Of all the chronic liver diseases, chronic hepatitis C is the most common. Between 8,000 and 13,000 deaths a year are associated with chronic hep C. Most liver transplants in the United States are performed on people with chronic hep C.
Chronic Hepatitis C
About 70 to 80 percent of people with hep C will have a long-term infection. This is called chronic hepatitis C. The infection could be lifelong unless treatment is provided that results in a cure.
Most people with hep C will not have symptoms, even if they have significant liver damage as a result. Among those who develop symptoms from hep C, fatigue is the most common.
Symptoms of hepatitis C include:
- Bleeding or bruising easily
- Yellow discoloration of the body (jaundice)
- Lack of appetite
- Muscle/joint aches
Chronic hepatitis C starts as acute hep C, which often goes undiagnosed because symptoms are rare. Acute hep C symptoms typically appear one to three months after exposure. If symptoms appear at all, they can last from a couple of weeks to a few months.
Acute hep C doesn’t always become chronic. Some people experience a spontaneous clearing of the virus. If diagnosed, acute hep C can be treated with antiviral therapy.
Hep C is caused by the hep C virus entering the bloodstream in an uninfected person. Blood can be transmitted a number of different ways.
The risk of exposure to hepatitis C increases if you:
- Work in a healthcare environment with exposure to infected blood, including a needle piercing the skin.
- Have ever inhaled or injected illicit drugs
- Have HIV
- Received a tattoo or piercing using unsterile equipment.
- Received a transplant or blood transfusion before 1992
- Received a clotting factor concentrate prior to 1987
- Were born to a mother with hepatitis C
- Spent any time in prison
- Were born between 1945 and 1965
Chronic hepatitis C (lasting years) can cause significant complications.
- Cirrhosis – Scarring of the liver (cirrhosis) can occur over long periods of time; 20 to 30 years of having a hepatitis C infection. Cirrhosis makes it difficult for the liver to function properly.
- Liver Cancer – Around 1 in 50 people with Cirrhosis and a hepatitis C infection will develop hepatocellular carcinoma, a type of liver cancer. The majority of people with cirrhosis and hepatitis C will not develop cancer.
- Liver Failure – Advanced cirrhosis could cause the liver to stop functioning.
Experts recommend anyone with an increased risk of hepatitis C to get a blood test to check for hepatitis C.
If the screening test is positive, further blood testing will be done to confirm the diagnosis of hepatitis C. This will include genotype testing, which helps determine the type of hepatitis C virus and the best treatment plan. Most people in the United States have type 1 hepatitis C.
A liver biopsy is not required for the diagnosis of hepatitis C, but may be performed when treatment is being considered. A biopsy can help determine the long-term prognosis and stage of the disease.
Hepatitis C Treatment
The goal of hepatitis C treatment is to stop the progression of liver disease. However, treatment isn’t recommended for everyone. Other health conditions, lifestyle choices, and the current level of liver damage will be reviewed before your doctor makes a treatment recommendation.
Antiviral Medications – Hepatitis C can be treated with antiviral medications which will help clear the virus from the body. After 8 to 12 weeks, you may be tested again for the hep C virus.
Cure is defined as a negative test for hepatitis C more than six months after stopping treatment. The cure-rate of type 1 hep C virus is around 40% to 50% and types 2 and 3 are around 80%.
Recurrence happens in about 25% to 35% of hepatitis C patients.
Liver Transplant – Because hepatitis C can cause serious liver complications, a liver transplant may be an option. Transplanted organs often come from deceased donors, but some come from living donors when only a portion of a healthy liver is transplanted.
Vaccines – There are no vaccines for hepatitis C, but your doctor may recommend vaccines for hepatitis A and B. Although these are separate viruses, they also affect the liver and can further complicate treating chronic hep C.
Long Term Management
Do not drink alcohol – Alcohol can damage the liver and speed the progression of liver disease.
Screening for cancer – People with hep C and cirrhosis should get regular screening tests every year or every other year. Testing for hepatocellular carcinoma usually includes a visual examination with ultrasound and a blood test to look evaluate the alpha-fetoprotein level.
Diet – There is no recommended diet for those with hep C.
Avoid Liver-Damaging Medications – Some medications could cause liver damage. Talk to your doctor about all medications you take, including over-the-counter medications, herbal supplements, or dietary supplements.
Prevent Spreading hepatitis C – You can help others not come in contact with your blood by taking precautions.
- Don’t donate blood, organs, or semen
- Don’t share toothbrushes or razors
- Tell healthcare workers you have the virus
- Tell your sexual partner prior to sex and use condoms during intercourse
Support Groups – There are many helpful support groups for people with hep C. Visit the American Liver Foundation for a complete list.
Hepatitis C Clinical Trials
Research is always being conducted for hep C – for more information on clinical trials for hep C, patients can search the NIH Clinical Trials database for current studies.