much for the information. I just printed it out and have added it to the other articles I found on the web. My brother and SIL don't have a computer and are a bit lost at the moment. After many years of living on the fringes being a lost soul, my brother has really straightened out in the past year, gotten married and just had a beautiful baby girl. I just talked to my SIL who said that DB has an appointment with the doctor on Monday. They live in Southern CA, so there are a lot of great medical resources close by. I am off to the post office now to mail the info packet. Thanks again.

[Robyncz]

I know that a new diagnosis like this can be terrifying. I have two close friends with Hep-C. One of whom most likely contracted it as an infant when she received a blood transfusion in Mexico. My other friend most likely got it in her early 20s--eiither from a blood transfusion received during emergency surgery, or possible from a sex partner. Both of my friends are living happy, healthy, productive lives. They have good health-care teams who monitor about their condition and they have frequent blood tests and liver biopsies at regular intervals (luckily, not so frequent!). They have both adopted healthier diets and exercise regimes to take a proactive approach to their over-all healt and they both are doing great. My point is that while Hep-C is a serious disease, not everybody who has it gets sick. I hope your brother is one of the lucky ones!

[AndreaU]

My brother-in-law was diagnosed with Hep C several years ago (thanks to a blood transfusion about 30 years ago). He eventually went on Interferon treatments which made him very depressed and sick. This was a few years ago, so I don't know if things have changed much with the treatment.

Recently he has been off interferon for a couple of years- he's happy, healthy and a dad to a new baby boy! The treatment was a big down time for him but something worked, he's doing great!

Best wishes for you, your brother and your families.