Hepatitis C Symptoms
In 70 to 80 percent of people, the infection becomes chronic. The word “chronic” implies that the infection will be prolonged, or even lifelong, unless treatment is given and results in a cure.
Many people with chronic hepatitis C have no symptoms, even if there is significant liver damage. Of those who do develop symptoms, the most common symptom is fatigue; other less common symptoms include nausea, lack of appetite, muscle or joint aches, weakness, and weight loss.
How did I Become Infected with Hepatitis C?
The hepatitis C virus is spread by contact with blood. Thus, patients with hepatitis should avoid activities that could expose other people to their blood. Examples include sharing a toothbrush, nail clippers, razors, and needles.
Blood and blood products – The current risk of becoming infected with hepatitis C from a blood transfusion is quite small, estimated at one in 1.9 million.
Sexual transmission — The virus can be spread sexually, although the risk is much smaller than with other types of viruses. The risk of transmission between stable monogamous sexual partners (i.e., between sexual partners who have no other sexual contacts) is estimated to be approximately 1 in a 1000 per year. Use of a condom is not routinely recommended due to the very low risk.
The risk of transmitting the virus is higher in people who are infected with both hepatitis C and HIV.
Other transmission — There is no evidence that kissing, hugging, sneezing, coughing, casual contact, sharing food, water, eating utensils or drinking glasses, or having other contact without blood exposure can spread the hepatitis C virus. Daily use of marijuana has been associated with worsening liver disease and is not recommended, particularly for people with hepatitis C.
Transmission during pregnancy — The risk of transmitting hepatitis C during pregnancy may depend upon the level of virus in the blood stream. In general, the risk is about 5 to 6 percent (about 1 in 20) but is increased in people who are also infected with HIV, in whom the risk increases to 12 percent or 1 in 8.
Hepatitis C Diagnosis
Blood tests — Hepatitis C is diagnosed with a blood test. In most cases, a screening blood test (hepatitis C virus antibody) is done because a person has risk factors for the infection, including the following.
If the screening test is positive for hepatitis C, further testing is performed to confirm that the virus is present.
Hepatitis C virus (HCV) RNA is a measure of the amount of virus circulating in the blood. HCV RNA is detectable in the blood within days to eight weeks following exposure. Hepatitis C genotype testing determines the specific type of HCV; most people in the United States have type I.
Liver biopsy — A liver biopsy is not required to diagnose hepatitis C. However, a biopsy is often performed if hepatitis C treatment is being considered. Results of the biopsy can help to determine the stage of the disease and the long-term prognosis.
Hepatitis C Complications
The hepatitis C virus causes a variable amount of damage to the liver, although the liver is able to repair itself to some degree. This damage occurs over many years.
In some people, scar tissue (called fibrosis) accumulates in the liver, which can eventually become extensive, leading to cirrhosis, in which the liver is severely scarred. People with cirrhosis are at increased risk for developing complications because the scarred liver is less able to function normally.
One of the most feared complications of cirrhosis is the development of liver cancer (called hepatocellular carcinoma), which occurs almost exclusively in people with cirrhosis. About 2 percent of people with cirrhosis (1 in 50) develop hepatocellular carcinoma each year. Therefore, the majority of people with cirrhosis due to hepatitis C will not get hepatocellular carcinoma.
Risk factors for complications — Only about 20 percent (or one in five) will develop cirrhosis within 20 years of acquiring the infection. Most others will have some degree of inflammation in the liver, but without a significant amount of scarring.
Consuming alcohol and Increasing amounts of inflammation make it more likely that the liver will become scarred.
Hepatitis C Treatment Options
The goal of treating hepatitis C is to prevent progression of liver disease. Unfortunately, it is not always possible to accurately predict who will develop progressive disease.
Pegylated interferon and ribavirin — The most common treatment for hepatitis C is a combination of two medications, pegylated interferon and ribavirin. The recommended duration of treatment with this combination is 48 weeks for genotype 1, and usually 24 weeks for genotype 2 and 3.
During therapy, the level of the virus in the blood (called the viral load) will be monitored, with the goal of completely eliminating the virus. Therapy may be stopped early if the virus does not respond or if there are intolerable treatment-related side effects.
Side effects occur in almost 80 percent of patients who are given pegylated interferon and ribavirin. The most common side effects include flu-like symptoms, low red and white blood cell counts, and fatigue. Treatments to minimize these symptoms are available.
Should I be treated? — Treatment for hepatitis C is not recommended for everyone. Treatment with interferon is not recommended for people whose depression is not well controlled because this group is at risk for committing suicide during treatment. Interferon may be used in people with well-controlled depression. Ribavirin is not recommended in women who are pregnant, contemplating pregnancy or unable to use a reliable form of birth control. People with underlying autoimmune disorders (e.g., lupus, rheumatoid arthritis) may be at increased risk of treatment-related complications related to interferon. People with normal liver function tests (ALT) who acquired hepatitis C under the age of 35 years, are women, do not drink alcohol, and have no or minimal fibrosis on liver biopsy may develop hepatic fibrosis at a slow rate. In such patients, it is reasonable to delay treatment until fibrosis progresses, liver function testing becomes abnormal, or clinical trials prove that earlier treatment is of benefit.
Cure — The chance of being cured depends in part upon the specific type of hepatitis C virus (i.e., the genotype). Overall, the chance is approximately 40 to 50 percent for genotype 1 and 80 percent or more with genotypes 2 and 3.
Recurrence happens in about 25 to 30 percent of cases. Cure is defined as absence of the virus for more than six months after stopping therapy.
Long-Term Management Of Hepatitis C
Screening tests — People with hepatitis C who have cirrhosis should have regular screening tests for hepatocellular carcinoma, which usually includes an ultrasound examination of the liver plus a blood test (alpha fetoprotein level) every year or every other year.
In addition, a procedure called an upper gastrointestinal endoscopy may be done to evaluate for esophageal varices (enlarged veins in the esophagus). Varices develop in roughly 50 percent of people with cirrhosis.
Diet — No specific diet improves signs or symptoms of hepatitis C. Drinking alcohol is strongly discouraged to protect the liver from further damage.
Vaccines — Anyone who is infected with hepatitis C should be vaccinated against hepatitis A and B, unless they are already known to be immune.
Prescription and nonprescription drugs — Most drugs are safe for people with hepatitis C unless the liver is scarred.
One important exception is acetaminophen (Tylenol); the maximum recommended dose is no more than 2000 milligrams or 2 grams per 24 hours or 500 mg every 6 hours (four times per day).
Herbal medications — Many herbal products claim to “cure” or improve hepatitis C; none of these claims has been proven true. In addition, some herbal medications can seriously injure the liver.
Support — Patients with hepatitis C should not underestimate the value of sharing their concerns with others who have the same diagnosis. The American Liver Foundation has helpful advice and list of support groups (www.liverfoundation.org).
For ongoing studies in the field of Hepatitis C, please visit: http://clinicaltrials.gov/.
Peter A. L. Bonis, MD; Sanjiv Chopra, MD; Adrian M. Di Bisceglie, MD; Leah K. Moynihan, RNC, MSN; Peter A. L. Bonis, MD.