All you need to know about Hepatitis C

Dr Suresh Singhvi

Chronic Hepatitis C is a serious disease that can result in long-term health problems. Approximately 60,000 people die every year from Hepatitis C related liver disease.

1. What is Hepatitis C?

Hepatitis C is a contagious liver disease that ranges in severity from a mild illness lasting a few weeks to a serious, lifelong illness that attacks the liver. It results from infection with the Hepatitis C virus (HCV), which is spread primarily through contact with the blood of an infected person.

Chronic Hepatitis C virus infection is a long-term illness that occurs when the Hepatitis C virus remains in a person’s body. Hepatitis C virus infection can last a lifetime and lead to serious liver problems, including cirrhosis (scarring of the liver) or liver cancer.

Approximately 75%–85% of people who become infected with Hepatitis C virus develop chronic infection.

2. How is Hepatitis C spread?

Hepatitis C is usually spread when blood from a person infected with the Hepatitis C virus enters the body of someone who is not infected. Today, most people become infected with the Hepatitis C virus by sharing needles or other equipment to inject drugs.

People can become infected with the Hepatitis C virus during activities like:

- Sharing needles, syringes, or other equipment to inject drugs

- Needlestick injuries in health care settings

- Being born to a mother who has Hepatitis C

Less commonly, a person can also get Hepatitis C virus infection through:

- Sharing personal care items that may have come in contact with another person’s blood, such as razors or toothbrushes

- Having sexual contact with a person infected with the Hepatitis C virus

3. Can Hepatitis C be spread through sexual contact?

Yes, but the risk of transmission from sexual contact is believed to be low. The risk increases for those who have multiple sex partners, have a sexually transmitted disease, engage in rough sex, or are infected with HIV. More research is needed to better understand how and when Hepatitis C can be spread through sexual contact.

4. Can you get Hepatitis C by getting a tattoo or piercing?

A few major research studies have not shown Hepatitis C to be spread through licensed, commercial tattooing facilities. However, transmission of Hepatitis C (and other infectious diseases) is possible when poor infection-control practices are used during tattooing or piercing. Body art is becoming increasingly popular , and unregulated tattooing and piercing are known to occur and other informal or unregulated settings.

5. How long does the Hepatitis C virus survive outside the body?

The Hepatitis C virus can survive outside the body at room temperature, on environmental surfaces, for at least 16 hours but no longer than 4 days. Hepatitis C virus is not spread by sharing eating utensils, breastfeeding, hugging, kissing, holding hands, coughing, or sneezing. It is also not spread through food or water.

6. Who is at the risk for Hepatitis C?

Some people are at increased risk for Hepatitis C, including:

- Current injection drug users

- Past injection drug users, including those who injected only one time or many years ago

- Recipients of donated blood, blood products, and organs

- Hemodialysis patients or persons who spent many years on dialysis for kidney failure

- People who received body piercing or tattoos done with non-sterile instruments

- People with known exposures to the Hepatitis C virus, such as:

- Health care workers injured by needlesticks

- Recipients of blood or organs from a donor who tested positive for the Hepatitis C virus

- HIV-infected persons

- Children born to mothers infected with the Hepatitis C virus

Less common risks include:

- Having sexual contact with a person who is infected with the Hepatitis C virus

- Sharing personal care items, such as razors or toothbrushes, that may have come in contact with the blood of an infected person

7. What is the risk of a pregnant woman passing Hepatitis C to her baby?

Hepatitis C is rarely passed from a pregnant woman to her baby. About 4 of every 100 infants born to mothers with Hepatitis C become infected with the virus. However, the risk becomes greater if the mother has both HIV infection and Hepatitis C.

8. Can a person spread Hepatitis C without having symptoms?

Yes, even if a person with Hepatitis C has no symptoms, he or she can still spread the virus to others.

9. Is it possible to have Hepatitis C and not know it?

Yes, many people who are infected with the Hepatitis C virus do not know they are infected because they do not look or feel sick.

