Hepatitis is an inflammation of the liver. It can be caused by heavy alcohol use, bacterial or viral infections. Hepatitis is a family of infections with the most common being Hepatitis A, B and C, which are all caused by different viruses. The symptoms can be similar but the mode of transmission and progression of disease and its effects on the liver are all very different. It is possible to contract more than 1 form of hepatitis. There are vaccines for hepatitis A and B but there is no vaccine to prevent hepatitis C.
Hepatitis C is spread through the blood of an infected person. The disease can be acute or chronic.
This is a short term illness that begins within 6 months of exposure to the virus. CDC statistics from 2009, reported 16,000 acute hepatitis C infections in the United States. According to the CDC, 75-85% of people with acute hepatitis C will develop chronic hepatitis.
This is a long term illness that can last a lifetime and lead to serious liver problems including cirrhosis and cancer. It is estimated that 3.2 million people have chronic hepatitis C but most do not know that they are infected because they are not exhibiting any symptoms and do not feel sick. According to the CDC, most people don’t have symptoms for many years until the liver becomes damaged. Hepatitis C is often detected during routine blood tests measuring liver function and liver enzymes. These levels can fluctuate, producing normal labs for an entire year. It may be necessary to recheck enzyme levels several times over a 6-12 month time span. Chronic hepatitis C is the leading cause of cirrhosis and liver cancer. The CDC reports that 5-20 people, out of 100 persons infected, will develop cirrhosis over a 20-30 year period. Cirrhosis is the result of damaged liver cells being replaced by scar tissue, that prevents the blood from flowing through the liver, causing more damage and loss of liver function. It is the most common reason for a liver transplant in the U.S. and approximately 15,000 people die every year from hepatitis C related liver disease.
Classes of Hepatitis C
There are 6 major genotypes and each genotype is treated differently.
Genotype 1: this is the most common type in the U.S. and Europe. Eighty percent of the hepatitis C in the United States is genotype 1.
Genotype 2: this is the second most common type in the U.S. Ten percent are infected with genotype 2.
Genotype 3: this is endemic in Southeast Asia, India, and the Far East. Only 6% of Americans are infected with genotype 3.
Genotype 4: this is found in Africa, the Middle East, Eastern Europe and Egypt.
Genotype 5: is found in South Africa.
Genotype 6: this is found in South China, Hong Kong, and Southeast Asia.
Hepatitis C is transmitted by the blood of an infected person entering the body of another person via a cut on the skin, or contact with the eyes or mouth. The hepatitis C virus can live outside the body on surfaces, at room temperature, for a minimum of 16 hours and up to 4 days maximum. It can be spread by people that are not exhibiting any symptoms or do not even realize that they are infected with hepatitis C. In 1992, the U.S. began screening blood for the hepatitis virus. Prior to this time, the infection was readily spread through blood transfusions and organ transplants. Today, most infections occur by sharing needles and by needle sticks. Less common modes of transmission include; sharing razors, toothbrushes or having sexual contact with an infected person while menstruating, during herpes outbreak or with micro tears in genital tissue. Intranasal drug use with shared equipment used to snort drug can be another possible source of transmission if the infected person using the device has broken nasal blood vessels. The Mayo clinic cautions against using tattoo or piercing facilities that are unclean and don’t use sterilized equipment. Four out of every 100 infants born to infected moms will become infected with the hepatitis C virus. The risk is higher if the mom has both HIV and hepatitis C.
Seventy to eighty percent of people with hepatitis C do not have any symptoms. Symptoms normally appear anywhere from 2 weeks to 6 months after exposure (6-7 weeks being the average). The following symptoms can range from mild to severe after becoming infected: fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain, dark urine, clay colored stool, joint pain, and jaundice- yellow skin or eyes.
Who should get tested?
This is a recommended list according to the Centers for Disease Control (CDC).
- Born between 1945-1965 (baby boomers).
- Current or former injection drug user- even if it was only one time and many, many years ago.
- Treated for a blood clotting problem prior to 1987.
- Received blood transfusion or organ transplant before July 1992.
- Long-term dialysis treatment.
- Abnormal liver tests or liver disease.
- Works in health care or public safety and exposed to blood through needle stick or other sharp object injury.
- Infected with HIV.
An initial test is done to look for antibodies to the hepatitis C virus. Antibodies are produced by the body in response to the virus. A positive result would indicate that the person was exposed to the hepatitis C virus at some point in their life. Additional testing would be required to confirm whether or not the virus is still present in their blood. Viral load needs to be measured and the genotype needs to be determined. Liver biopsies are performed to evaluate the severity of liver damage. Labcorp’s FibroSURE testing can also be run to assess liver damage. HCV FibroSURE is for hepatitis C patients and ASH FibroSURE tests for alcohol liver damage. These panels give the stages of fibrosis of the liver. The Fibrosure tests can provide important information regarding the status of scarring of the liver in the absence of biopsy.
Liver Function Tests
- Serum albumin- protein made in liver
- Alpha-1-antitrypsin- tests for cirrhosis
- ALP(alkaline phosphatase)- body tissue protein that is high in the live
- ALT(alanine transaminase)- enzyme found in high amounts in liver and is released from liver damage
- AST(aspartate aminotransferase)- enzyme found in high amounts in the liver, heart and muscle
- GGT (gamma-glutamyl transpeptidase)- enzyme increased by alcohol consumption
- PT (prothrombin time)- measures the time it takes for the plasma of your blood to clot. The liver makes these clotting proteins.
- Serum bilirubin- yellow pigment in the bile that is broken down by the liver in order to be removed in the stool. Large amounts lead to jaundice.
- Urine bilirubin- not normally found in urine
- Alfa-fetoprotein- detects liver cancer
A physical exam should be performed. Findings may include an enlarged and tender liver, yellowing of the skin and/or eyes (jaundice), and abdominal swelling (ascites).
Acute Hepatitis C
There is no medication to treat acute hepatitis C. Rest, adequate nutrition and fluids are recommended. 15-25% of people will clear hepatitis C from their body without treatment and will not develop a chronic infection.
Chronic Hepatitis C
Treatment is usually Interferon and Ribavirin. These drugs can cause serious side effects and not everyone will be a candidate and benefit from their use.
Alcohol needs to be avoided in order to prevent further liver damage.
Check with health care provider before taking any prescription drugs, over the counter medications or supplements that could potentially damage the liver.
Boceprevir and Telaprevir. These must be used along with interferon and Ribavirin. This is designed to attack the hepatitis C virus and keep it from growing. It is used for genotype 1, the most common strain of hepatitis C. Side effects can include; flu-like symptoms, anemia, low white blood cells and platelets, depression, irritability, anxiety, fatigue, headache, rash, thinning hair, GI upset, and nausea.
This is not a cure for hepatitis C. Anti viral meds will still be necessary since the virus is likely to recur in the new liver.
The Mayo clinic recommends having vaccinations against hepatitis A and B viruses to decrease the risk of further liver damage that could be caused by these infections.
Lifestyle Changes (according to the Mayo clinic)
- Immediately stop drinking alcohol. Alcohol speeds the progression of liver disease.
- Avoid medications that cause liver damage. This can include over the counter products as well.
- Do not donate blood, body organs or semen.
- Inform your health care providers that you have the virus.
- Cover wounds and don’t share toothbrushes or razors.
- Eat plenty of fruits and vegetables, daily exercise and get plenty of sleep.