Hepatitis C

November 21, 2011

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Hepatitis C was discovered in the 1970’s and was called “non-A, non-B hepatitis.” In pre-donor screening, it was the most common form of hepatitis to be acquired from transfusions or blood products. Since the 1980’s, blood tests for HCV effectively screen blood donors.

HCV used to account for 90% of transfusion-related cases of hepatitis. About 35,000 Americans are diagnosed each year with hepatitis C and the HCV virus seems to be more of a problem in causing chronic hepatitis than HBV. An estimated 80% of those infected with HCV, develop chronic hepatitis compared to only 2 to 10% of those infected with HBV. The disease may progress over a period of 10 to 40 years.

HCV is not easily transmitted through sexual contact as is HBV. The main route of transmission involves contact with infected blood and body fluids. Among patients with reported cases of acute HCV infection, 40% had no significant, common risk factor for contracting the disease although many cases are seen in lower socioeconomic groups. There also seems to be a higher risk of getting HCV infection in those persons undergoing organ transplants and in AIDS patients. Chronic HCV hepatitis occurs in as many as 20% of kidney transplant patients.

There is currently no vaccine available for hepatitis C, although research is being conducted to develop one.

How is HCV spread?

Contact with infected blood, contaminated IV needles, razors, tattoo/body piercing tools, nail files, tooth brushes or acupuncture needles can transmit the virus. It is not known whether semen or saliva can transmit HCV virus. Although not as infectious as other hepatitis viruses, anyone who is infected should consider themselves infectious to others. Household contact with HCV infected persons is rarely dangerous and HCV is not readily transmitted through sexual contact. The potential for transmission from an infected mother to her newborn baby is less than 5% but babies born to infected mothers should be tested for the HCV virus.

What are the symptoms of HCV infection?

In the acute stage, mild flu-like symptoms can be present. However, most people with acute HCV infections have no symptoms and no jaundice. After being exposed to the virus, HCV infection takes about 15 to 160 days to develop, with an average of 50 days.

Who is at risk for developing HCV infection?

Those who are at the highest risk are people who have had blood products or transfusions prior to 1992; hemodialysis patients; hemophiliacs taking blood products for their disease; and IV drug users. Health care workers are also at risk.

How is HCV infection diagnosed?

A blood test that determines the presence of antibodies to HCV (anti-HCV) is routinely done but this test can not discriminate whether the infection is current or chronic. Anti-HCV becomes undetectable after acute infection with HCV but is present in over 90% of persons with chronic hepatitis C infection. A second, more specific anti-HCV (EIA) is recommended if the first anti-HCV test is positive to confirm the diagnosis. The anti-HCV test can identify infected persons as early as 5 to 8 weeks after exposure to the virus.

How is HCV infection treated?

Immune globulin which is normally given in the first few weeks before or after exposure to hepatitis A and B is ineffective in preventing hepatitis C. There are three types of interferon used for treating chronic HCV and also a combination of ribavirin and interferon. Treatment takes about six months and 90% of patients have a good response within the first three months of therapy. The downside is that the relapse rate approaches 90% but in those persons who relapse, re-treatment with interferon almost always leads to another favorable response. Combined therapy (interferon and ribavirin) eliminates the virus in 50% of patients after six months of treatment. There may be considerable side-effects from the combination therapy. All of these treatments are reserved for chronically infected HCV patients who have symptoms of chronic liver disease (jaundice, cirrhosis) and not for those who are chronically infected but have no symptoms. Almost half of the liver transplants in the U.S. are performed for hepatitis C liver failure.

How can you prevent hepatitis C infection?

Precautions should be taken when handling anything that could have been contaminated with blood from an infected HCV person such as razors, scissors, tooth brushes, nail files, clippers and tampons. Safe sex is recommended.

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