What Is Hepatitis C?
Acute viral hepatitis is caused by several types of blood-borne viruses that produce inflammation of the liver. Hepatitis C is considered the most serious of these viruses and is the most common cause of chronic hepatitis, which may cause no symptoms for years yet can result in long-term health problems. (Hepatitis A, another common form of acute viral hepatitis, can cause flu-like symptoms but usually results in complete recovery and immunity to future type A infection. Hepatitis B may cause mild symptoms that resolve without treatment, but this virus, like type C, can cause chronic infection.)
About 85% of acute infections of hepatitis C become chronic. Chronic hepatitis C is characterized by ongoing inflammation of the liver and destruction (necrosis) of liver cells that persist for more than six to 12 months. Symptoms may be mild, vague, or nonexistent. The condition may progress slowly and can subside spontaneously over months or years. In some cases, the destruction of liver cells results in serious liver damage, including scar tissue in the liver (cirrhosis) and liver cancer, and may ultimately lead to liver failure. Chronic hepatitis C is the leading reason for liver transplants in the United States.
For some patients, therapy can retard progression of hepatitis C or cure the disease, and new combination therapies have dramatically improved cure rates. Still, in recent years, about 15,000 people have died annually from cirrhosis or liver cancer caused by hepatitis C. Those numbers will probably decrease, however, as better treatments become widely available.
Who Gets Hepatitis C?
About 29,500 new cases of acute hepatitis C occur each year—and some 3 million Americans are estimated to have chronic hepatitis C infection. (Because of effective vaccination strategies for preventing hepatitis A and B, rates for those infections have steadily declined in recent years.) Four in five people diagnosed with hepatitis C are baby boomers, most of whom became infected during the 1970s and 80s, when rates of hepatitis C peaked. Most of these individuals don’t know they are infected.
Hepatitis C may not cause any symptoms at all. In fact, most people with hepatitis C have no symptoms and are diagnosed when a routine blood test identifies abnormal liver enzymes or they are screened for a blood donation. When symptoms do occur, they can include the following:
- General discomfort.
- Loss of appetite.
- Nausea and vomiting.
- Aching muscles or joints.
- Abdominal discomfort or pain.
- Jaundice (yellowish tinge to the eyes and skin).
- Dark urine and pale stools.
- Abdominal swelling caused by fluid accumulation (as cirrhosis develops).
- Viruses cause acute hepatitis.
- Hepatitis C may be spread by exposure to contaminated blood (both fresh and dried) on infected needles or during a blood transfusion. People on long-term hemodialysis are also at risk, as are people who have received piercings and tattoos in non-sterile environments.
- About 25% of people with HIV, the virus that causes AIDS, also have hepatitis C.
- The virus may be transmitted to an infant at childbirth by an infected mother.
- Risk of transmission by sexual contact is very low, according to the Centers for Disease Control and Prevention (CDC).
What If You Do Nothing?
In about 25% of people who contract hepatitis C, acute infection resolves on its own, often within six months but sometimes years later. But the majority become chronic carriers who, without medical treatment, face potentially fatal complications, notably cirrhosis and liver cancer.
- Hepatitis C can be diagnosed with blood tests that detect the virus or antibodies to the virus.
- A liver biopsy (removal by needle of a small sample of tissue) may be recommended to confirm a diagnosis of advanced chronic hepatitis C and determine the extent of liver damage.
- The U.S Preventive Services Task Force and the CDC recommend testing for anyone at increased risk for infection, including people who:
- were born between 1945 and 1965
- have ever injected illegal drugs or shared needles
- received blood transfusions or solid organs transplants before 1992
- are on long-term dialysis
- are infected with HIV
- may have been exposed through an occupation, like healthcare workers
- were born to mothers with hepatitis C
Some experts think that widespread screening is premature, since it may subject some patients to treatment they might not have ever needed. Discuss the benefits and potential drawbacks of screening with your doctor.
- Treatment for hepatitis C is evolving rapidly. An injectable drug, pegylated interferon— often combined with ribavirin, an oral medication—has been the standard treatment for years. But newer antiviral drugs—simprevir (Olysio) and sofosbuvir (Solvadi)—have become available that can actually cure more patients and with fewer side effects than interferon.
- Harvoni, which contains sofosbuvir and ledipasvir, is a new combination drug that has high cure rates with mild side effects. One downside it shares with the other new medications is its high cost—as much as 100,000 for a 12-week regimen.
- More new drugs are expected to be approved within the next few years, so it’s important to discuss all available treatment options with a doctor.
- Avoid alcoholic beverages during recovery.
- Rest as needed.
- Increase caloric intake. Several small meals daily rather than a few large ones may help combat nausea and loss of appetite.
- If the liver has been severely damaged, liver transplantation may be recommended.
- Sterile or disposable needles should be used in acupuncture, ear piercing, or tattooing. Ask about sterilization procedures in advance.
- There is no vaccine for hepatitis C. But to protect your liver, get vaccinated for hepatitis A and B.
When To Call Your Doctor
- Call a doctor if you develop symptoms of hepatitis C.
- Talk to a doctor about screening for hepatitis C if you are in a high-risk group.
Reviewed by Jenifer K. Lehrer, M.D., Department of Gastroenterology, Aria-Torresdale Hospital, Aria Health System, Philadelphia, PA. Review provided by VeriMed Healthcare Network.