10. What are the symptoms of chronic Hepatitis C?

Most people with chronic Hepatitis C do not have any symptoms. However, if a person has been infected for many years, his or her liver may be damaged. In many cases, there are no symptoms of the disease until liver problems have developed. In persons without symptoms, Hepatitis C is often detected during routine blood tests to measure liver function and liver enzyme (protein produced by the liver) level.

11. How serious is chronic Hepatitis C?

Chronic Hepatitis C is a serious disease that can result in long-term health problems, including liver damage, liver failure, liver cancer, or even death. It is the leading cause of cirrhosis and liver cancer and the most common reason for liver transplantation. Approximately 60,000 people die every year from Hepatitis C related liver disease.

What are the long-term effects of Hepatitis C?

Of every 100 people infected with the Hepatitis C virus, about:

- 75–85 people will develop chronic Hepatitis C virus infection; of those,

- 60–70 people will go on to develop chronic liver disease

- 5–20 people will go on to develop cirrhosis over a period of 20–30 years

- 1–5 people will die from cirrhosis or liver cancer

12. Who should get tested for Hepatitis C?

Talk to your doctor about being tested for Hepatitis C if any of the following are true:

- You are a current or former injection drug user, even if you injected only one time or many years ago.

- You were treated for a blood clotting problem before 1987.

- You received a blood transfusion or organ transplant before July 1992.

- You are on long-term hemodialysis treatment.

- You have abnormal liver tests or liver disease.

- You work in health care or public safety and were exposed to blood through a needle stick or other sharp object injury.

- You are infected with HIV.

13. What blood tests are used to test for Hepatitis C?

Several different blood tests are used to test for Hepatitis C. A doctor may order just one or a combination of these tests. Typically, a person will first get a screening test that will show whether he or she has developed antibodies to the Hepatitis C virus. (An antibody is a substance found in the blood that the body produces in response to a virus.) Having a positive antibody test means that a person was exposed to the virus at some time in his or her life. If the antibody test is positive, a doctor will most likely order a second test to confirm whether the virus is still present in the person's bloodstream.

Treatment

14. How is acute Hepatitis C treated?

There is no medication available to treat acute Hepatitis C infection. Doctors usually recommend rest, adequate nutrition, and fluids.

15. How is chronic Hepatitis C treated?

Each person should discuss treatment options with a doctor who specializes in treating hepatitis. This can include some internists, family practitioners, infectious disease doctors, or hepatologists (liver specialists). People with chronic Hepatitis C should be monitored regularly for signs of liver disease and evaluated for treatment. The treatment most often used for Hepatitis C is a combination of two medicines, interferon and ribavirin/sofosbuvir. However, not every person with chronic Hepatitis C needs or will benefit from treatment. In addition, the drugs may cause serious side effects in some patients.

16. Is it possible to get over Hepatitis C?

Yes, approximately 15%–25% of people who get Hepatitis C will clear the virus from their bodies without treatment and will not develop chronic infection. Experts do not fully understand why this happens for some people.

17. What can a person with chronic Hepatitis C do to take care of his or her liver?

People with chronic Hepatitis C should be monitored regularly by an experienced doctor. They should avoid alcohol because it can cause additional liver damage. They also should check with a health professional before taking any prescription pills, supplements, or over-the-counter medications, as these can potentially damage the liver. If liver damage is present, a person should check with his or her doctor about getting vaccinated against Hepatitis A and Hepatitis B.

Vaccination

18. Is there a vaccine that can prevent Hepatitis C?

Not yet. Vaccines are available only for Hepatitis A and Hepatitis B. Research into the development of a vaccine is under way.

19. What is the new wonder drug for the treatment of Hepatitis C ?

Sofosbuvir is recommended as a possible treatment for adults with some types (called genotypes) of chronic hepatitis C. It is taken with other drugs (peginterferon alfa and ribavirin, or ribavirin alone). The medicines should be taken under the supervision of a specialist and after relevant blood tests. The patients genotypes determines the type of treatment that will be initiated by the specialist doctor.

(The Author is a Senior Consultant Liver transplant Surgeon with Sir Ganga Ram Hospital, New Delhi. Website: www.liverdiseaseindia.com)