Hepatitis C

Definition

Hepatitis C is a specific type of virus that may cause the clinical disease called hepatitis. It is referred to as the hepatitis C virus (HCV). Hepatitis (literally, inflammation of the liver) can be caused by many drugs, toxic agents and numerous viruses.

Description

Infection with the hepatitis C virus (HCV) poses a significant public health problem, the magnitude of which may match or eventually exceed that of hepatitis B virus (HBV).

In the United States, more than 150,000 people a year are infected with HCV. Hepatitis C accounts for more than 90 percent of non-A, non-B hepatitis cases attributable to intravenous drug use, transfusion, and other percutaneous (through the skin) exposures.

More than 80 percent of community-acquired non-A, non-B hepatitis can be traced to HCV infection. At least one-fifth of people with chronic hepatitis C will go on to develop scarring of the liver (cirrhosis).

Hepatitis C has been implicated as a cause of cancers originating in the liver.

Causes and Risk Factors

IV drug use appears to be the most common mode of HCV transmission, accounting for 50 percent or more of infections. Having received a tattoo from an unclean needle can also a risk factor. Sexual transmission is less common than with hepatitis B. Maternal transmission of HCV infection has been demonstrated, but the incidence appears to be low (less than 1 percent). Co-infection with HIV may increase the risk of maternal and perhaps sexual HCV transmission.

The risk of HCV infection from a blood transfusion is now less than 1 in 100,000 units transfused in the U.S. HCV has been responsible for over 90 percent of cases of post-transfusion hepatitis, but only 4 percent of cases of hepatitis C are attributable to blood transfusions.

Symptoms

The clinical picture of viral hepatitis is variable, ranging from asymptomatic infection with no evidence of jaundice, to a rapidly progressive disease. Symptoms of hepatitis C include fatigue, decreased appetite, nausea, jaundice, fever, and an enlarged liver.

Following acute infection with HCV, over 80 percent of patients will develop chronic hepatitis. Cirrhosis may develop in up to 30 percent of those with chronic hepatitis C. These patients are also at risk (about 3 percent per year) of all liver cancer (hepatocellular carcinoma).

Diagnosis

An accurate diagnosis of hepatitis C hinges on a thorough history, with careful attention paid to percutaneous (through the skin) exposures. Blood tests will be performed, including liver exzymes and antibody to HCV (anti-HCV). Liver enzymes may be an unreliable marker, as alanine aminotransferase levels can fluctuate for months or years and can be normal. However, they may be markedly elevated early in the course of the disease. A liver biopsy is rarely indicated.

Treatment

The decision to treat chronic hepatitis C remains problematic. Many physicians prefer a wait-and-see approach given the low risk of mortality, the high proportion of asymptomatic patients and the considerable cost of treatment. Others believe the strong association between HCV and cirrhosis justifies treatment much of the time.

The only approved treatment for acute HCV and the only one with demonstrated efficacy, is interferon alfa-2b (Intron A). Interferon's effect in patients with chronic hepatitis C usually results in viral suppression rather than eradication or a cure. Treatment with interferon appears to decrease the risk of chronic hepatitis.

Several investigational interferon alfa-2b protocols are being evaluated. Some begin with the approved regimen and taper the dosage after six months. Patients then remain on the maintenance therapy at the lowest effective dose.

In controlled studies, corticosteroids have not demonstrated any benefit in patients with viral hepatitis, including HCV.

Prevention

Although there is little evidence that HCV is spread by sexual contact, HCV-infected persons should practice safe sex. Additionally, NEVER share needles with others and make sure that tattooing and body piercing are performed with sterile needles.

Related Issues Currently Being Researched

A vaccine for hepatitis B is widely available and effective. Unfortunately, little progress has been made towards developing a vaccine for hepatitis C.

Questions to Ask Your Doctor

What medications will you prescribe? For how long?

Is it contagious?

How communicable is the disease?

What precautions can be taken to minimize the exposure to hepatitis?

How frequently do you recommend testing for a hepatitis relapse?

Are there any lasting effects after treatment?

Can a regular exercise program be resumed? If so, when?