Hepatitis C is an infection and inflammation of the liver caused by the hepatitis C virus. It is one of several types of hepatitis.
What is going on in the body?
The liver is an important organ located in the upper right quadrant of the abdomen. It is responsible for:
- filtering the blood
- making bile, a substance that aids in the digestion or fats and that excretes certain fatty substances from the body
- processing and hooking fats to carriers (cholesterol) and storing sugars (glycogen), helping the body transfer and save energy
- making important proteins, such as those involved in blood clotting
- metabolizing many medications, such as barbiturates, sedatives, and amphetamines
- storing vitamins A, B12, D, and several of the B-complex vitamins. The liver also stores iron and copper.
- making important proteins like albumin that regulate fluid transport in blood vessels and the kidneys
- helping break down and recycle red blood cells
Infection of the liver by a virus can cause hepatitis, a term that means inflammation of the liver. Hepatitis can interfere with normal liver functions. The hepatitis C virus is transmitted through contact with blood. After entering the bloodstream, the virus directly invades the liver cells. It reproduces there and can kill liver cells directly.
Many of the symptoms of the disease, including liver inflammation, are caused by the body's immune system reacting to infection with the virus. Unlike other hepatitis viruses, hepatitis C causes chronic rather than acute problems with liver consequences apparent 20-30 years after infection begins.
What are the causes and risks of the disease?
Hepatitis C is found throughout the world. It is estimated that 3.9 million people in the U.S. are infected. Hepatitis C may be spread by infected needles and through blood and blood product transfusions that were not screened for hepatitis (rare today in the U.S. and other countries with modern blood banking practices).
Some organ transplants may contribute to the spread of hepatitis C, but this has also become uncommon. Sharing contaminated personal hygiene items, such as toothbrushes and razors, may also cause the spread of hepatitis C. Tattooing may spread the virus. Transmission by sexual intercourse occurs, but is less common than for HIV or hepatitis B.
What can be done to prevent the disease?
A vaccine against Hepatitis C is currently not available. Postexposure treatment (such as with immune globulin) is not protective. Avoiding high-risk behaviors and screening blood and organ donor supplies play a major role in prevention of this disease. Sharing personal hygiene items and material potentially contaminated with blood is clearly risky, and this includes materials used for nasal cocaine and tattoos.
Practicing safer sex may help prevent sexual transmission. Even when hepatitis C is diagnosed early, it is difficult to keep it from progressing to chronic liver disease. It is important to avoid drugs, especially alcohol and excessive use of acetaminophen (i.e., Tylenol). Alcohol coupled with hepatitis C infection accelerates liver injury.
How is the disease diagnosed?
The healthcare provider should suspect possible hepatitis C infection in people who practice risky activity. Liver function tests may be abnormal. Another blood test for hepatitis C antibodies, often drawn at the same time as the liver function tests, can confirm that hepatitis C is responsible for the liver problem. An actual "viral load" (the amount of virus in the blood) may be drawn before and during treatment. Chronic hepatitis can be diagnosed with a liver biopsy. Specimens from the biopsy can be graded in terms of severity.
Long Term Effects
What are the long-term effects of the disease?
Chronic hepatitis C occurs in at least 70% of the people who develop acute hepatitis C. Individuals with moderate chronic active hepatitis C have roughly a 50% chance of developing progressive liver disease. Severe chronic active hepatitis has a high likelihood of progressing to cirrhosis over several decades. People with cirrhosis may develop liver cancer and die from either of these two conditions.
What are the risks to others?
Hepatitis C is contagious and can be spread from person to person by blood products, sexual contact, and sharing personal items.
What are the treatments for the disease?
Because many people with acute hepatitis C have no symptoms, it is not always possible to treat the disease in its early stages. For those individuals with symptoms (ongoing liver injury and fibrosis), treatment may include the following:
- abstaining from high risk behaviors (many of them can transmit other diseases that can make the course of hepatitis C worse)
- avoiding potentially toxic medications like acetaminophem (i.e., Tylenol)
- avoiding alcohol
The antiviral medication interferon alpha 2a (i.e., Roferon A) is often used to treat hepatitis C. It is presently administered in a new form called "pegylated" interferon (peginterferon alfa 2b: i.e., PEG-Intron).
Ribavirin (i.e., Copegus, Rebetol, Ribasphere) is also used in combination with interferon. Rebetron is one product that has these two medications combined together. A person who has severe cirrhosis or liver cancer may be a candidate for a liver transplant.
There are a number of natural medications used to treat Hepatitis C. The Natural Medicines Comprehensive Database has looked at the evidence from studies around the world on the treatment of Hepatitis C and rated lactoferrin and phosphatidylcholine as "possibly effective." St. John's Wort is rated "possibly ineffective." The Database has concluded there is "insufficient evidence" to evaluate European mistletoe or milk thistle for the treatments of Hepatitis B or Hepatitis C.
The extra-hepatic problems with hepatitis C may require stronger immune medications (azathioprine: i.e., Azasan, Imuran) for treatement.
What are the side effects of the treatments?
Side effects will depend on the treatments used. Side effects of interferon and ribavirin treatment include bone marrow suppression (affecting red, white cells and platelets), depression and mood swings, fever and body aches (like flu), nausea, thyroid gland inflammation, hair loss, retina disease, reactions at the injection site, destruction of red cells, cough, and/or rash. . The medications should not be taken by pregnant women.
The combination of alpha interferon and ribavirin may aggravate hepatitis in some people.
Patients with hepatitis C should be screened for possible liver cancer. The screen involves an alpha-fetoprotein twice a year (a blood test) and an ultrasound of the liver once a year.
Persons with hepatitis C patients should receive all immunizations recommended for their age group.
A liver transplant may be required if liver disease progresses despite treatment. Failure or rejection of the new, transplanted liver can occur.. After a liver transplant, a person will need to take powerful anti-rejection medications for the rest of his or her life. Side effects of these medications increase the person's risk for infections, certain cancers, and other problems.
What happens after treatment for the disease?
During and after treatment, individuals with hepatitis C are monitored for their response to the therapy (viral load is measured). Sometimes treatment must be discontinued because of side effects, even though the treatment has been effective. After treatment, individuals can have a reactivation of the virus, which can lead to a need for further, repeat treatment. It is possible for an individual to become reinfected with hepatitis C following a liver transplant.
How is the disease monitored?
Periodic visits to the healthcare provider are essential for persons with hepatitis C infection. Liver function tests may be used to monitor the activity of the hepatitis and to determine liver function. Remaining questions about liver status may require a liver biopsy. Decisions regarding further treatment options (like interferon, lamivudine <i.e. Epivir>, or other antivirals) or eventual liver transplantation are frequently made based on these tests.