Hepatitis C

The hepatitis C virus (HCV) is an organism that affects the liver. The liver is the largest internal organ in the body and among its many functions is processing products of digestion by storage and distribution.  It also makes proteins and substances to help the blood clot and to break down medications and alcohol. Approximately 80% of the people who are exposed to the virus will be chronic carriers. HCV can cause chronic inflammation and scarring of the liver.  When the liver becomes inflamed, it cannot perform the necessary functions that keep the body working efficiently. There are typically no symptoms of HCV so people do not know if they have been infected until they get a blood test. It is estimated that more than 4 million Americans have been infected with HCV, with 9,000 to 10,000 people dying from it each year.

Hepatitis C is passed from person to person by blood. Some people never know how they caught the virus. The top ways that people are exposed to HCV are:

• Blood transfusion before 1992 (when tests for HCV became available and the blood was tested)

• Intravenous drug use (recreational 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 infections

Because up to 1 in 20 individuals with hepatitis C have no known risk factors, it is recommended that all adults be tested at least once in their lifetime. If you have any of the above risk factors, you should consider being tested for hepatitis C. Spouses of those with hepatitis C should also be tested. It is not always necessary to have children tested, since household transmission of HCV is extremely rare.

You should also know that hepatitis C is not transmitted by social contact such as kissing, hugging, shaking hands, or sharing food. Sexual transmission is not common, but can occur, and appropriate precautions should be taken.

If you have been diagnosed with hepatitis C, you should not share razors, nail clippers, toothbrushes, or any items that may be contaminated with your blood and can mix with someone else’s blood. Cover cuts with waterproof dressing and clean up any leftover blood with paper towels.

Diagnosis Of Chronic Hepatitis C

Individuals that are infected with HCV are often found to have elevated liver enzymes on a routine blood test. Testing for hepatitis C is done with an antibody test which, if positive, is then confirmed with a test to detect the virus in blood. Other tests can be used to provide additional information. These exams include the following:

• Viral load: an actual count of how much of the virus is in the blood.

• Genotype: identifies the strain of the virus. There are currently 7 known genotypes and 67 subtypes of HCV.

• Liver function tests: these can tell us how the liver is working and if there is inflammation.

• FibroSure®: blood test that helps evaluate amount of fibrosis (scar tissue) in the liver.

• Abdominal ultrasound: useful to show if there is excessive fat or tumors in the liver.

• Transient elastography: performed during ultrasound; helps evaluate amount of fibrosis (scar tissue) tissue in the liver.

• Liver biopsy: a sample of liver tissue is examined under a microscope to see if there is inflammation or scarring.

Complications Of Hepatitis C

The majority of patients with chronic hepatitis C do not have symptoms. However HCV can cause chronic inflammation of the liver that may not show up until 10-20 years after an exposure. If HCV goes undetected and untreated, HCV can cause cirrhosis (scarring of the liver), liver failure, and liver cancer. It is strongly recommended that if you have hepatitis C, you should be treated, even if you have no symptoms.

Treatment Of HCV

Direct-acting antivirals in the form of oral pills are the treatments of choice for HCV. Treatment usually lasts for 8 to 12 weeks, has no or minimal side effects, and is effective in the great majority of patients. Once patients complete a course of treatment, it is important to check additional blood tests 3 months later to make sure that the hepatitis C is gone and that the liver inflammation has resolved.